Stages of a therapeutic relationship

Phases of The Therapeutic Relationship | Nursing Best Practice Guidelines

stages of a therapeutic relationship

Start studying PHASES OF THERAPEUTIC RELATIONSHIP DEVELOPMENT. Learn vocabulary, terms, and more with flashcards, games, and other study tools. PHASES OF THERAPEUTIC NURSE PATIENT RELATIONSHIP; Peplau's Interpersonal Theory (). Preinteraction/ Preorientation. The therapeutic relationship between the patient and the nurse. Chapter .. Peplau identified five phases of the nurse–patient relationship: orientation, iden-.

Remember therapy has to be more introspective and active among client and therapist in this phase and not didactic. With this understanding we are starting to prepare for the final stage of therapy, the termination phase. Termination Phase of the Therapeutic Process As with any healthy relationship saying goodbye can be a very hard thing to do.

The Phases of Therapy

During the termination phase we will help the client understand this process. We will help the client understand how this closure process is important as it relates to many important stages of life and transitions through the processes.

The termination phase is you will be formulating an after care plan to help client with maintenance. This will include assisting clients to build support networks in order to identify alternative resources and areas for support in the event future issues should occur. Termination also represents the closure of the professional relationship between client and therapist. For some patients longer term therapy may be necessary, and in some instances the therapist may need to make a referral to another source if appropriate.

As therapist we have to use our professional judgment to determine if ongoing therapy is necessary or if some of the issues have fallen outside of our area of expertise.

Phases of The Therapeutic Relationship

Also, we must accept that although we want to help, therapy may not work for everyone, therefore it is helpful to be familiar with additional community resources that could be helpful for the patient. So as you can see there are many steps throughout the process of therapy.

All stages are essential to the successful completion through the therapeutic process. As therapist we must be skilled in facilitating smooth transitions from phase to phase as we complete therapy. The author of this blog may be compensated to provide opinion on products, services, websites and various other topics. The results of these studies have led researchers to consider the existence of two important phases in the alliance.

The first phase coincides with the initial development of the alliance during the first five sessions of short-term therapy and peaks during the third session.

During the first phase, adequate levels of collaboration and confidence are fostered, patient and therapist agree upon their goals, and the patient develops a certain degree of confidence in the procedures that constitute the framework of the therapy.

The deterioration in the relationship must be repaired if the therapy is to be successful. This model implies that the alliance can be damaged at various times during the course of therapy and for different reasons.

The effect on therapy differs, depending on when the difficulty arises. In this case, the patient may prematurely terminate the therapy contract. According to Safran and Segalmany therapies are characterized by at least one or more ruptures in the alliance during the course of treatment. Randeau and Wampold analyses the verbal exchanges between therapist and patient pairs in high and low-level alliance situations and find that, in high-level alliance situations, patients responded to the therapist with sentences that reflected a high level of involvement, while in low-level alliance situations, patients adopted avoidance strategies.

Although some studies are based on a very limited number of cases, the results appear consistent: While recent theorists have stressed on the dynamic nature of the therapeutic alliance over time, most researchers have used static measures of alliance. There are currently several therapy models that consider the temporal dimension of the alliance, and these can be divided into two groups: Few studies have analyzed alliance at different stages in the treatment process.

stages of a therapeutic relationship

According to the results proposed by Traceythe more successful the outcome, the more curvilinear the pattern of client and therapist session satisfaction high—low—high over the course of treatment. When the outcome was worse, the curvilinear pattern was weaker. Kivlighan and Shaughnessy use the hierarchical linear modeling method an analysis technique for studying the process of change in studies where measurements are repeated to analyses the development of the alliance in a large number of cases.

According to their findings, some dyads presented the high—low—high pattern, others the opposite, and a third set of dyads had no specific pattern, although there appeared to be a generalized fluctuation in the alliance during the course of treatment. In recent years, researchers have analyzed fluctuations in the alliance, in the quest to define patterns of therapeutic alliance development.

Kivlighan and Shaughnessy distinguish three patterns of therapeutic alliance development: They based their analysis on the first four sessions of short-term therapy and focused their attention on the third pattern, in that this appeared to be correlated with the best therapeutic outcomes.

In further studies of this development pattern, Stiles et al. Unlike Kivlighan and Shaughnessy, these authors considered therapies consisting of 8 and 16 sessions, using the ARM to rate the therapeutic bond, partnership, and confidence, disclosure, and patient initiative.

No significant correlation was observed between any of the four patterns and the therapeutic outcome. However, the authors observed a cycle of therapeutic alliance rupture—repair events in all cases: On the basis of this characteristic, the authors hypothesize that the V-shaped alliance patterns may be correlated with positive outcomes. In particular, Stiles et al. The results of the study by De Roten et al. According to De Roten et al.

  • The termination phase: Therapists' perspective on the therapeutic relationship and outcome.
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De Roten et al. According to Castonguay et al. This has supported the idea that therapeutic alliance may be characterized by a variable pattern over the course of treatment, and led to the establishment of a number of research projects to study this phenomenon. Discussion and Conclusion According to their meta-analysis based on the results of 24 studies, Horvath and Symonds demonstrate the existence of a moderate but reliable association between good therapeutic alliance and positive therapeutic outcome.

More recent meta-analyses of studies examining the linkage between alliance and outcomes in both adult and youth psychotherapy Martin et al.

stages of a therapeutic relationship

Thus, it is not by chance that in their meta-analysis, Horvath and Luborsky conclude that two main aspects of the alliance were measured by several scales regardless of the theoretical frameworks and the therapeutic models: This accounts for the difficulties associated with the concept of alliance, which is built interactively, and so any assessment must also consider the mutual influence of the participants.

In a helpful contribution, Hentschel points out that the problematic aspect of empirical studies investigating the alliance is their tendency to view the alliance construct as a treatment strategy and a predictor of therapeutic outcome: The use of neutral observers or the creation of counterintuitive studies is therefore recommended.

From this historical excursus, it is clear that research into the assessment of the psychotherapeutic process is alive and well.

The development of a dynamic vision of the concept of therapeutic alliance is also apparent. The work of theorists and researchers has contributed toward enriching the definition of therapeutic alliance, first formulated in Research aimed at analyzing the components that make up the alliance continues to flourish and develop.

Numerous rating scales have been designed to analyses and measure the therapeutic alliance, scales that have enabled us to gain a better understanding of the various aspects of the alliance and observe it from different perspectives: Attention has recently turned toward the role of the therapeutic alliance in the various phases of therapy and the relationship between alliance and outcome. So far, few studies have regarded long-term psychotherapy involving many counseling sessions.

This topic, along with a more detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects. Equally important, in our opinion, will be the findings of studies regarding drop-out and therapeutic alliance ruptures, which must necessarily consider the differences between that perceived by the patient and that perceived by the therapist.

Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments The authors thank Mauro Adenzato for his valuable comments and suggestions to an earlier version of this article. A Research Handbook, eds Greenberg L.

stages of a therapeutic relationship

Guilford Press;— Bibring E. On the theory of the results of psychoanalysis. The generalizability of the psychoanalytic concept of the working alliance. Clinical Applications of Attachment Theory. Routledge and Kegan Paul Budman S. Cohesion, alliance and outcome in group psychotherapy.

stages of a therapeutic relationship

Psychiatry 52, — [ PubMed ] Burlingame G. Cohesion in group therapy. But this is how it moves, thrives, and persists. I hope this guide will help you understand how the therapeutic process works. We live in a world of quick fixes, of check lists and goals. Psychotherapy and the healing of old and new wounds and traumas is not a linear process.

But if you are committed to your healing and stick with it you will see progress over time, there will be great healing, and your capacity and resilience will increase. The plateaus are just as important as the big healing moments, because the bodymind knows when it needs to rest, and often there is deep work happening in the deeper parts of the self that our conscious mind is not able to track.

There is no way to estimate at the outset how long any of the stages will take, and sometimes the process may even move to a previous stage before going ahead again. Human beings are complex. Most of us have been through a lot. We need to allow for that complexity and give ourselves the time it takes to heal. There is no doubt that therapy works, if we stick with it, and are patient with ourselves and open to new ways of understanding.

Introduction and Assessment The therapist and client get to know one another. The foundation for trust is laid. If a diagnosis is being made it often happens during this stage, though it can change later as deeper understanding is build. Please give yourself plenty of time for this initial stage.