Relational Psychotherapy Research Articles

Jeremy David Safran (1952–2018).

Present an obituary for Jeremy David Safran (1952-2018). In 1993, Safran became full professor and director of clinical training at the New School for Social Research. At the New School, he developed the program with an affiliation to Beth Israel Medical Center, where he was a principal consultant on a psychotherapy research program founded by Arnold Winston and directed by me. In 2001, Jeremy completed psychoanalytic training at the New York University Postdoctoral Program. Subsequently, he cofounded (with Lewis Aron and Adrienne Harris) the Sandor Ferenczi Center at the New School, became president of the International Association for Relational Psychoanalysis and Psychotherapy, and served as associate editor for Psychoanalytic Dialogues. Jeremy's efforts and collaborations regarding emotion and interpersonal process laid the foundation for our own collaboration regarding ruptures in the therapeutic alliance. Our aim was to promote a "second generation" of alliance research that went beyond demonstrating its predictive validity and could be applied across treatment orientations to redress failure rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychotherapy relationships that work III.

This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

“Where All the Ladders Start”: A Clinical Account of Object Relations Legacies, Self-States and Analytic Process

This paper evolved from an earlier panel presentation on conceptual tributaries to relational thinking at the 2015 International Association for Relational Psychoanalysis and Psychotherapy Conference in Toronto. Representing the place of Object Relations theory in the DNA from which Relational Psychoanalysis emerged, I emphasized—and provide here an abbreviated review of—the contributions of Fairbairn, Klein, and Winnicott. Then, as now, believing in the communicative power of clinical examples, I offer an extended clinical narrative in which the medium is the message and clinical phenomena such as multiple self-states, enactments, negotiation, play, and the residue of internal object relations (in both patient and analyst) are brought to life. Also, as the Toronto Plenary overview paper by Jody Davies has developed into its current substantial elaboration of distinctly relational issues (multiple self-states, co-creation, and the interplay of process and insight) and serves as the capstone paper for this published version of our panel, I respond to Jody’s conceptual contributions and her perspective on Relational thinking.

The effects of relationship and progress feedback in group psychotherapy using the Group Questionnaire and Outcome Questionnaire-45: A randomized clinical trial.

Routine outcome monitoring (ROM) systems that identify clients at-risk for treatment failure using outcome and therapeutic process measures are a recognized evidence-based practice. However, only 3 empirical studies have tested ROMs in group therapy, producing mixed results. This randomized clinical trial tested the Outcome Questionnaire System, the ROM system with the most empirical support for individual therapy patients, with 430 group therapy patients who were randomly assigned to 2 experimental arms (Group Questionnaire [GQ] + Outcome Questionnaire-45 [OQ-45] vs. OQ-45). Given the strong evidence for progress feedback, the primary purpose of this study was to ascertain if therapeutic relationship feedback using the GQ reduced rates of relationship deterioration and failure when progress feedback was held constant. Group leaders simultaneously ran pairs of groups that were randomly assigned to the 2 conditions. Of the 430 patients enrolled in 58 groups, 374 attended more than 4 sessions. Results showed that therapeutic relationship predicted improvement in outcome and that feedback reversed the course of relationship deterioration and reduced rates of relationship failure. Although there were no effects on attendance and dropout for feedback, the 2 experimental arms produced mixed results for the OQ-45 not-on-track cases. The combined relationship and progress feedback (GQ/OQ-45) was associated with fewer outcome deterioration cases, while the progress feedback condition (OQ-45) showed higher outcome improvement cases. Findings are discussed with respect to previous group ROM studies, clinical implications, and future research. (PsycINFO Database Record

Commentary on “Night Cries: A Rural Tragedy” by Tracey Moffatt and Discussion of “States of Exile and Marginalization” by Gillian Straker

This is an excerpt of the work that I presented in Sydney last May at the International Association for Relational Psychoanalysis and Psychotherapy Conference “From the Margins to the Centre: Contemporary Relational Perspectives” in my capacity as discussant of Gill Straker’s work, which included the viewing of the film Night Cries by Tracey Moffatt. I focused on the relationships that are characterized by abuse of power, by inequalities that define interpersonal relationships, and by the type of trauma that ensues from them and on the ways and possibilities to find a way out, a method to reconcile with the victims.

Considerations in Francisco Varela for Psychotherapy of Sense

Under the influence of dialogic and narrative models, relational systemic psychotherapy has shifted its attention towards understanding the relational self, its agency and off-centered nature. In order to substantiate its new clinical positions, it has reached for other disciplines such as philosophy and literature. Francisco Varela’s approach regarding the ontological aporia between the individual and the relationship may provide conceptual foundations to propose a clinical understanding where identity and sense play a key role. By considering intentionality as the engine of everything that’s living, Varela generates a difference between the extensive environment in which individuals unfold, and the singular investiture of significance through which people seek relationships to recognize their identity. A model for a relational psychotherapy of sense is proposed, based in Francisco Varela’s conceptual influences.

Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy

The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.

The role of the therapeutic relationship in the association between interpersonal behaviors and outcome: Comparison of two competing models

Objective: The patient–therapist relationship may be the mechanism behind the effect of pretreatment interpersonal patient behaviors on the outcome of psychotherapy for depression, or the factor determining for whom interpersonal behaviors affect outcome. We seek to establish which of these two alternatives receives empirical support. Method: We conducted a secondary analysis of the findings from the Treatment for Depression Collaborative Research Program to examine two alternative models. First, a deterministic model, in which clients’ ability to create satisfactory interpersonal relationships affects their ability to build a strong therapeutic relationship, which in turn affects outcome; and second, a compensation model, in which patients in a treatment focusing on interpersonal mechanisms of change and not in placebo, who compensate for their maladaptive pretreatment interpersonal behaviors by building a strong therapeutic relationship, benefit from treatment more than do patients who cannot build such relationship. Results: The compensation, rather than the deterministic model, was supported, suggesting that the interpersonal behavior–outcome association is significantly moderated by the therapeutic relationship in interpersonal psychotherapy and not in placebo. Conclusions: Findings support an optimistic view whereby patients seeking treatment for maladaptive interpersonal behaviors can achieve good outcomes if work on interpersonal relationships is conducted in the presence of a strong therapeutic relationship. Clinical or methodological significance of this article: This study highlights an important optimistic view in which patients with maladaptive interpersonal style who can form a strong therapeutic relationship can benefit from treatment focusing on interpersonal relationships.

Empathy and therapeutic relationship in cognitive psychotherapy: a systematic review

Empathy and therapeutic relationship in cognitive psychotherapy: a systematic review

Hypnotic susceptibility and affective states in bipolar I and II disorders

BackgroundHighly hypnotizable individuals have impaired executive function, elevated motor impulsivity and increased emotional sensitivity, which are sometimes found in bipolar disorder patients. It is then reasonable to assume that certain aspects of hypnotic susceptibility differ with the types of bipolar disorder.MethodsThe Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) test, the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32) and the Plutchick-van Praag Depression Inventory (PVP) were applied to 62 patients with bipolar I disorder, 33 bipolar II disorder, and 120 healthy volunteers.ResultsThe passing rate of the SHSS:C ‘Moving hands apart’ item was higher in bipolar I patients than in controls, whereas for ‘Mosquito hallucination’ the rate was lower. Bipolar I and II patients scored significantly higher on MDQ, HCL-32 and PVP scales than controls. The passing rates of ‘Mosquito hallucination’ in controls, ‘Arm rigidity’ in bipolar I, and ‘Age regression’ in bipolar II predicted the respective MDQ scores.ConclusionIn contrast to cognitive suggestions, bipolar I patients followed motor suggestions more often under hypnosis. Furthermore, both bipolar disorder patients and healthy volunteers demonstrated associations between mania levels and certain hypnotic susceptibility features. Our study aids in better understanding the altered conscious states in bipolar disorders, and encourages the use of related psychotherapy for these patients.

Leader or Guide? A Response to R.M. Billow’s ‘Relational Group Psychotherapy: An Overview. Part III: Modes of Therapeutic Leadership’, September 2017

Richard Billow’s review of relational group psychotherapy has been divided into three parts, on account of its length, but it is really an organic whole. It is a valuable summary of his theoretical and technical position on group psychotherapy, but it differs significantly from that of group analysis, since it is more psychoanalytic than group-analytic. The main difference is that the author conceives the conductor as a leader and advocates the need for his constant presence from a central position. Group analysis, instead, poses that the conductor should strive to leave his initial central position and help the group to become group-centred and take over the functions he initially performed. The conductor in group analysis is not a leader, but a guide, a coach, or a midwife who accompanies and cares for a natural process. These differences in conception and overall strategy are extensively discussed. Nonetheless, Billow’s presentation has many valuable contributions on the technical level.

A Response to Richard Billow’s ‘Relational Psychotherapy: An Overview: Part III: Modes of Therapeutic Leadership’, September 2017

A Response to Richard Billow’s ‘Relational Psychotherapy: An Overview: Part III: Modes of Therapeutic Leadership’, September 2017

A Therapist’s Review of Process: Rupture and repair cycles in relational transactional analysis psychotherapy for a client with a dismissive attachment style: ‘Martha’

This article is a therapist review of the process that occurred during a systematic case study of psychotherapy with ‘Martha’, a female client who presented with depression, anxiety, alexithymia and dismissive/avoidant attachment style. Assessment, diagnosis of the client and treatment direction is described, followed by a detailed account of the therapeutic process through 12 sessions and 2 post-therapy interviews. Analysis team results are summarised, indicating support for the therapist’s identification of issues during the process of the therapy. Particular attention is paid by the analysis team two points of rupture and repair, with pragmatic evaluation confirming that the relational struggles between therapist and client seemed pivotal in generating positive change.Citation - APA format:Baba Neal, S. (2017). A Therapist’s Review of Process: Rupture and repair cycles in relational transactional analysis psychotherapy for a client with a dismissive attachment style: ‘Martha’. International Journal of Transactional Analysis Research & Practice, 8(2), 24-34.

Exploring the Metaphor–Body–Psychotherapy Relationship

ABSTRACTThis article explores the interfaces between two constructs in linguistics and psychotherapy—metaphor and the human body—as a means of illustrating meaningful exchange between linguistic and mental health research. Three distinctly well-motivated research strands with underexplored overlaps: (a) the theoretical relationship between metaphor and the body, (b) the use and management of metaphors in therapy, and (c) the body as a therapeutic resource complementing verbal interaction, are first described. Taking a practitioner-informed approach called “correspondent analysis,” which combines the methods and insights of the metaphor researcher and psychotherapist, a series of session extracts are then analyzed to illustrate the connections between the three strands and what they imply for both metaphor research and therapeutic practice. This culminates in the proposal of a triangle model for the metaphor–body–psychotherapy relationship, with wider implications for applied metaphor research also discussed.

‘I like your new coat’: The emergence of secure base and sense of self and other through an art psychotherapy relationship

ABSTRACTArt therapists working with learning disabled clients are used to adapting an art therapy model to work in a way meaningful to the individual. The attuned response to working with past trauma may often be a more interactive responsive style depending on the ability of the client to process cognitive material. This article illustrates in detail an example of an art therapy intervention which demonstrates a flexible, collaborative approach as well as presenting retrospectively gathered evidence of the outcomes of the work. It highlights the ability of an art therapy relationship to enable positive changes in a client whose distressed behaviour could not be managed by behavioural strategies or use of psycho-active medication alone.

How to Fall in Love With Time-Limited Therapy: Lessons From Poetry and Music

ABSTRACTWith rising student demand, time-limited therapy is becoming the rule rather than the exception at college counseling centers today. While many have viewed this shift as an unwelcome intrusion, this article will examine how to embrace and capitalize on this new, compressed form. Rather than seeing it as a constraint, it will be argued that it provides an opportunity to be more poetic and musical about our work, allowing us to take more therapeutic risks, establish greater momentum, and increase the number and variety of transformative moments in our sessions. Emphasis will be placed on the lessons that poetry and music can teach with respects to deepening and enhancing relational psychotherapy with our students.

Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire

ABSTRACTThe aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, & Westen, 2005), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 314) of different theoretical orientations completed the PRQ, as well as the Shedler–Westen Assessment Procedure–200 (SWAP–200; Westen & Shedler, 1999a, 1999b) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients’ personality characteristics and psychological functioning, regardless of the clinicians’ orientations. The findings support that the PRQ is a valid and reliable tool for evaluating the patients’ relational patterns emerging in clinical practice in a clinically coherent and psychometrically robust way. Clinicians’ careful understanding of these patterns can be very useful for making accurate diagnostic formulations, as well as for providing a roadmap for effective therapeutic intervention.

The Common Factors Discrimination Model: An Integrated Approach to Counselor Supervision

Clinical supervision is a cornerstone of counselor training (Barnett, Erickson Cornish, Goodyear, & Lichtenberg, 2007) and serves the cardinal functions of providing support and instruction to supervisees while ensuring the welfare of clients and the counseling profession (Bernard & Goodyear, 2014). Numerous models of clinical supervision have been developed, varying in emphasis from models based on theories of psychotherapy, to those that focus on the developmental needs of the supervisee, to models that emphasize the process of supervision and the various roles of the supervisor (Bernard & Goodyear, 2014). However, despite the abundance of available supervision models, there is little evidence to support that any one approach is superior to another (Morgan & Sprenkle, 2007; Storm, Todd, Sprenkle, & Morgan, 2001). Thus, a growing body of clinical supervision literature underscores a need for strategies that integrate the most effective elements of supervision models into a parsimonious approach rather than emphasizing differences between models (Lampropoulos, 2002; Milne, Aylott, Fitzpatrick, & Ellis, 2008; Morgan & Sprenkle, 2007; Watkins, Budge, & Callahan, 2015). Common factors models of supervision bridge the various approaches to supervision by identifying the essential components that are shared across models, such as the supervisory relationship, the provision of feedback, and supervisee acquisition of new knowledge and skills (Milne et al., 2008; Morgan & Sprenkle, 2007). Other common factors approaches to supervision draw on psychotherapy outcome research, aiming to extrapolate common factors of counseling and psychotherapy-such as the therapeutic relationship and the instillation of hope-to clinical supervision approaches (Lampropoulos, 2002; Watkins et al., 2015).Although reviews of the supervision literature allude to commonalities among supervision approaches (Bernard & Goodyear, 2014), there is a dearth of published literature offering practical strategies for bridging common factors of counseling and supervision. Perhaps even more limited is literature that addresses the necessary convergence of both common and specific factors, or the integration of common factors of supervision with particular interventions that are applied in various supervision approaches (e.g., role-playing or Socratic questioning; Watkins et al., 2015). In a recent article, Watkins and colleagues (2015) proposed a supervision model that extrapolates Wampold and Budge's (2012) psychotherapy relationship model to specific factors of supervision, encouraging supervisors to apply such relationship common factors to some form of supervision. However, there remains a need for a structured approach to supervision that integrates the common factors of counseling and supervision with the specific factors of commonly used, empirically supported models of clinical supervision.Because the common factors are, by definition, elements that are shared among theories of counseling and supervision, it can be argued that common factors approaches can be applied to almost any supervision model. However, we argue for the integration of common factors with the discrimination model for several reasons. First, the relationship has been found to be the essential common factor shared among counseling (Lambert & Barley, 2001; Norcross & Lambert, 2014) and supervision approaches, and is often cited as the most critical element of effective supervision and other change-inducing relationships, such as counseling, teaching and coaching (Lampropoulos, 2002; Ramos-Sanchez et al., 2002). The supervisory roles of teacher, counselor and consultant are built into the discrimination model, providing supervisors with natural avenues for fostering a strong supervisory relationship. However, the proposed Common Factors Discrimination Model (CFDM) expands on the discrimination model by providing specific recommendations for how supervisors might use such roles as opportunities for developing and maintaining the supervisory relationship. …

Модель анализа отношений личности на основе «принципа оппозиций»

Исследования, посвященные отношениям личности, отличаются большим многообразием затронутых проблем, методологических и теоретических подходов, эмпирических результатов и значительными различиями в практической ценности открытых идей и разработанных методов. Среди этих исследований обнаруживается существенный пробел в плане построения строгих и целостных психологических моделей отношений, а также в плане структурного моделирования способов их изучения и интерпретации. Кроме того, в исследованиях отношений личности редко ставится проблема обнаружения оппозиций в их структуре, процессах и эффектах реализации, что существенно затрудняет понимание коллизий отношений, ресурсов их развития и условий их регресса. К числу малоисследованных проблем относятся многомерные, противоречивые связи отношений с культурой, определяющие их ценностный характер. В арсенале инструментов анализа отношений в индивидуальной диагностике, консультировании и психотерапии недостает аналитических моделей, ориентированных на выявление оппозиций, субъективное обращение с которыми влияет на динамику познавательной, этической, эстетической, творческой, рефлексивной активности личности в культуре и во взаимодействии с другими людьми. В перспективе развития психологического знания об отношениях личности необходимы обоснование новых взглядов на роль оппозиций в жизненном становлении ценностных отношений, разработка многовариантных теоретических и герменевтических моделей их анализа в аспекте «оппозиций», апробирование и валидизация моделей в работе с индивидуальными случаями, направленной на определение потенциалов развития отношений. Авторы статьи предлагают свою версию решения этих задач.

Psicoterapia Integrativa en Intervención con Familiares en Duelo por Suicidio

El suicidio de una persona allegada constituye un evento traumático especialmente impactante. Para los familiares, el duelo consecuencia del suicidio presenta características diferenciales y requiere intervenciones terapéuticas específicas en comparación con otro tipo de duelos. En este artículo se describen los métodos principales de la Psicoterapia Integrativa como psicoterapia relacional y su aplicación al tratamiento de familiares en casos de suicidio. Se detalla el proceso terapéutico en una mujer cuyo padre hace un intento de suicidio y se presenta el testimonio escrito de su experiencia fenomenológica del proceso desde las necesidades relacionales.