Negotiating the Therapeutic Alliance: A Relational Treatment Guide / Edition 1

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A half-century of psychotherapy research has shown that the quality of the therapeutic alliance is the most robust predictor of treatment success. This unique book provides a systematic framework for negotiating ruptures and strains in the therapeutic alliance and transforming them into therapeutic breakthroughs. Cutting-edge developments in psychoanalysis and other modalities are synthesized with original research and clinical wisdom gleaned from years of work in the field. The result is a practical and highly sophisticated guide that spells out clear principles of intervention while at the same time inspiring therapists toward greater creativity.

The book contains no figures.

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Editorial Reviews

Safran (psychology, New School for Social Research) and Muran (Director of the Brief Psychotherapy Research Program at Beth Israel Medical Center) present a guide for training therapists to work constructively with negative process in psychotherapy and to skillfully negotiate ruptures in the therapeutic alliance. After a review of theoretical considerations of the therapeutic alliance, the authors discuss ruptures from problems in the relational bond to disagreements about the goals of therapy. Recommendations for clinical intervention are then elaborated, illustrated with case vignettes and transcript material. Annotation c. Book News, Inc., Portland, OR (
From the Publisher

"While clinical research has demonstrated the efficacy of a variety of psychotherapeutic procedures, what is often overlooked is the critical role played by the 'common factors' of psychotherapy. This important book details procedures for optimizing the therapeutic alliance and maximizing treatment effectiveness. It should be read by all clinicians." --David H. Barlow, PhD, Professor and Director Center for Anxiety and Related Disorders, Boston University

"This is a splendid book, expertly written by two exceptionally creative psychotherapy theorists and researchers. Its strength lies in drawing out the implications for practice of the relational perspective, and doing so in both a scholarly and practical way. It is broad and integrative, bringing together psychoanalytic and experiential perspectives as well as Western and Eastern outlooks. The clinical vignettes are excellent, as is the coverage of procedures for teaching and training. All therapists will benefit enormously from learning about this exciting and powerful approach." --Stanley B. Messer, PhD, Professor and Chair, Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University

"A remarkable achievement. This masterfully crafted guide to relational psychotherapy is one of only a handful of books that have bridged the chasm between empirical research and improvements in psychotherapeutic technique. It represents one of the few genuine advances in psychotherapeutic technique over the last quarter-century. Focusing on the difficult-to-engage patient, the authors provide a wise, detailed, and comprehensive guide to effective psychotherapy intervention which always remains firmly grounded in theory and research. All therapists, novices and experts, will improve the quality and effectiveness of their work having read this book." --Peter Fonagy PhD, Freud Memorial Professor of Psychoanalysis, University of London

"This forward-looking book documents significant changes in psychodynamic theory and practice as relational thinking is superseding the classical drive model. The emphasis on therapist training and clinical illustrations is particularly helpful." --Hans H. Strupp, PhD, Distinguished Professor of Psychology, Emeritus, Vanderbilt University

"This book is an unparalleled achievement that transcends many of the usual dichotomies in the field. Structured as a treatment manual, the book elaborates detailed interventions and techniques, but it is also personal and experiential, emphasizing procedural knowledge, self-awareness, and reflection-in-action. It is among the few comprehensive texts that truly integrates ongoing empirical research with cutting-edge developments in clinical psychoanalysis, as well as elements of other therapeutic modalities. It outlines broad theoretical and philosophical principles, yet at the same time provides clear-cut intervention strategies, illustrated with lively and meaningful clinical material. On top of all this it is clearly and engagingly written, well organized, and even includes a creative chapter on the largely unexamined area of training issues and supervision. This book will be used both as a classroom text and as a sourcebook for working clinicians, researchers, and theorists." --Lewis Aron, PhD, Director, Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University

"This is a brilliant book. Informed by the authors' internationally recognized research program on ruptures in the therapeutic alliance, the book is enlightening in two major ways. First, its focus on ruptures opens a route to understanding the nature and utility of the therapeutic alliance. Second, the authors show how to negotiate ruptures, offering a veritable guide to moving from rupture to healing. Focusing on an important and neglected area of clinical training, this is an invaluable text for beginning and advanced psychotherapy courses." --Lester Luborsky, PhD, Professor of Psychology in Psychiatry, Department of Psychiatry, University of Pennsylvania

American Journal of Psychiatry

"The quality of the therapeutic alliance is the most powerful predictor of success in psychotherapy. Given the inevitability of stresses, strains, and breakdowns in that alliance, the identification and repair of these difficulties are among the most important skills for the psychotherapist to acquire....[This book] belongs in the library of every mental health professional who practices or teaches psychotherapy."--American Journal of Psychiatry
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Product Details

  • ISBN-13: 9781572308695
  • Publisher: Guilford Publications, Inc.
  • Publication date: 5/22/2003
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 260
  • Sales rank: 902,478
  • Product dimensions: 5.90 (w) x 8.90 (h) x 0.90 (d)

Meet the Author

Jeremy D. Safran, PhD, is Professor of Psychology at the New School for Social Research, where he was formerly Director of Clinical Psychology. He is also Senior Research Scientist at New York's Beth Israel Medical Center. He is the author of Widening the Scope of Cognitive Therapy, coauthor of Emotion in Psychotherapy and Interpersonal Process in Cognitive Therapy, and coeditor of Emotion, Psychotherapy, and Change and The Therapeutic Alliance in Brief Psychotherapy. He is an advisory editor for Psychotherapy Research, Journal of Clinical Psychology, Journal of Psychotherapy Integration, and several other journals, and maintains a private practice in New York City.

J. Christopher Muran, PhD, is Chief Psychologist and Director of the Brief Psychotherapy Research Program at Beth Israel Medical Center, where he maintains a private practice. He is also Associate Professor of Psychiatry at Albert Einstein College of Medicine. He completed a fellowship in cognitive-behavioral therapy at the Clarke Institute of Psychiatry, University of Toronto, as well as analytic training in the New York University Postdoctoral Program. He received the Early Career Award from the Society for Psychotherapy Research, and serves as an advisory editor for Psychotherapy Research. He is the coeditor of The Therapeutic Alliance in Brief Psychotherapy and editor of the forthcoming Self-Relations in the Psychotherapy Process.

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Table of Contents

1 The Therapeutic Alliance Reconsidered 1
Overview of the Book 5
A Brief History of the Therapeutic Alliance 6
A Reconceptualization of the Therapeutic Alliance 12
A Taxonomy of Interventions for Addressing Alliance Ruptures 15
2 Fundamental Assumptions and Principles 30
Agency versus Relatedness 31
Constructivism and Realism 34
Beginner's Mind: The Dangers of Reification 36
One-Person and Two-Person Psychologies 38
Interventions as Relational Acts 41
Motivation and Emotion 42
Affective Appraisal and Communication 45
Understanding and Experiencing/Insight and Awareness 47
Participant-Observation and Observing-Participation 51
Intersubjectivity 52
Mindfulness: The Therapist's Observational Stance and Inner Work 55
Circles, Cycles, and Matrices 59
Beyond Countertransference 62
Multiple Selves 67
The Paradox of Acceptance 69
3 Understanding Alliance Ruptures and Therapeutic Impasses 72
Hope and Despair 73
Resistance: Intrapsychic, Characterological, and Relational 77
Will and Responsibility 81
Impasses as Windows into Core Organizing Principles 85
Restructuring the Patient's Relational Schemas 88
Affective Miscoordination and Repair 90
Recovering a Split-Off Part of the Self 92
Transitional Experience 94
Optimal Disillusionment 98
Subjects and Objects 101
Need versus Neediness 103
Surviving and Containing 105
4 Therapeutic Metacommunication: Mindfulness in Action 108
Clinical Vignettes 110
Principles of Metacommunication 114
Clinical Illustration 130
5 Stage-Process Models of Alliance Rupture Resolution 140
A Resolution Model for Withdrawal Ruptures 142
A Resolution Model for Confrontation Ruptures 154
6 Brief Relational Therapy 175
The Dynamic Focus 177
Awareness and the Focus on the Present Moment 178
Termination and Optimal Disillusionment 181
Case Illustration 183
7 A Relational Approach to Training and Supervision 204
Explicitly Establishing an Experiential Focus 207
Mindfulness Training 209
Self-Exploration 210
The Relational Context of Supervision 213
Audio- and Videotaping 215
Awareness-Oriented Role Plays 217
Supervisors as Models 220
Training Illustration 222
Afterword 233
References 239
Index 255
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