Showing papers in "Psychotherapy in 1979"

The generalizability of the psychoanalytic concept of the working alliance.

Abstract: The psychoanalytic concept of the working alliance is reviewed and elaborated. It is argued that various modes of psychotherapy can be meaningfully differentiated in terms of the kinds of working alliances embedded in them. Moreover, the strength, rather than the kind of working alliance, will prove to be the major factor in change achieved through psychotherapy. Strength of alliance will be a function of the goodness of fit of the respective personalities of patient and therapist to the demands of the working alliance. Past research bearing on these propositions and indicated future research are discussed. Extensions to changes sought in teaching and other group processes are briefly touched. Proliferation of psychotherapies has dominated the sixties and seventies. Thirty-six psychotherapies (Harper, 1959) had to be supplemented by an additional compilation (Harper, 1975). Unchecked, this trend would come perilously close to the solipsism, a psychotherapeutic method for each psychotherapist. Not unexpectedly, research in psychotherapy has suffered from an analogous lack of convergence, and with it a disappointing impotence about providing empirical tests of competing claims. As Donald Campbell (1976) suggests, given the wide prevalence of the need for psychotherapy, and the continuing ability of individuals or society to pay for it, the winnowing of this harvest of methods must come from research. Campbell (1976) speaks to the practitioner, exhorting him or her to engage in systematic follow-up. This essay addresses those prac1 An earlier version of this paper was given at the annual meeting of the Society for Psychotherapy, June, 1975. * Requests for reprints should be sent to Edward S. Bordin, Ph.D., University of Michigan Counseling Center, 1007 East Huron Street, Ann Arbor, Michigan 48109. titioners who are also research workers, to call attention to a point of view that can encompass most, if not all, approaches to psychotherapy and can lead toward the needed convergence in research. There has been a promising rate of growth of research and research workers, with encouraging trends toward a coming together on basic issues: I aim to contribute to that movement. Moreover, because of the generalizability of my ideas to all change situations, I hope to stimulate research applications to teaching and to community change processes. 1 propose that the working alliance between the person who seeks change and the one who offers to be a change agent is one of the keys, if not the key, to the change process. The working alliance can be defined and elaborated in terms which make it universally applicable, and can be shown to be valuable for integrating knowledge—particularly for pointing to new research directions. As my initial statement suggests, a working alliance between a person seeking change and a change agent can occur in many places besides the locale of psychotherapy. The concept of the working alliance would seem to be applicable in the relation between student and teacher, between community action group and leader, and, with only slight extension, between child and parent. While I believe such extensions to be fruitful, they are beyond the scope of this paper. I shall confine myself to the therapeutic working alliance, making only brief inferences to extensions to other change enterprises.2 2 One might extend the idea of working alliances to nonchange situations. Although prisons, under reform ideology, have been set up as change situations, most observation suggests that staff and inmates typically arrive at a mutually agreed-upon alliance to get through their relationship with as little upset as possible.

Gratification: A pivotal point in psychotherapy.

Abstract: This theoretical peEer is\based on the premise that, nearly, all people who enter therapy dO so, to varying iegrees, with the wish (consclous or unconscious demand). to hAie dependent longing end affectionalneeds gratified in the therapy itself. The conditions. underand the extent to which, the therapist proVides direct. ( gratifiation are crucial determinarts ofthe cutcomeof therapy. ' While certain amounts and forms 'of direct gratification are helpful and often necessary, too, -much and/or certain.kindsof gratification may be d.estructive. The paper presents five rules-of-thumb tohelp guide therapist decisions about whet to gratify what demands. An. . effort f,,p made. to tcnnect the ruls'to clinical theory and recent ,research.,,The. rule-of-thumb foc1;is cn: 1(a) differentiating petween paients, wants and needs; (b). a prcper therapeutic stance Vis-a-vis 'direct -gratification; (c) the use of, direct gratification in the early stage of therapy; (d) patient characteristiqs severit of disturbance and infantilism of ' demand ) tmodrating the,, appropriateness of, direct gratiIicatio 'throughout the therapy. (Author)