Changes in clients and therapists experiences of therapeutic distance during psychodynamic therapy

Egozi, Sharon; Tishby, Orya; Wiseman, Hadas

doi:10.1002/jclp.23077

Cited by 11 publications

(22 citation statements)

References 39 publications

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“…Although not part of the research hypotheses, we found almost no reciprocal effects (improvement in a client's therapeutic distance relating to the therapist's alliance and vice versa). This connects to an earlier study that showed no dyadic influences in therapeutic distance scale changes of clients and therapists (Egozi et al, 2020).…”

Section: Discussionsupporting

confidence: 88%

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Client–therapist closeness–distance dynamics as a pathway for understanding changes in the alliance during psychodynamic therapy

Egozi

Tishby

Wiseman

2021

Couns and Psychother Res

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This study examines how changes in clients’ and their therapists’ perceptions of the therapeutic distance relate to changes in their reported alliance. Alliance is commonly measured using self‐report questionnaires that provide information regarding the partners’ bond and collaboration, but do not reflect the interactions or events underlining them. We developed the Observer Version of the Therapeutic Distance Scale (TDS‐O; Egozi et al., 2020) to assess components of the therapeutic relationship, including closeness–distance dynamics, autonomy and engagement. Sixty‐seven clients and their 27 therapists completed the Working Alliance Inventory (WAI) and underwent Relationship Anecdote Paradigm (RAP) interviews in which they related narratives about their experiences with each other three times during psychodynamic therapy (after sessions 5, 15 and 28). The clients’ and their therapists’ narratives were rated on the TDS‐O. Clients’ and therapists’ decrease in their sense that the partner was too distant correlated with WAI increase, as did therapists’ decrease in their opinion that the client was too close. Increases in both partners’ engagement was also related to WAI increase. A clinical example of a successful case demonstrates these changes and highlights significant moments that might contribute to positive change. The study establishes the relationship between the alliance and therapeutic distance, and reveals discrepancies in the experiences of clients and therapists. Tracking therapeutic distance has the potential to refine therapists’ attunement to their clients’ emotional needs.

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Section: Discussionsupporting

confidence: 88%

“…The TDS-O (Egozi et al, 2020(Egozi et al, , 2021 is based on the self-report measure developed by Mallinckrodt (TDS; Mallinckrodt et al, 2015).…”

Section: Therapeutic Distance Scale-observer Version (Tds-o)mentioning

confidence: 99%

Client–therapist closeness–distance dynamics as a pathway for understanding changes in the alliance during psychodynamic therapy

Egozi

Tishby

Wiseman

2021

Couns and Psychother Res

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“…The SRTD model predicts significant change in Growing Autonomy and Growing Engagement only for clients who manage to establish a secure attachment to their therapist. Nevertheless, the TDS-O proved to be a valuable assessment tool for the data analyzed in these two studies (Egozi et al, 2021a(Egozi et al, , 2021b. Further research is needed to evaluate the congruence of observer and client ratings of therapeutic distance.…”

Section: Corrective Emotional Experiencesmentioning

confidence: 99%

Clients’ experiences of attachment in the psychotherapy relationship.

Mallinckrodt¹

2022

The Other Side of Psychotherapy: Understanding Clients’ Experiences and Contributions in Treatment.

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J ohn Bowlby (1988), in one of his last scholarly writings, asserted that the adult client-therapist relationship could be understood as a form of attachment. In the decades following his seminal work, a large body of research has accumulated to support this position (for reviews, see Levy et al., 2019;Mikulincer & Shaver, 2016). It is perhaps understandable that much of this attention has focused on the therapist's role in facilitating client change through providing and regulating a secure therapeutic attachment (e.g., Teyber & Teyber, 2017). However, the goal of this chapter is to reexamine this literature from the client's perspective of experiencing attachment in the psychotherapy relationship. We begin this exploration from outside the therapeutic setting by considering the elements of all healthy child-caregiver attachments. HEALTHY CHILD-CAREGIVER ATTACHMENTSSummarizing a large body of theory and research, Mikulincer and Shaver (2016, pp. 15-16) identified five key functions that secure attachment to caregivers serve for a developing child. Attachment figures provide (a) a target for proximity seeking, (b) a safe haven when children feel threatened, and (c) a secure base that permits children to explore the environment and develop growing mastery. Together, these first three elements promote a sense of "felt security."

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“…Taking a relational perspective that highlights the mutual aspects of the encounter between client and therapist (Aron, 1996;Muran, 2019;Safran & Muran, 2000; see also Chapter 5 by Tishby in this volume), we developed the Therapeutic Distance Scale Observer version (TDS-O; Egozi et al, 2020) to assess the therapeutic distance as experienced by each partner in the dyad. The TDS-O includes a version for the client and one for the therapist.…”

Section: Assessment Of Therapeutic Distancementioning

confidence: 99%

“…The TDS-O includes a version for the client and one for the therapist. Like the self-report TDS, the Observer versions also comprise four scales: Too Distant (the partner is perceived as distant and inaccessible), Too Close (the partner is perceived as intrusive and forcing closeness), Growing Autonomy (therapy encourages clients to make independent decisions and to take the initiative, from either the client's or the therapist's view), and Growing Engagement (clients' ability to discuss sensitive issues and relinquish concerns regarding the need to reveal themselves, from either the client's or the therapist's view; Egozi et al, 2020).…”

Section: Assessment Of Therapeutic Distancementioning

confidence: 99%

Attachment theory as a framework for responsiveness in psychotherapy.

Wiseman¹,

Egozi²

2021

The Responsive Psychotherapist: Attuning to Clients in the Moment.

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In this chapter, we use attachment theory as a framework to begin the pathway to conceptualization of therapists' responsiveness to their clients by considering the responsiveness of parents to their infants. Research in developmental psychology on mother-infant attachment flourished following Ainsworth et al.'s (1978) groundbreaking strange situation paradigm. First, we touch on the nature of early infant-parent interaction to highlight the centrality of responsiveness in infant-parent bonds. Second, we consider key concepts in attachment theory that are applicable to responsiveness in psychotherapy: the provision of a secure base by parents and by therapists and internal working models and relationship representations. We then turn to consider attachment dynamics in psychotherapy, focusing on therapist responsiveness to client attachment needs through regulating therapeutic distance. We provide narrative illustrations (derived from interviews with clients about their experiences with their therapists) that depict lack of responsiveness and appropriate responsiveness, as well as misattunement and attunement. Finally, we present relevant assessment tools for attachment processes and research. RESPONSIVENESS IN THE ATTACHMENT PATHWAYConsidering conceptualizations of responsiveness by diverse theoretical approaches in relationship science, Reis (2013) viewed attachment theory as featuring caregiver responsiveness to infants' expressions of need or distress as accounting for socioemotional development. As Bowlby (1969/1982) first theorized and Ainsworth et al.'s (1978 subsequent research confirmed, infants with caregivers who respond sensitively and supportively to them learn to be confident about their caregivers' availability and responsiveness. This sense of confidence, or felt security, is internalized and generalized to other caregivers, providing a foundation for the development of secure internal working models that serve the individual throughout life. Thus, attunement and appropriate parent responsiveness to infants' needs are the hallmark of secure attachment. In relation to the findings of prospective studies on the association between infant attachment and maternal responsive behavior, Holmes (1993) stated, "Mothers of secure one-year-olds are responsive to their babies, mothers of insecure-avoidants are unresponsive, and mothers of insecure-ambivalents are inconsistently responsive" (p. 107).

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Changes in clients and therapists experiences of therapeutic distance during psychodynamic therapy

Cited by 11 publications

References 39 publications

Client–therapist closeness–distance dynamics as a pathway for understanding changes in the alliance during psychodynamic therapy

Client–therapist closeness–distance dynamics as a pathway for understanding changes in the alliance during psychodynamic therapy

Clients’ experiences of attachment in the psychotherapy relationship.

Attachment theory as a framework for responsiveness in psychotherapy.

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