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?
This blog is dedicated to exploring this questions with you, which I take to be central in the continuing development of therapists, both individually and collectively as a profession. You are welcome to join in the enquiry around this topic by commenting below.
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, these professions are welcome 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.
“An approximate answer to the right question is worth a great deal more than a precise answer to the wrong question.” John Tukey