The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.
In psychoanalysis the therapeutic relationship has been theorized to consist of three parts: the working alliance, transference/countertransference, and the real relationship. Evidence on each component's unique contribution to the outcome has been gathered, as well as evidence on the interaction between components. In contrast to a social relationship, the focus of the therapeutic relationship is on the client's needs and goals.
The therapeutic alliance, or the working alliance may be defined as the joining of a client's reasonable side with a therapist's working or analyzing side. Bordin conceptualized the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client's goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals.
Research on the working alliance suggests that it is a strong predictor of psychotherapy or counseling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy. Therapeutic alliance has been found to be effective in treating adolescents with PTSD, with the strongest alliances were associated with the greatest improvement in PTSD symptoms. Regardless of other treatment procedures, studies have shown that the degree to which traumatized adolescents feel a connection with their therapist greatly affects how well they do during treatment.
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Relational psychoanalysis is a school of psychoanalysis in the United States that emphasizes the role of real and imagined relationships with others in mental disorder and psychotherapy. 'Relational psychoanalysis is a relatively new and evolving school of psychoanalytic thought considered by its founders to represent a "paradigm shift" in psychoanalysis'. Relational psychoanalysis began in the 1980s as an attempt to integrate interpersonal psychoanalysis's emphasis on the detailed exploration of interpersonal interactions with British object relations theory's ideas about the psychological importance of internalized relationships with other people.
Interpersonal psychoanalysis is based on the theories of American psychiatrist Harry Stack Sullivan (1892–1949). Sullivan believed that the details of a patient's interpersonal interactions with others can provide insight into the causes and cures of mental disorder. Current practitioners stress such features as the detailed description of clinical experience, the mutuality of the interpersonal process, and the not-knowing of the analyst.
Body-centred countertransference involves a psychotherapist's experiencing the physical state of the patient in a clinical context. Also known as somatic countertransference, it can incorporate the therapist's gut feelings, as well as changes to breathing, to heart rate and to tension in muscles. Dance therapy has understandably given much weight to the concept of somatic countertransference. Jungian James Hillman also emphasised the importance of the therapist using the body as a sounding-board in the clinical context.
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