Alliance: a common factor of psychotherapy modeled by structural theory

Abstract

There is broad consensus that the therapeutic alliance constitutes a core common factor for all modalities of psychotherapy. Meta-analyses corroborated that alliance, as it emerges from therapeutic process, is a significant predictor of therapy outcome. Psychotherapy process is traditionally described and explored using two categorically different approaches, the experiential (first-person) perspective and the behavioral (third-person) perspective. We propose to add to this duality a third, structural approach. Dynamical systems theory and synergetics on the one hand and enactivist theory on the other together can provide this structural approach, which contributes in specific ways to a clarification of the alliance factor. Systems theory offers concepts and tools for the modeling of the individual self and, building on this, of alliance processes. In the enactive perspective, the self is conceived as a socially enacted autonomous system that strives to maintain identity by observing a two-fold goal: to exist as an individual self in its own right (distinction) while also being open to others (participation). Using this conceptualization, we formalized the therapeutic alliance as a phase space whose potential minima (attractors) can be shifted by the therapist to approximate therapy goals. This mathematical formalization is derived from probability theory and synergetics. We draw the conclusion that structural theory provides powerful tools for the modeling of how therapeutic change is staged by the formation, utilization, and dissolution of the therapeutic alliance. In addition, we point out novel testable hypotheses and future applications.

Synchrony in Psychotherapy: A Review and an Integrative Framework for the Therapeutic Alliance

“…Researchers from different therapeutic traditions have emphasized either the patient’s or the therapist’s contributions to the alliance. However, the latter may be mainly a matter of perspective, given that the alliance emerges from the mutual interactions between patient and therapist ( Bordin, 1979 ; Hougaard, 1994 ; Tschacher et al, 2015 ).…”

“…Indeed, the alliance emerges from the mutual interactions between patient and therapist, that reciprocally influence each other as the actions of the patient influence the actions of the therapist, which then go on to influence the patient whose actions again influence the therapist, and so on. Theoretical accounts of the alliance should do justice to these interpersonal dynamics, which go the heart of the alliance as a trans-active, relational phenomenon ( Bordin, 1979 ; Hougaard, 1994 ; Tschacher et al, 2015 ).…”

“…Measuring these objective, physical aspects of the alliance is often technically difficult, which may be why these kinds of measures have been understudied. Nevertheless, the scientific analysis of the alliance will not be complete until it addresses both the subjective-linguistic and the objective, physical aspects of the alliance ( Tschacher et al, 2015 ).…”

“…This approach seems overly restrictive, given that the alliance is a multi-faceted phenomenon that has many meaningful relations with topics that are studied in other scientific disciplines. Indeed, several disciplines have made advances that seem potentially relevant to the scientific analysis of the alliance, including relationships science (e.g., Fitzsimons et al, 2015 ), social-cognitive neuroscience (e.g., Konvalinka and Roepstorff, 2012 ), cognitive linguistics ( Fusaroli et al, 2012 ), emotion science ( Rimé, 2009 ), and dynamical systems theory ( Tschacher et al, 2015 ). Consequently, alliance research would do well to nurture a more multidisciplinary orientation.…”

Psychedelics and Psychotherapy

“…Aside from therapeutic alliance, other relational common factors include cathartic and corrective emotional experiences, improving mentalization, mobilizing hope, and decreasing isolation [14,33]. Meaning and relationship are linked in psychotherapy-a strong rapport may be necessary for a patient to absorb difficult or new interpretations.…”