Castonguay, Constantino, Holtforth, 2006, Working
The Castonguay, Constantino, and Holtforth article cast the atmosphere of disarray that seems to pervade the area of psychotherapy research in a slightly more hopeful light. In particular, it seems that – though the authors may proclaim its promise a bit too zealously for my taste – the therapeutic working alliance between client and therapist may indeed provide a fruitful avenue for exploration for effective differential treatment and training. Though I was, on the whole, interested in this article, my ears perked up in a few places, namely:
-The finding that “when faced with alliance ruptures or therapeutic impasses, therapists’ increased or rigid adherence to prescribed techniques or the therapeutic rationale may fail to repair such ruptures and may even exacerbate them.” (p. 272) This seems to fly in the face of the position of pure treatment manual acolytes, who go around knocking on doors when hard-core CBT therapists deviate from their scripts. It also seems to echo one of the themes of the article: that therapists (either via training, formal measures, or both) need to become actively aware of the therapeutic alliance, in the same way that Freudians used to command that psychoanalysts attend to their transference and counter-transference processes – though with a bit less pressure this time.
-The authors note on page 273 that “the alliance can no longer be viewed as a ‘nonspecific’ variable, i.e. a variable for which the nature and impact is not yet understood.” Faced with the cacophony of naysayers who claim that therapeutic effects can almost ENTIRELY be ascribed to nonspecific effects, it is a fairly large and significant finding that alliance – which, one way or another, is present in all therapeutic relationships – can be differential, quantifiable, and capable of being manipulated. This leads logically, later, to the promising point that attempting to “match specific interventions to significant in-session events such as anger… is likely to enhance significantly our understanding of the process of change, as well as to make research efforts more meaningful and relevant to practitioners.” (p. 275) So, not only can the alliance help us understand change processes as researchers, it can help clinicians to directly impact those processes for the better – which seems to be what we’re all hoping to get at in the first place.
-An interesting point that I don’t think was satisfactorily addressed in this article is the question of whether the alliance needs to be made explicit, or remain in some meaningful way implicit – or even elusive – for the client. Though there seems to be some evidence presented in the article to support the claim that bringing the status of the alliance to bear is helpful for the therapist, it’s not immediately clear that the same is true for the client. In fact, one could make the argument that such a thing might be detrimental – that part of the alliance (and its attendant change processes) hinges on the sense in the client’s head that the therapist “just gets me.” Though many clinical researchers scoff at the “mystical” claims of some forms of therapy, I’m not sure what the empirical status of therapeutic mystique is; do we know that the sense that many clients have that their therapist has privileged knowledge – even privileged power -- isn’t valuable? I, even, wonder if some of the more powerful alliance effects might even come from this, and, just as importantly, if the dissolving of this presumed insight (through alliance measures with very high face validity, for instance) might serve to undo those very effects.
Kirschenbaum & Jourdan, 2005, Current Status of Person-Centered Approach
If the therapeutic alliance and
3 comments:
I like that you brought up a mystique associated with the therapist. I wonder about that. I imagine, for example, that this mystique could be constructed by both the therapist and the client--the therapist's behaviors and the client's perceptions/expectations.
Jim -- agreed. I think the question that's interesting to me is: what, if anything, is the value of that mystique? Does it serve a useful purpose. After knowing more about this, I'd THEN want to know how to construct it.
This is an absolutely fascinating issue that I hope we get some time to talk about in the morning. The issue is this: What is the relative value of, on the one hand, good, researched, psychotherapeutic affectations (behaviors known to facilitate affiliation and alliance that are essentially acted), and, on the other hand, authentic interpersonal connections that may be somewhat idiosyncratic? Do authentic interpersonal connections always come packaged with the same "common factors?" I don't know the answer to this, and I'm not sure there is one, but I'll offer two other observations: 1) some people are just better at forging solid interpersonal connections based on mutuality and trust, as if they are musicians skilled in jamming with others; and 2), as an old music instructor used to tell me, some people just can't be taught jazz.
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