The interplay between therapeutic relationship and therapeutic technique: “It takes two to tango”

Abstract

The idea that the therapeutic relationship is at the core of psychotherapy is shared by most therapeutic approaches.Also, an increasing variety of therapeutic approaches, consider experiential techniques as central tools to promote effective therapeutic change. Commonly, it is argued that the creation of a positive, empathic, safe, and solid therapeutic alliance should be a prerequisite for administering these techniques. However, recent evidence is beginning to challenge this cautious stance showing that the introduction of experiential work early in therapy can be safe and effective. So, the quality of the therapeutic relationship may either facilitate or hinder the use of experiential techniques, but the use of these techniques may also strengthen or cause ruptures in the therapeutic alliance. So how do we balance the attention to the therapeutic relationship and the use of active, emotionally arousing techniques? In this paper, we present an issue of the Journal of Clinical Psychology: In Session exploring the complex interplay between therapeutic relationship and experiential practices in light of different psychotherapeutic approaches. We do so by first providing an initial overview of the topic. Next, we introduce the five papers of the issue along with some thoughts on how authors from diverse psychotherapeutic orientations contributed to illustrate and reflect on this multifaceted "dance" between therapeutic relationship and techniques.

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder

“…In keeping with recent trends exploring the interplay between experiential techniques and the therapy relationsip (Matos & Dimaggio, 2023), we suggest that tasks are negotiated in a nondirective way, with a constant attention to their impact on the therapeutic relationship. In the orientation described in this paper, curiosity and the need to validate patients' experience play a central role.…”

“…In this paper, we proposed that the use of homework in‐between sessions, assignments that are agreed upon by therapist and patient, can both increase self‐awareness and drive change. Notably, therapists should first consider the impact of homework assignments on the therapeutic relationship (see Matos & Dimaggio, 2023, Steindl et al [2023] for similar reflections when introducing experimental practices). Once patients realize they can break these patterns in therapy, creating space for healthier relationships, therapists can encourage them to try breaking these patterns in their everyday lives, exploring new ways of relating to others.…”

“…Is it changing? Is it improving as the patient feels therapy is more active and may be gaining more benefits from it (Centonze et al, 2023; Matos & Dimaggio, 2023)? Do relational problems emerge which need attention and repairing?…”

A Proposed Definition of Psychological Treatment and Its Relation to Empirically Supported Treatments

“…Even in cognitive-behavioral therapy, which entails specific procedures for behavior change, the therapist must be sensitive and alert to the patient's reactions and responses, which should inform and guide the next step in the process (e.g., Beck et al, 1979). There is also the notion that the patient-therapist relationship or the therapeutic alliance may facilitate the specific psychological procedures that we believe are critical in defining psychological treatment (Steindl, Matos, & DiMaggio, 2023).…”

Homework as a driver of change in psychotherapy

“…These behaviors are usually related to either strong needs for autonomy and control, or attachment (Safran & Muran, 2000). Either way, therapists need to be mindful of how the use of techniques and the therapeutic relationship interact (Centonze et al, 2023;Dimaggio et al, 2015;Matos & Dimaggio, 2023;Ryum et al, 2010b), in particular when working with clients who present with prominent maladaptive personality traits (e.g., avoidance, perfectionism, etc. ), where the risk for an alliance rupture is relatively high.…”