Responsiveness in psychodynamic relational psychotherapy.

Abstract

The unique feature of psychodynamic relational theory is its focus on therapy as an intersubjective process that occurs on both conscious and unconscious levels. Therapist and client cocreate the meaning and form a unique dyadic relationship. This chapter begins with a presentation of basic concepts in the two-person paradigm, followed by a description of relational events that therapists should be attuned to, such as negotiating the alliance, resolving ruptures in the alliance, attuning to the transference-countertransference matrix, processing enactments, and attuning to dissociated self states. These processes are illustrated by clinical vignettes with commentaries. Research in this area is still quite limited, but a number of recent studies that lend support to relational processes in therapy are presented. The chapter also addresses attunement to diversity and implications for training.

Responsiveness: Can psychotherapies and psychotherapists adapt effectively to participant and clinical contexts?

“…Two different models have been proposed to conceptualize responsiveness in psychotherapy. The first, characterized as a two-person model (Safran & Muran, 2000;Schore, 2019;Tishby, 2021), requires clinicians and researchers to consider what is happening within the therapist and the client and what is being communicated by each person in the interaction. The second model, identified by Hatcher (2021), sees therapists as goal-directed, responsive agents.…”

“…The debate over the conceptualization of CT, its complexity, and the fact that it is often out of awareness, poses challenges for researchers. However, in the last two decades the lag between theoretical-clinical interest in CT and empirical studies has been reduced somewhat as research on CT has gained considerable momentum (Hayes et al, 2018;Tishby, 2021). In an effort to integrate various conceptions of CT, considering the value and limitations of definitions being either too narrow or too broad, Gelso and Hayes (2007) suggested a pan-theoretical definition: "the therapist's internal or external reactions that are shaped by the therapist' s past or present emotional conflicts and vulnerabilities" (p. 25).…”

“…Responsiveness is not taught as a specific skill in graduate programs (Silberschatz, 2021;Tishby, 2021;Wu, 2020), leading Silberschatz (2021) to suggest: "Instead of training therapists to adopt a specified technique for patients who share a diagnosis, therapists need to receive more training on how to be more responsive to their patients' particular problems, goals, and needs" (p. 148). Training in responsiveness needs to focus on increasing mutual recognition and emotional attunement, identifying and managing CT, and becoming aware of the role that clients' and therapists' attachment styles can play in the interaction so that these can be moderated, as well as learning to recognize and attend to different therapist, client, and interpersonal signals in each approach and across different approaches in order to respond more appropriately.…”