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

Abstract

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.

The experience of closeness and distance in the therapeutic relationship of patients with different attachment classifications: an exploration of prototypical cases

“…The TDS-O enables us to follow congruence and incongruence between patient and therapist experiences regarding their proximity, and thus has the potential to contribute to therapist ability to attune to patient emotional needs at the specific moment (49). The second study (47), demonstrated significant relations between the TDS-O and the therapeutic alliance. Patient and therapist decrease in their sense that the partner was too distant correlated with increase in the alliance, as did therapist decrease in the sense that the patient was too close.…”

“…Following Mallinckrodt and Jeong's (45) model, and taking a relational perspective (46), the TDS-O was developed to track the unique dyadic dance between patient and therapist, focusing on the closeness-distance experiences of both patients and therapists. The TDS-O expanded the TDS by creating an observer-narrative-based version [TDS-O; (20,21,47)], which enables the researcher to follow both the patient's and the therapist's experiences through their descriptions of their interactions with each other. The narratives told by patients and therapists provide a window into subjective significant moments at different phases of therapy by coding the narratives on the four scales of the TDS-O.…”

New skills for distance regulation: Therapists’ experiences of remote psychotherapy following the COVID-19 pandemic.

“…The therapists’ lasting ambivalence toward the remote format in our study raises the issue of patient–therapist matching. How to optimize the distance is dependent on the patient–therapist matching in each individual case (cf., Egozi et al, 2022; Werbart et al, 2018). As expressed by the therapists in our study, the distance–closeness regulation in remote encounters requires new and advanced therapeutic skills.…”

“I miss not being able to offer my couples a box of tissues…”: Couples' and therapists' perspectives on the therapeutic alliance with the transition to online couple therapy

“…The idea of therapeutic distance can be traced back to the work of Mallinckrodt (2010), Mallinckrodt et al (2015) and is defined as therapists' ability to regulate themselves based on their client's emotional needs during a session. Using therapeutic distance increases the scaffolding of the therapeutic alliance, as it creates a dynamic of closeness and distance between client and therapist (Egozi et al, 2021). Tremain et al (2020) suggest that for people with serious mental illnesses, therapeutic alliance can be fostered through digital interventions (technology-based interventions providing information and support, as well as emotional, decisional, behavioral, and neurocognitive therapy for physical and mental health problems), but that such an alliance may have unique characteristics that have yet to be confirmed in digital settings.…”

“…The idea of therapeutic distance can be traced back to the work of Mallinckrodt (2010), Mallinckrodt et al (2015) and is defined as therapists' ability to regulate themselves based on their client's emotional needs during a session. Using therapeutic distance increases the scaffolding of the therapeutic alliance, as it creates a dynamic of closeness and distance between client and therapist (Egozi et al, 2021).…”