The Therapeutic Alliance: Implications for Therapeutic Process and Therapeutic Goals

Interest in the importance of the therapeutic alliance to the psychotherapeutic process has recently grown across theoretical domains. Through a case example the author demonstrates that in some cases a familiar pattern of relating with the therapist may be more important for the client in terms of treatment success than positive regard early in treatment. Also, charting shifts in the quality of the relationship rather than quantitative changes in the alliance may help the therapist navigate the recursive emergent properties of relationship, goals of treatment and choice and timing of interventions. Finally, the author suggests that the therapist’s internalization of the client may represent a significant leap in the relationship, and help reduce some of the “sloppiness” that is inherent in the therapeutic process.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Therapeutic turn

This paper offers a systematic and critical exploration of contemporary theology of pastoral care in the Evangelical Lutheran Church of Finland in light of the history of the practice of care-giving and Western cultural change. Currently, pastoral care is characterized by a therapeutic approach that aims to offer sincere help for earthly suffering and to promote the good things that the individual chooses to reach for. This has been drastically different than historical models from Luther to the early twentieth century that were spiritual and paternalistic in nature. The therapeutic turn connects to the therapeutic culture that has set self-actualization as a central idea determining Western cultural ethos. The therapeutic approach calls into question how the spiritual task of the church is carried out. The prevailing pastoral-psychological theology of pastoral care proves to be problematic. The spiritual task of pastoral care should be based on the basic Lutheran theology of God as objective and not conditioned upon the human mind. Yet, the therapeutic aim should still be maintained as the basic approach of care.     

Therapeutic Interventions

This article has two aims. One is addressed to practitioners, to say to them that too big a distinction is being drawn between interpretations and other interventions, and in particular that the term directive is being wrongly used. This militates against important moves toward the integration of different therapies. The other is addressed to researchers, to say to them that their research will be inadequate to the extent that they ignore many of the interventions used in therapy. Both of these aims are eventually served by the provision of a list of interventions running the whole continuum from non-directive to more directive. By looking at this list, we can become more aware of the range of what is possible in psychotherapy, and also of where the standard types of interpretations come in the scheme of things. It seems as though the wide range of interventions available in psychotherapy represents one of the ways in which it differs from counseling.     

Therapeutic Use of Space

ABSTRACT

The project described in this article addresses the therapeutic use of physical space in an outpatient counseling facility. It was theorized that an improved facility environment could be used as a practice tool when working with a vulnerable population. The authors undertook the project with limited time and finances. The process of the change project is discussed in detail in an attempt to encourage other counseling facilities and social service agencies to consider such an effort. Related literature from varied fields is reviewed. The article also relays client and staff feedback regarding the redecorated space and addresses design considerations such as the relative strengths and drawbacks to involving clients and staff in the process.     

Therapeutic Relationships Re-Defined

Abstract

The therapeutic relationship has traditionally been central to occupational therapy. This study surveyed 129 practicing occupational therapists in Connecticut, concerning how they define and use the therapeutic relationship with clients in today's cost-conscious health care environment. The following four hypotheses: (1) Therapeutic relationships are related to functional outcome, (2) Definitions of therapeutic relationships include words and phrases expressed in the literature and by experts, (3) There are differences in perceptions of therapeutic relationships among pediatric, adult, and geriatric specialty subgroups, (4) Most occupational therapists learned skills in developing therapeutic relationships “on the job,” rather than during professional education, were all supported. This study reaffirms the importance of the therapeutic relationship in occupational therapy practice and provides an updated definition: A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.     

Therapeutic neutrality reconsidered

This paper suggests that therapists' tendency to ignore the impact of their own religious beliefs on their patients constitutes an area of potential abuse of psychotherapy. The author reviews the religious stance of the founders of psychotherapy, as well as recent criticisms of the therapeutic process, and proposes steps to safeguard against the inadvertent fostering of therapists' religious views on the patient.     

阿尔茨海默病的治疗进展

阿尔茨海默病(AD)的病因学和发病机制尚不清楚,目前存在胆碱能假说、β-淀粉样肽假说、基因假说、营养因子假说、有害网络假说等,但尚无一种假说能较完整地解释AD的发病机制,所以AD的临床治疗仍然是一个亟待解决的难题.     

Psychodynamic Measures of Therapeutic Change

After a brief critique of the current emphasis on symptom reduction as a criterion of therapeutic change, this paper presents several methods for assessing changes in the developmental organization and thematic content of mental representations (concepts of self and significant others). These methods constitute psychodynamically oriented ways of assessing therapeutic change in psychological structures in both long-term, intensive and brief treatment. We also consider how differences in pretreatment characteristics among patients have an important impact on the therapeutic process and on the nature of therapeutic change.     

Therapeutic Experiences of Lesbian Couples

Abstract

This study explores the therapeutic experience of lesbian couples who had received couples psychotherapy earlier in their relationship. It examines their feelings regarding their own levels of acceptance, disclosure of sexual orientation, and connectedness with the professional providing services using qualitative methodology. The perspectives of both members of the lesbian couple were taken into account and explored. Lesbian couples who had accepted their sexual orientation appeared to have higher levels of satisfaction in their therapeutic experience and reported having an improved sense of self. Couples who had a therapist that portrayed a positive acceptance of homosexuality, low levels of heterosexism, and knowledge of issues relevant to the lesbian community reported an experience that was conducive to growth and development thus leading to an enriched relationship.     

Therapeutic handling of marital infidelity

Abstract

In working with couples and families, the occasional clinical use of mental imagery techniques can frequently promote therapeutic breakthroughs. When sessions focused on a couple's (family's) current communication problems reach a point where progress seems slow and laborious, a therapist can encourage the couple (parents and perhaps even older children) to try one or more imagery sessions to understand their interactional patterns within the context of their own developmental periods. This article describes how imagery can lead couples to new and more constructive perspectives on the meaning of their interactions.