A review of therapist characteristics and techniques negatively impacting the therapeutic alliance.

Abstract

The present review is a comprehensive examination of the therapist's personal attributes and in-session activities that negatively influence the therapeutic alliance from a broad range of psychotherapy perspectives. Therapist's personal attributes such as being rigid, uncertain, critical, distant, tense, and distracted were found to contribute negatively to the alliance. Moreover, therapist techniques such as over structuring the therapy, inappropriate self-disclosure, unyielding use of transference interpretation, and inappropriate use of silence were also found to contribute negatively to the alliance. In addition, this review reveals how therapist's personal qualities and use of technique have a similar influence on the identification or exacerbation of ruptures in the alliance.

A review and critical appraisal of measures of therapist-patient interactions in mental health settings

“…76 Other therapist behaviours that patients have described as intrusive and defensive and as having a negative impact on the relationship include therapists imposing their own values, making irrelevant comments, or being critical, rigid, bored, blaming, moralistic or uncertain. 77 Poor use of therapeutic techniques, such as continued application of a technique when not accepted by or found to be …”

“…28,81,82 Such ruptures in therapy are common and an expected part of treatment. 28,75,77,83 Crits-Christoph 84 describes ruptures as transference reactions; others when the therapist makes mistakes, is anxious or has a strong need for approval, or when patients experience negative feelings about the therapist as a result of the therapist doing something they did not want, or not doing something they did want.…”

“…Additional therapist characteristics that are associated with negative aspects of the patient-therapist relationship include being rigid, uncertain, distant, tense and distracted, and their level of experience. 77,87 Attitudinal variables that are associated with the development of a good relationship include perceptions that the therapist is trustworthy, interested, affirming, confident, respectful and open. 101 These attributes potentially help patients to develop confidence in and collaboration with the therapist.…”

Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa

“…For example, therapist warmth, flexibility, and interpretive accuracy have been positively associated with alliance quality (see Ackerman & Hilsenroth, 2003), while therapist rigidity, criticalness, and inappropriate self-disclosures have been negatively associated with alliance quality (see Ackerman & Hilsenroth, 2001). Furthermore, the nature of the alliance has been differentially associated with the therapist's own interpersonal history, interpersonal style, and self-concept (e.g., Henry, Strupp, Butler, Schacht, & Binder, 1993;Hersoug, 2004;Hersoug, Hoglend, Monsen, & Havik, 2001;Hilliard, Henry, & Strupp, 2000).…”

Ciclos Cognitivos Interpessoais: Desafios E Estratégias De Fortalecimento Da Relação Terapêutica

“…Podemos, em consequência do que temos vindo a aflorar, afirmar que os ciclos cognitivo-interpessoais podem ser entendidos enquanto cristalização, e manutenção no tempo, de esquemas interpessoais disfuncionais, que são confirmados nas suas vivências quotidianas pelos pares com quem contacta, estando o/a terapeuta, enquanto ser humano que é, em risco de constituir um dos elementos que fornece estas respostas complementares, reforçando, pelas suas ações, os ciclos cognitivo-interpessoais (Ackerman & Hilsenroth, 2001;Baldwin, Wampold & Imel, 2007;Safran & Kraus, 2014). Pelo exposto se depreende que é essencial, neste âmbito, que a ação do/a terapeuta se paute pela desconfirmação destes ciclos, permitindo ao paciente a abertura a novas respostas (e.g., Safran, 1990;Safran & Muran, 2000;Ackerman & Hilsenroth, 2003;Ribeiro, 2009).…”