Compare and contrast the models of therapeutic relationship

The importance of an effectual curative relationship in successful psychotherapeutics is without inquiry and can be traced back to the most cardinal facets of a ‘relationship ‘ in society. Indeed, one of the great determiners of societal wellbeing and felicity stems from the ability to organize close relationships with others, illustrated by the construct of ‘support webs ‘ as a curative construction. The patient-physician relationship is a portion of this curative support web, possibly even a compensatory mechanism for the sensed diminution in spiritual and moral relationships entered into in the modern age. Upon geographic expedition of the interaction between physician/therapist and patient it would look that several different methodological attacks are practiced, changing harmonizing to the intended purpose of the curative relationship and the intrinsic vicissitudes apparent in the ‘presenting ailment ‘ . Two good known and utilized positions of the curative relationship include the transference/countertransference theoretical account and the reparative theoretical account, both of which follow different methods in order to analyze and research the pertinent issues of the curative demand. This paper will supply an overview of the curative relationship in modern pattern, peculiarly through comparing and contrast of these theoretical accounts, supplying illustrations of effectual curative application. The similarities and differences between the theoretical accounts will be discussed and suitably summarised.

The Therapeutic Relationship

When sing the indispensable constituents to a successful curative partnership, deconstruction of the motives of the healer is required in order to specify the kineticss which may emerge, as necessarily the patient has a clear function in the partnership, ‘ … to utilize the analyst non merely to decide them, but as a receptacle for his repressed feelings ‘[ 1 ]. One of the cardinal facets of the function of the healer should be that they enter into the relationship on a voluntary footing and strive to consequence a working relationship, by whatever agencies or theoretical account they feel most appropriate. Indeed, it has been suggested that the peculiar pick in theoretical account does non act upon the result of therapy significantly, but instead the relationship formed is a more of import determiner of success[ 2 ]. In malice of this a figure of different techniques are utilised to assorted grades by clinical psychologists, adapted to accommodate peculiar jobs. Clarkson ( 1990 ) provides an overview of these theoretical accounts, placing five major illustrations: the on the job confederation ; the transference/ countertransference relationship ; the reparative/ developmentally needed relationship ; the I-You relationship ; and, the transpersonal relationship[ 3 ]. In this paper the transference/countertransference and the reparative will be discussed in item.

Overview of Models

The transference/countertransference theoretical account is based on the construct of transference, which is an of import thought in psychodynamic theory, as relevant today as it was a century ago. Basically, transference is when feelings present from childhood re-emerge and go a agency of construing current state of affairss. These feelings are frequently representative of experiences with parental figures from childhood[ 4 ]. In the curative sphere, projection of these wants and/or frights onto the curative relationship can take two different signifiers: proactive and reactive. Proactive transference refers to the past experiences which the patient brings to the relationship, where as reactive transference is the reaction of the patient to thoughts introduced by the healer. This leads to the definition of countertransference, which is basically the elements of the relationship introduced by the healer ( and can besides be proactive or reactive )[ 5 ]. Both elements must be addressed for the relationship to work.

A normally cited illustration of transference is the infliction of a parental figure onto the healer. Something may hold triggered this phenomenon, such as wonts or visual aspect of the healer, ensuing in emotional and psychological demand transference to the present state of affairs[ 6 ]. This construct was ab initio identified by Freud, but was non greatly elaborated upon: he considered that it may be a barrier to psychotherapeutic success ab initio. However, countertransference enables the healer to better understand the relationship and enables greater control over their ain feelings. Of class, the healer is a human being with past experiences and emotional positions and hence brings a certain grade of those exposures to the relationship. Establishing how the patient may be trying to arouse responses from the healer, is one of the cardinal characteristics of countertransference apprehension[ 7 ].

The end of this intercession is to set up the implicit in grounds for the transference and to border those inappropriate responses with a reaction that is appropriate to the proposed curative dynamic i.e. the existent state of affairs. It is of import to observe that although it is an of import procedure, and underlies a big grade of psychoanalytical theory, it is non an indispensable measure in ‘curing ‘ the patient[ 8 ]. It should surely non be forcibly introduced into a relationship. Rather transference should be invited as portion of the analytical procedure and so bit by bit disassembled through reading[ 9 ].

The 2nd theoretical account is the reparative relationship, which adopts a contrasting attack to the declaration of patient issues and concerns. The footing of this attack is that the healer deliberately aims to rectify or mend a parental relationship or action when there is grounds for maltreatment, lacks or over-protection in the initial parenting. Those elements which were absent in that initial parental relationship are supplied by the clinical psychologist in an effort to counterbalance for the old actions. Another term for this theoretical account is the developmentally needed relationship, which is an accurate description in a batch of instances, as there is a sensed demand in the present that was missing in childhood[ 10 ]. Typically, it can be observed that the grownup ( patient ) regresses i.e. reverts to a signifier of believing more suitable to earlier phases of their development, when such a demand arises, specifying the function of the healer as the go-between of the arrested development through reparation[ 11 ].

A assortment of good known psychoanalysts have adopted this attack in response to grownups who were mistreated or under-loved as kids. Sechehaye and Ferenczi both extended the parametric quantities of this relationship to the point that they would take the patient on excursions, or allow them populate at place with them for extended periods of clip[ 12 ]. Surely, a dynamic attack is adopted by many clinical psychologists who utilise this theoretical account, though possibly non to the same extremes.

Comparison of theoretical accounts

Having explored the elaboratenesss of the two theoretical accounts, there are some noticeable differences which are instantly identifiable. First, the attack to the patient is rather different: where as in the transference/ countertransference theoretical account there is a general consensus that the healer should stay impartial in their responses, rather the antonym is true in the reparative theoretical account. A good illustration of this is illustrated by Clarkson, who uses the healer response to the patient-posed inquiry ‘How are you? ‘ , frequently the first noteworthy interaction in a curative session, as a agency of contrasting these theoretical accounts. For case, the healer would either respond mutely or by questioning the implicit in grounds for wishing to cognize why the patient is concerned with the healers good being in the transference theoretical account. In the reparative theoretical account, the healer will establish their response on the perceived developmental demand of the patient: if they were encouraged non to show their attention towards their parent as a kid, the healer might react and thank them for their involvement in their wellbeing[ 13 ].

The reply to this simple inquiry is a microcosm for subsequent interactions in the session, or Sessionss, with the general impression that in the reparative procedure an deliberately structured set of responses are offered to fulfill the developmental demand, while in the transference method an opposing position is offered which does non conform to the child-parent interaction that may be desired by the patient. Therefore it can be said that the function of the healer is in contrast: one method sees the healer as a parental figure ( or replacement in utmost illustrations ) , and the other sees the healer moving as an ‘adult ‘ instead than a ‘parent ‘[ 14 ]. Or set another manner, that the healer does non indulge in the child-parent interaction desired by the patient. Indeed, this would look to reflect an elevated degree of dynamism on behalf of the healer in the reparative theoretical account.

The attack adopted by the healer is really different in these theoretical accounts, which possibly implies that there is a difference in intended curative result or ‘end-point ‘ . Of class, as mentioned earlier, there is grounds to propose that it is the curative relationship itself which determines the effectivity of intercession, instead than the theoretical account used, nevertheless it is clear that the ‘means to an terminal ‘ are rather different in these illustrations. First, in the transference theoretical account there is an accent on the analytical power of the procedure, instead than any impression of sensed ‘cure ‘ . If performed right, exposure of the transferences and their implicit in causes lead to analysis and redress. However, when one considers the methods utilised in the reparative theoretical account it would look that the intent of intercession is to arouse alteration straight. Therefore, it can be said, that the reparative theoretical account, instead than moving as an analytical tool per Se, acts as a pivot for alteration by turn toing the inadequacies/deficiencies in the patient ‘s yesteryear. Interestingly, this raises another differentiation, where it is suggested that the transference relationship is ‘past-focused ‘ and the developmentally needed relationship ‘future-focused ‘[ 15 ]. Clearly, this is an over-simplification, but basically when a patient undergoes reparation there is an accent on future alteration which compensates for past happenings.

Despite these differences, there are distinguishable characteristics present in both theoretical accounts. For illustration, the nature of transference is a nucleus constituent of the reparative theoretical account as there is a re-living of the yesteryear in the present. In the reparative theoretical account the repeat of the yesteryear is altered in such a manner so that traumatic incidents are non invariably revisited, instead by modifying an facet of the yesteryear ( i.e. the healer following a parental function ) the experience acts as a platform for mending. However, it can be argued that the reparative attack represents nil but an idealized version of the transference relationship, hence a deficiency of acknowledgment of the theoretical account in some of import psychotherapeutics plants[ 16 ]. Therefore the grade of similarity can transform the reparative attack into an extension of transference. Contemporary idea still maintains a differentiation between the theoretical accounts nevertheless, based on the pronounced differences as discussed antecedently.

Decision

In drumhead, the curative relationship is a critical portion of the curative procedure. A figure of different attacks are available to the healer, which facilitate contrasting interactions with the patient, unique to their issues. In transference/countertransference the client imposes facets of their childhood onto the curative relationship, coercing the healer to accommodate their responses in order to dispute this behavior. Once the behavior has been identified so farther analysis will enable declaration. This contrasts to the reparative relationship theoretical account, in which the healer seeks to rectify parental insufficiencies or overprotectiveness by changing their responses consequently. The client will project certain behaviors and feelings onto the curative relationship and the healer must steer this arrested development, in order to ease future behavioral alteration. In malice of these differences, it is clear that whichever theoretical account is utilized, provided it is done efficaciously, the results should non differ greatly. The increased duty and attempt on behalf of the healer in the reparative theoretical account, may nevertheless restrict its usage in pattern.