Necessary factors in psychotherapy: A model for understanding iatrogenic disturbances

Psychotherapy is conceptualized within a phenomenoiogical framework as a relationship with a focus. Both these factors, the relationship and the focus, are examined as necessary factors for the creation of the therapeutic alliance which is seen as a sufficient condition for intrapsychic change. The proper balancing of the two necessary factors is seen as essential for a therapeutic alliance to evolve. The relationship factor is described in existential terms as a special form of the I-Thou encounter, while the focus factor is examined as part of the diagnostic aspect of psychotherapy. Iatrogenic distortions in psychotherapy are discussed in terms of distortions in the necessary factors-the focus and relationship. Four types of iatrogenic distortions are described: (1) overemphasis of the relationship and focus, (2) underemphasis of the relationship and focus, (3) overemphasis of the relationship and underemphasis of the focus and (4) underemphasis of the relationship and overemphasis of the focus.