Confronting Patients: Therapists’ Model of a Responsiveness Based Approach

Abstract

Confrontation represents a way of challenging patients in psychotherapy to stimulate change. Confrontation draws attention to discrepancies, for example between elements in a patient’s functioning. The present study was designed to construct a conceptual model of confrontation used by therapists when trying to address two main questions: what are the risks and opportunities of confrontation and how can these effects be influenced? Fifteen therapists from the Psychotherapy Outpatient Clinic of the University of Bern in Switzerland participated in semi-standardized interviews, which were analyzed using qualitative content analysis and thematic analysis. Several main themes merged into a dynamic, sequential model: groundwork required before a confrontation, shaping the confrontation, the (immediate) effects, and management of negative consequences. Therapists assume that a confrontation may induce insight and can strengthen the therapeutic relationship either directly or indirectly through the repair of a rupture in the alliance.