Online Collective Enquiry: Overestimating the Working Alliance?

Investigating our shared ‘implicit relational knowing’ about the working alliance by considering the question:

Do therapists tend to over-estimate the working alliance they have with their clients?

Take part in our online enquiry and join us in a shared experimental learning process.

Over the next few months I will be using Twitter, Facebook and LinkedIn to enquire into these questions with you. You are welcome to join in the enquiry around this topic which I take to be central in the continuing development of therapists, both individually and collectively as a profession.

In facilitating and contributing to the enquiry, I will take a broad-spectrum integrative stance which recognises the historical gifts and shadow aspects of the diverse therapeutic approaches.
One of the foundations of this enquiry will be a recognition of the multiple relational modalities of the therapeutic relationship (or kinds of therapeutic relatedness - I will provide references and starting points for discussion from the relevant literature - Petruska Clarkson, Martha Stark, etc).
As the working alliance is relevant in all kinds of helping professions as well as counselling and psychotherapy, the group will be open to these professions as well.

Our inherited understanding and definition of the working alliance is pretty vague.

Clarkson (1994 p. 34) quotes Safran: “Precisely how, why, when and what this working alliance may encompass in a particular approach may "vary as a function of a complex, interdependent and fluctuating matrix of therapist, patient and approach specific features” (Safran 1993, p. 35).”

As a starting point for the enquiry I would like to offer the following propositions regarding the working alliance:

  • Considering the central importance which the working alliance has in our work, it is arguably one of the least understood and most mis-conceptualised aspects of therapy – its theoretical formulation across the approaches is incoherent and contradictory.
  • As such, it offers great opportunities for profound learning and an ideal entry point for enquiry. Because it is surrounded by misleading traditional assumptions and loaded with out-dated inherited paradigms, an investigation of its reality in everyday practice promises deep insight into what we do (both what we are doing and what we are trying to do).
  • Although the working alliance is not well understood or defined, it is considered one of the – if not the – main factor in the success of therapy (apparently, there is a direct correlation between the alliance and therapy outcomes).
  • If the working alliance is generally accepted as the lynch pin of whether therapy works for the client or not, then investigating it may help us understand more deeply how therapy actually works - and how it doesn’t.
  • I think that such enquiry works best if it is ...
    • a) phenomenological (in simple terms: sticking close to what we experience rather than what we think about it or assume) and if it is ...
    • b) a collective effort (averaging out our individual idiosyncrasies and foibles, hopefully helping us access some general principles of the profession).
  • Considering that the working alliance is an intersubjective notion, comprising two people’s experience together, on what basis can I as a therapist say anything about it? How do I perceive and apprehend the working alliance?
  • In the first instance, I have a sense of the working alliance, an intuition of the atmosphere of the relationship – it’s only later that I bring theoretical reflection to bear on it and evaluate it more precisely and rationally.
  • Because the working alliance is such a complex multi-layered and paradoxical two-person phenomenon, my impression of it must be rooted in pre-reflexive and subliminal perceptions (‘implicit relational knowing’ is the term used by Boston Change Study Group - Lyons-Ruth 1998, or Schore’s ‘right-brain-to-right-brain attunement). In order to think or say anything about it, I must be relying on embodiment: on right-brain overall-pattern detection, non-verbal intersubjective communication and embodied perception. In order to do it justice, I will need to rely on an integration of left-brain and right-brain perceptions and understandings.
  • Having studied the working alliance from an embodied perspective for many years, I have - as many of you know – proposed that the working alliance is inherently paradoxical: in order for it to exist and deepen, it needs to be capable of breaking down and disappearing.
  • Rather than clinging on to the working alliance as a mark of the therapist’s competence, a paradoxical notion suggests that the therapeutic process consists of deepening rupture-and-repair cycles of the working alliance and the phenomenology of what I have called the ‘3 kinds of contact’ as the working alliance continues to oscillate through these deepening cycles.

These are the kinds of ideas and questions which I suggest we investigate over the coming months. This is an experiment – I have no idea whether and how this cyber-process will work for us.

“An approximate answer to the right question is worth a great deal more than a precise answer to the wrong question.” John Tukey

Format of Online Enquiry

I propose to start off the process by collating in fairly condensed form the received wisdom on the working alliance - something like a review of the existing literature as well as practice. I have collected some relevant and significant quotes which I want to share, in order to establish some joint reference points and definitions as a basis for discussion. You are obviously welcome to contribute to this.

Once we’ve laid out the existing diversity of ideas and inherited notions, I suggest we spend some time on a critique of these established perspectives.
Hopefully, this will allow us to generate some exploratory questions for focussed enquiry together which we can then take into actual practice, as orienting pointers for qualitative research.

After that, I suggest we use LinkedIn as a forum for discussion - they have the internet facilities for such a professional discussion already in place, so we might as well use it. Some of you may be more savvy than the rest of us at conducting these kinds of internet discussions, so please feel free to bring your expertise to bear on the format and procedure.

Here are the links you need to join the discussion on LinkedIn:
If you are not already a member, it’s free to join on the basic membership.
If you are already a member (or once you have signed up), you can join the discussion group for the enquiry.

Online Enquiry: Overestimating the Working Alliance?

Investigating our shared ‘implicit relational knowing’ about the working alliance by considering the question:

Do therapists tend to over-estimate the working alliance they have with their clients?

Take part in our online enquiry and join us in a shared experimental learning process.

You are welcome to join in the enquiry around this topic which I take to be central in the continuing development of therapists, both individually and collectively as a profession.

In facilitating and contributing to the enquiry, I will take a broad-spectrum integrative stance which recognises the historical gifts and shadow aspects of the diverse therapeutic approaches.
One of the foundations of this enquiry will be a recognition of the multiple relational modalities of the therapeutic relationship (or kinds of therapeutic relatedness - I will provide references and starting points for discussion from the relevant literature - Petruska Clarkson, Martha Stark, etc).
As the working alliance is relevant in all kinds of helping professions as well as counselling and psychotherapy, the group will be open to these professions as well.

Our inherited understanding and definition of the working alliance is pretty vague.

Clarkson (1994 p. 34) quotes Safran: “Precisely how, why, when and what this working alliance may encompass in a particular approach may "vary as a function of a complex, interdependent and fluctuating matrix of therapist, patient and approach specific features” (Safran 1993, p. 35).”

As a starting point for the enquiry I would like to offer the following propositions regarding the working alliance:

  • Considering the central importance which the working alliance has in our work, it is arguably one of the least understood and most mis-conceptualised aspects of therapy – its theoretical formulation across the approaches is incoherent and contradictory.
  • As such, it offers great opportunities for profound learning and an ideal entry point for enquiry. Because it is surrounded by misleading traditional assumptions and loaded with out-dated inherited paradigms, an investigation of its reality in everyday practice promises deep insight into what we do (both what we are doing and what we are trying to do).
  • Although the working alliance is not well understood or defined, it is considered one of the – if not the – main factor in the success of therapy (apparently, there is a direct correlation between the alliance and therapy outcomes).
  • If the working alliance is generally accepted as the lynch pin of whether therapy works for the client or not, then investigating it may help us understand more deeply how therapy actually works - and how it doesn’t.
  • I think that such enquiry works best if it is ...
    • a) phenomenological (in simple terms: sticking close to what we experience rather than what we think about it or assume) and if it is ...
    • b) a collective effort (averaging out our individual idiosyncrasies and foibles, hopefully helping us access some general principles of the profession).
  • Considering that the working alliance is an intersubjective notion, comprising two people’s experience together, on what basis can I as a therapist say anything about it? How do I perceive and apprehend the working alliance?
  • In the first instance, I have a sense of the working alliance, an intuition of the atmosphere of the relationship – it’s only later that I bring theoretical reflection to bear on it and evaluate it more precisely and rationally.
  • Because the working alliance is such a complex multi-layered and paradoxical two-person phenomenon, my impression of it must be rooted in pre-reflexive and subliminal perceptions (‘implicit relational knowing’ is the term used by Boston Change Study Group - Lyons-Ruth 1998, or Schore’s ‘right-brain-to-right-brain attunement). In order to think or say anything about it, I must be relying on embodiment: on right-brain overall-pattern detection, non-verbal intersubjective communication and embodied perception. In order to do it justice, I will need to rely on an integration of left-brain and right-brain perceptions and understandings.
  • Having studied the working alliance from an embodied perspective for many years, I have - as many of you know – proposed that the working alliance is inherently paradoxical: in order for it to exist and deepen, it needs to be capable of breaking down and disappearing.
  • Rather than clinging on to the working alliance as a mark of the therapist’s competence, a paradoxical notion suggests that the therapeutic process consists of deepening rupture-and-repair cycles of the working alliance and the phenomenology of what I have called the ‘3 kinds of contact’ as the working alliance continues to oscillate through these deepening cycles.

These are the kinds of ideas and questions which I suggest we investigate over the coming months. This is an experiment – I have no idea whether and how this cyber-process will work for us.

“An approximate answer to the right question is worth a great deal more than a precise answer to the wrong question.”
John Tukey

Format of Online Enquiry

I propose to start off the process by collating in fairly condensed form the received wisdom on the working alliance - something like a review of the existing literature as well as practice. I have collected some relevant and significant quotes which I want to share, in order to establish some joint reference points and definitions as a basis for discussion. You are obviously welcome to contribute to this.

Once we’ve laid out the existing diversity of ideas and inherited notions, I suggest we spend some time on a critique of these established perspectives.
Hopefully, this will allow us to generate some exploratory questions for focussed enquiry together which we can then take into actual practice, as orienting pointers for qualitative research.

After that, I suggest we use LinkedIn as a forum for discussion - they have the internet facilities for such a professional discussion already in place, so we might as well use it (if you are not already a member, it’s free to join on the basic membership). If you are already a member (or once you have signed up), you can join the discussion group for the enquiry.

Some of you may be more savvy than the rest of us at conducting these kinds of internet discussions, so please feel free to bring your expertise to bear on the format and procedure.

By | July 1st, 2015|Enquiry into Working Alliance|0 Comments

Defining the working alliance – 1

Clarkson, P. (1995) The Therapeutic Relationship. Whurr

The working alliance is the part of client- psychotherapist relationship that enables the client and therapist to work together even when the patient client experiences some desires to the contrary. (Clarkson 1994 p. 31)

The working alliance or psychotherapeutic alliance is probably first encountered as a concept in psychoanalytic theory (Greenson 1967; Sterba 1934; Zetzel 1956). It is conceptualised as an explicit or implicit contract or agreement between the psychotherapist and the client. (Clarkson 1994 p. 32)

By | September 16th, 2014|Enquiry into Working Alliance|0 Comments

Defining the working alliance – 2

Ralph R Greenson (1967) Technique and Practice of Psychoanalysis

Greenson defined the working alliance as: “the relatively non-and neurotic, rational, and realistic attitudes of the patient towards the analyst … It is this part of the patient-analyst relationship that enables the patient to identify with the analyst’s point of view and to work with the analyst despite the neurotic transference reactions” (Greenson 1967 p.29)

By | September 15th, 2014|Enquiry into Working Alliance|0 Comments

Supershrinks – What’s the secret of their success?

This 2008 paper "Supershrinks - What's the secret of their success?" by Scott Miller, Mark Hubble, and Barry Duncan is one of the inspiration for this enquiry. They claim that therapists DO over-estimate their effectiveness and the working alliance. It's a great read (that does not mean I agree with everything they say, but they do say it clearly, evocatively and entertainingly) - what do YOU think about it?

By | September 14th, 2014|Enquiry into Working Alliance|0 Comments