Introduction: Clarkson’s seminal contribution

I sometimes get asked why I put such emphasis in my teaching on relational modalities - an idea first formulated in a paper by Petruska Clarkson in 1990. Because it is such a well-known model, that has formed the basic framework for integrative counselling and therapy training courses all over the world, it is often assumed that it is by now well-understood and ‘old hat’. However, based upon what I can gather from CPD teaching and supervision, I'm not left with the impression that it is indeed well-understood, nor often used in a way which is actually as clinically helpful as Petruska intended it to be.

Clarkson’s model and formulation was seminal and revolutionary in the early 1990s - it was one early and major manifestation of the shift towards a relational perspective, which has since been one of the significant influences across the field. During the 1990s Clarkson’s model spread across a wide variety of integrative counselling and therapy training courses, especially in the UK (with the Metanoia Institute being the organisational origin), but also internationally. [1]

Reviewing Clarkson’s model and developing it further

Considering that Clarkson’s model is 25 years old, we are now in a position to review it and update it as well as developing it further. Having worked with this model since its beginnings, and combined it with embodied and other relational perspectives (especially relational psychoanalysis), I have found certain gaps, deficiencies and flaws in the model itself, but especially in how the model is being used in practice, teaching and supervision, including internal supervision.

For the last 15 years I have been suggesting certain extensions and re-formulations of the model, to help update it and keep it current, but most importantly: to make it workable in a practical and experience-near fashion, so that is helpful in my moment-to-moment internal process as a therapist.

For the last 10 years I’ve been calling these adaptations to the traditional Clarkson formulation my ‘Diamond Model’ [2], which currently forms the foundation for my teaching on relational modalities.

Synthesising ideas on relational stances from Lavinia Gomez, Martha Stark & Petruska Clarkson

Some of the issues with Clarkson's model can be explicated by comparing and contrasting it with other well-known ideas on different kinds of therapeutic relatedness: I'm drawing especially on a significant paper by Lavinia Gomez (2004) that challenges the integrative project and proposes a distinction between ‘opposite’ and ‘alongside’ relational positions.

But the most well-known formulation, complementary to Clarkson, comes from the US (which may be one of the reasons why some kind of cross-fertilisation between these models hasn't thoroughly occurred yet): Martha Stark’s (1999) description of a historical arc from classical ‘one-person psychology’ to modern relational ‘two-person psychology’.

These three formulations - Gomez, Stark & Clarkson - overlap and nicely complement each other - by combining them, we can compensate for the limitations of each of these models just by itself. In what follows, I am building towards a synthesis of all of them, which then constitutes the foundation on which I can later present the ‘Diamond Model’.

Relational modalities as a precondition for surviving enactments

At the growing edge of psychotherapy as a discipline at the present time, the key point of distinguishing different relational modalities is that they are, in my view, the foundation and a precondition for recognising and surviving enactments. The different habitual stances we inherit down the generations of therapeutic sub-cultures and approaches effectively blind us to certain enactments, and we need the reference points of the other modalities to help us become aware of these enactments as such, i.e. as repetitions of negative scenarios in the client's experience which undermine our therapeutic alliance with them. So our moment-to-moment awareness of the diversity of relational modalities help us not so much in understanding enactment as a concept in principle, but in actually becoming aware of it when entangled within it, and in being relationally flexible in responding from within it in order to survive it transformatively. This, of course, was not the point 25 years ago when Petruska Clarkson put relational modalities on the map - at the time it was only about psychotherapy integration, and it is, of course, an essential tool for that.
As an illustration of how across the different approaches therapists are struggling with the idea of relationality (and enactment as a key ingredient within it), I was invited to give a response to a paper by the TA therapist Ray Little (Soth 2013 "We are all relational, but are some more relational than others?").

Relational modalities as a foundation for psychotherapy integration

Because the integrative movement has been incredibly successful, especially in the UK, there is less need these days to support psychotherapy integration and justify why it is a good idea in the first place. One of the downsides of its success has been that the notion ‘integrative’ has become diluted: in common usage it is now frequently indistinguishable from ‘eclectic’ - a danger which the early champions of psychotherapy integration were all too aware of [3]. So for the purposes of evolving an integrative perspective beyond its currently dominant eclectic manifestations, towards the possibility eventually of some kind of more coherent pluralistic profession, relational modalities are still an essential concept within the further evolution of psychotherapy integration.

The integrative project: robust flexible (integrative) diversity or headless (eclectic) chicken?

However, my main reason for emphasising relational modalities in my teaching is no longer the integrative project itself. An astonishing majority of therapists now do call themselves 'integrative', and as a result we have moved on to new issues and new struggles. Many integrative therapists are knowledgeable and skillful in drawing from a variety of therapeutic traditions in terms of theories and techniques, but are struggling with issues of containment in the working alliance - issues which were first pointed out as one of the dangers of integrative practice by Lavinia Gomez in 2004. These issues are to do with the therapist - often inadvertently - switching relational stance as a by-product of switching into a different theory or technique. It's that switch in the therapist's relational stance which usually constitutes an unwitting enactment and can have detrimental effects on the working alliance.
The notion of enactment, as we discovered painfully throughout the 1990's and as it has come to be understood in relational psychoanalysis, implies by definition that the unconscious processes constituting enactments are not available in the therapist's awareness and therapeutic reflections - as dissociated dynamics, they manifest through largely non-verbally communicated attitudes and relational positions, on the level of implicit relational knowing. The therapist's rationale and the explicit content of the therapeutic interaction, on the level of the ego-ego alliance between client and therapist, becomes the unwitting vehicle of enactment: enactments occur in spite of the therapist's intention and reflection via theory or technique.
So whilst the therapist is consciously aware of having a very valid therapeutic rationale for switching towards a different therapeutic approach and technique, unconsciously an enactment is taking place on the level of relational position and implicit relational stance. But because the therapist is convinced of their therapeutic intention and rationale, they override their awareness of the intensifying enactment that is escalating in the background.

Challenging the prevalent eclecticism of the integrative project

Lavinia Gomez’s challenge to the integrative project - i.e. that any such switch by the therapist can be experienced by the client as 'breaking the container' (what I would simply call 'a wounding re-enactment') - establishes precisely the significance of the therapist’s underlying and implicit relational stance: Lavinia implies that the therapist's stance is more significant and impactful on the process than their conscious rationale and intention. She offers us a basic distinction into ‘opposite’ and ‘alongside’ relational positions, and associates these with the essence of the psychodynamic and humanistic traditions respectively. These two positions can be readily recognised experientially and observed in practice – during CPD training with integrative groups, therapists find it easy to identify these positions in each other in skills practice or role-play.

The central point of Gomez’s challenge is that ‘opposite’ and ‘alongside’ relational positions cannot just be mixed and matched: “What we are not free to do is encourage a fixation on ourselves [she means inviting the transference] by promoting an ‘opposite’ position, and [then] trying to conduct the therapeutic work through both channels.” She means that once we have allowed the transference to become constellated, we can't just arbitrarily and eclectically switch relational positions from then onwards (well, we can, but it is going to mess up the therapy, or in her language: containment).

It is ultimately an awareness of these relational vicissitudes of therapy which helps us recognise how insufficient - and counter-therapeutic - a fairly pragmatic, utilitarian eclecticism can become. This is because eclectic practitioners, supposedly using whatever 'works' from the various traditions, take their own relational position for granted as self-evident and obvious commonsense, including their associated notions of what actually constitutes ‘therapy working’ in the first place: “I am just intuitively selecting from a variety of techniques and go with whatever seems appropriate.” They thus assume that their own good intention and rationale for a therapeutic response or intervention outweighs and is more important than how the client receives it, consciously and/or unconsciously.

Some of the time that kind of rationale may indeed be appropriate and ‘good enough’ and work very well, but Gomez’s challenge is that when it goes 'wrong', it usually goes wrong spectacularly and disastrously: as this kind of eclectic attitude doesn't take into account the relational implications, let alone attend to unconscious processes and enactments, it tends to gravitate towards a more superficial level of interaction, that takes its cues from the client’s own ideas of being helped and does not take into account the client's internal conflicts (as we will see in more detail below).

In summary: it is attention to relational stances and modalities which is capable of challenging the therapeutic pitfalls of eclecticism as well as helping us transcend these; and Gomez’s distinction of the inherent relational positions underlying the humanistic and psychodynamic traditions is therefore a good starting point.

Beyond an eclectic, pragmatic, commonsense conception of the therapeutic relationship

Gomez’s formulation makes clear that historically both the humanistic - and to a lesser extent - the psychodynamic tradition were conceiving of the therapeutic position in too simplistic terms. Traditional notions of the working alliance framed it as what I call the ‘ego-ego alliance’ only, and were caught in too 'singular' a conception both of the client and the therapist, and therefore the relationship, too (as if both client and therapist could be reduced to their 'singular' ego identity). Even psychoanalysts like Greenson (1967) - when thinking about the working alliance - abandon their conception of the client’s conflicted inner world and unconscious processes, and define it as the supposedly healthy bond between the supposedly rational conscious parts in both client and therapist, that are supposedly capable of co-operating for the sake of creating a helping relationship [4].

Once I have reduced both people to their rational identities, then the working alliance becomes an oversimplified and simplistic idea which is unhelpful in practice. The client is not simply somebody who 'wants help' or 'wants to get better'. The therapist is not just an altruistic ego that wants to 'help' the client.

Due in part to the long-standing polarisation between the humanistic and psychodynamic traditions, their respective conceptualisations - as long as they are deprived of the kernel of validity of the other – thus each end up with a commonsense notion of the therapeutic position which relies too heavily on the public preconception of it as one more helping profession. As long as the general public, and other helping professions, think of the therapist as ‘simply doing their job’, ‘helping’ the client, the therapeutic complexity of actually being a relational other has already been lost or reduced beyond recognition. Whilst we cannot expect the general public to appreciate that complexity of the therapeutic position and its inherent multiple relational stances, for many decades neither have the traditions themselves, in terms of their self-understanding and self-definition.

Gomez’s ‘alongside’ versus ‘opposite’ = reparative versus transferential

Gomez - in order to focus on what therapists actually do, rather than what they think they do or say they do - to some extent bypasses humanistic theory and philosophy, by reducing the humanistic ‘alongside’ stance to an essentially reparative position. Within humanistic terminology itself, we might say that the ‘alongside’ position consists essentially of championing the client’s self-actualising tendency, and many humanistic practitioners would see their task as precisely that. A well-known declaration of this position would, for example, be Alice Miller's (2008) who tries to be an ally to the client’s woundedness as well as their potential for development, focusing especially on the gifted inner child. But this is just one version of a wide variety of ways in which humanistic therapists might frame and justify an ‘alongside’ position.

By placing the psychodynamic ‘opposite’ stance then in opposition to that, Gomez harks back to a long-standing debate within psychoanalysis itself: does therapy work by providing corrective emotional experiences (Alexander 1950), i.e. is the purpose of therapy effectively reparative? Or does it work by the therapist being a transferential relational other, allowing the client’s wounding (their character pattern, script and habitual relational style) to be manifested and repeated in relation to the therapist, so it can be understood, contained, and worked through? In her writing, Gomez does not end up taking sides one way or the other in this psychoanalytic argument. It is, in fact, the inadequacy of this binary opposition which is made explicit by Gomez’s formulation, as clearly both elements are in principle needed - the question is how they can both occur in practice when in theory they appear to be mutually exclusive?

Lavinia does not address or resolve this question. However, the point Lavinia is making is that one cannot just mix and match these positions, i.e. one cannot arbitrarily move between them from moment to moment or session to session in eclectic fashion. In her view, such fickle over-flexibility on the therapist’s part inevitably leads to lack of containment and is therefore counter-therapeutic. She does not quite spell it out like that, but implicitly her reasoning – well-grounded in the psychoanalytic tradition - goes like this: once a negative transference is constellated, to switch away from it into any other position essentially conveys to the client an avoidant message to the effect that the therapist cannot bear the heat of the transferential constellation. Psychoanalysts understand that in order to rationalise an escape away from the intensity of the transference, any kind of therapeutic rationale will do, and are adept at challenging the manouvres therapists resort to in order to minimise, evade and side-step the heat.

What Lavinia does not spell out, either, is her implicit assumption that if any therapist were to switch stance, they would do so unconsciously, i.e. that any switching into another position would not only be perceived by the client’s unconscious as avoidance, but would in fact have to have avoidant functions for the therapist.

In my reply to her at the time (Soth 2004), I was very much agreeing with Gomez’s thinking in principle, but I was questioning whether these assumptions would necessarily have to be the case (i.e. might it be conceivable for the therapist to switch not exactly consciously but with some awareness of the avoidant function of the switch?, or, in enactment terms: recognising that multiple enactments are at stake either way, and that multiple relational stances are present in the field all the time, anyway, the therapist might switch with awareness; ‘working through’ would then become a more complex notion than is assumed in the psychoanalytic tradition where ‘working through’ is seen as depending upon holding to one's position in the transference without wavering).

The missing authentic person-to-person relationship in Gomez’s formulation

Having framed the crux of the ‘alongside’ position as reparative, what is missing from Gomez’s formulation is the essence of many humanistic therapists’ explicit self-understanding: they do see themselves as indeed providing a relational other, just not a transferential one, but an authentic one. In Gestalt, this would be a dialogical other; a similar understanding underpins the existential approaches, drawing on the philosophical history of Buber’s I-Thou and Gadamer’s (1980) conditions for dialogue. The idea that transference-free authentic relating is not only possible, but might provide a fundamental and valid therapeutic stance was anathema to traditional psychoanalysis. However, modern relational psychoanalysis is less categorical on this presumed impossibility.

Extending Gomez’s distinction by Stark’s ‘kinds of therapeutic relatedness’

The more we investigate Gomez’s distinction, the more we recognise that it is a useful broad brush-stroke starting point only and - in and of itself - not fine-grained enough to catch up with the majority of enactments.

The model that helps us push Gomez’s distinction further is Martha Stark’s distinction between ‘one-person’, ‘one-and-a-half-person’ and ‘two-person psychology’. Having been inspired by Stephen Mitchell’s (1988) distinction between the “drive-conflict model, the deficiency-compensation model, and the relational-conflict model”, her formulation from the beginning was always predominantly based upon psychoanalysis, but from a perspective which critiques the ‘one-person’ medical model assumptions of its origins.

The more we think of the client’s inner world as inherently conflicted between different parts (as psychoanalysis has maintained all along, and Mitchell’s model implies, too), the more Gomez’s notions ‘opposite’ and ‘alongside’ break down: the notion of relational stances then becomes a more complex phenomenon, as I may be simultaneously alongside or opposite different parts in the client.

In the most simple classical terms: if the client's ego is defended against an underlying anxiety and impulse, am I opposite or alongside the ego in its repressive project?
Am I alongside the ego, or am I alongside the repressed?
Am I opposite the ego, or am I opposite the repressed?

The client’s conflict becomes the therapist’s conflict

Because the client’s internal conflict is such a crucial and fundamental point when it comes to conceptualising the working alliance, I have tried over the years to present a formulation of that conflict which can resonate with the various therapeutic languages, and can therefore be applied across the approaches. I use the terms ‘habitual mode’ versus ‘emergency’ to describe the client’s internal conflict, and the dilemma it constitutes for the therapist. I will not present this here in detail, as it would take us too far off topic, but for many years I have been using the following hand-out: The Client’s Conflict becomes the Therapist’s Conflict (Soth 1998). An updated version of this hand-out is: The Client’s Conflict across the Window of Tolerance.

As soon as we consequently follow through depth-psychological assumptions about the conflictedness of the client’s inner world, we recognise how complex and paradoxical the therapeutic relational space inherently is and needs to be.

As I hinted above, it is astonishing for how many years psychotherapy has been thinking about the working alliance in singular, simplistic terms which fly in the face of some of its most well-established recognitions: on the one hand psychoanalysts maintained that nothing is outside the transference, on the other hand they conceptualised the working alliance as precisely that; on the one hand we see the client's character conflict as manifesting in each and every department of their life; on the other hand we are positioning ourselves as if coming to therapy and supposedly being helped by a therapist is a simple and straightforward conflict-free procedure.

I am generalising and exaggerating somewhat to make the point, but I'm doing this because this kind of doublethink is still pervasive throughout the field to this day. And it is this kind of doublethink that is a manifestation of unwitting switches in a therapist’s relational stance, leading to confusions and double messages which fuel uncontainable enactments, specifically through therapists inhabiting and communicating simultaneously two contradictory relational positions, without being aware of it. This then makes it impossible for the therapist to notice how their own relational stances are contributing to and feeding enactments.

It would be conceptually clearer to distinguish two relational spaces: one in which the transference/countertransference dynamic is dominant and figural; and one - clearly defined by Clarkson, as we will see later - as transference-free person-to-person relating. Even if in lived reality and in practice these two relational spaces never appear as clearly distinct (as they are in constant dialectic tension with each other), to conceptualise them as discrete allows us to then monitor their occurrence moment-to-moment in a way which makes their conflictedness clinically useful.

The missing authentic person-to-person relationship in Stark’s formulation

Stark, charting the development of relational stances within the psychoanalytic tradition from which she predominantly writes, is not concerned with the similarities and differences with the humanistic tradition. She therefore doesn't emphasise enough that the development of ‘two-person psychology’ had significant roots in humanistic perspectives which long pre-dated the development of intersubjectivity and relationality in modern psychoanalysis.

Stark’s definition of ‘two-person psychology’ does use terms like ‘authentic’, building on ideas of mutuality and Benjamin’s ‘mutual recognition’. However, much of Stark’s actual description of ‘two-person psychology’ stops a long way short of existential or Gestalt notions of dialogue, because she mostly formulates the engagement of the therapist’s authentic self as relevant in terms of the countertransference. So there are significant confusions entailed in squaring Stark's formulation with humanistic terms which she does not explicitly refer to, or mis-represents, or gives new meanings to. Clarkson's distinctions are clearer and more embracing across the humanistic-psychodynamic divide.

The ‘one person-psychology’ medical model as one valid relational modality

However, what we do get from Stark, as a significant addition to Gomez’s distinction, is the role of ‘medical model’ ‘one-person psychology’ in therapy.

Both Gomez - and as we will see later, Petruska Clarkson - excluded the medical model a priori, because they see it for various good reasons as extraneous to the paradigms of psychotherapy. However, with Freud taking it for granted that he was dispensing treatment and having no doubt that he was operating as a doctor, Stark’s formulation makes it explicit that the ‘medical model’ needs to be included as one possible and valid option, albeit challenged and superseded in its erstwhile dominance, in a comprehensive spectrum of therapeutic stances.

Although Stark gives somewhat mixed messages about the validity of ‘one-person psychology’ within a postmodern perspective, she does accord it some validity, rather than excluding it to begin with. To recognise and appreciate the relational aspects of a medical model stance, we want to imagine a traditional family doctor, working holistically within long-standing systemic attachments.

Complementing Gomez and Stark with Petruska Clarkson’s model

Apart from some other misgivings I have about Stark’s formulation which I do not need to detail here (but have spelled out in my commentary to her introductory chapter - Soth 2015), we can see that neither Stark’s nor Gomez’s models are sufficiently differentiated, even if we combine them, to do justice to the multiplicity of relational modalities we actually find in existence across the field. This is why we need to combine both of these models with the diversity of modalities as in Clarkson’s formulation, to give us a more comprehensive phenomenology.

Over recent years, with the relational movement rippling through all the traditional approaches, the idea of relationality has been claimed by just about everybody who values the therapeutic relationship. It has been appropriated and integrated by all kinds of therapeutic orientations, each mostly defining relationality as what they have been doing all along. This flies in the face precisely of what Petruska Clarkson was trying to establish: a differentiated overview that equally validates all relational modalities without fudging them or collapsing them into each other.

So we could ask: does being a therapeutic relational other mean …

1. providing professional collaborative help through clearly negotiated role responsibilities (i.e. a position that monitors the alliance and its effectiveness, e.g. feedback-informed treatment)
2. being therapeutically reparative, i.e. providing corrective emotional experiences
3. being a transferential other who allows themselves to be constructed and used as an object (in Winnicott's terms), including being experienced as a 'bad' object, thus allowing 'working through'
4. being a dialogical, existential other – offering an authentic I-You encounter
5. providing expert treatment in a benign, friendly (and probably collaborative) fashion like a family doctor would

If we add Clarkson’s transpersonal modality, this gives us six distinct relational spaces, based on six distinct therapeutic stances. At this point, this looks very much like Clarkson's original formulation, with the addition of the ‘medical model’. However, based on some of the above and including especially Gomez’ challenge to the integrative project, we are now in a very good position to take Clarkson's model beyond the way it has largely been taught, into a foundation for thinking about the complexity of the relational space between client and therapist, especially in terms of enactments and how they threaten the working alliance.

Interim conclusion: a comprehensive phenomenology of relational modalities

In terms of establishing the principle that several distinct relational modalities do in fact exist across the field of the psychological therapies, Clarkson's original impulse still seems to me as valid as ever. None of the other formulations come near the degree of differentiation that she proposes. I have indicated that Clarkson's a priory exclusion of the medical relationship has serious disadvantages, so, following Stark, I would (re-)include the ‘one-person psychology’ medical model as one valid modality in a comprehensive spectrum.

On the other hand, as neither Gomez nor Stark fully differentiate the authentic person-to-person relationship (although some of Stark’s ‘two-person psychology’ language seems to be nudging in that direction), I would stick with Clarkson's categories in this respect.

All three writers agree on the significance of the transference / countertransference modality, and all three are committed to some idea of integrating the different categories they distinguish, but it is only Gomez who posits limitations to that integration. This is a crucial challenge for the whole integrative movement, which hasn't really been taken up, let alone answered. As I described above, it is a challenge that is appears in the debate between what Clarkson calls the ‘reparative/developmentally needed’ versus ‘transference/countertransference’ modality. However, the underlying and fundamental tension inherent in the therapeutic position is better formulated as the dialectical polarity between: allowing myself to be constructed and used as an object VERSUS mutual recognition - dialogical relating - authentic I-Thou encounter (The essential relational conflict inherent in the therapeutic position). I would prefer to re-translate Gomez’s ‘alongside’ and ‘opposite’ positions in these terms, but maintain the point of the challenge.

Whilst recognising that Gomez’s association of the ‘alongside’ position with the humanistic and the ‘opposite’ position with the psychodynamic is historically valid (and because it lingers as a polarisation within the field, is therefore still experientially useful to explore and reflect upon, until some more solid integration between humanistic and psychodynamic principles is established), I hope I have also begun to show how her distinction is limiting and can be transcended.

As I suggested earlier, these three formulations by Gomez, Stark and Clarkson overlap and nicely complement each other [5] - by combining them, we can compensate for the limitations of each of these models just by itself. Building on the synthesis between them gives us a good foundation for presenting my ‘Diamond Model’, which is intended to draw on the most precious aspects of each, whilst going further towards the formulation that addresses the crucial paradox at the heart of therapy: how to be fully involved in the relationship and make ourselves available to enactments whilst maximising the chances that these will become transformative, and thus allow increasing possibilities for authentic meeting.

References:

Alexander, F. (1950) Analysis of the therapeutic factors in psychoanalytic treatment. The Psychoanalytic Quarterly, Vol 19, 1950, 482-500.

Benjamin, J. (2007) Intersubjectivity, Thirdness, and Mutual Recognition; accessed online 15/11/2015: http://icpla.edu/wp-content/uploads/2013/03/Benjamin-J.-2007-ICP-Presentation-Thirdness-present-send.pdf

Clarkson, P. (1990) A Multiplicity of Therapeutic Relationships. In: British Journal of Psychotherapy: Volume 7, Issue 2, pages 148–163

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

Gadamer, H.G. (1980) Dialogue and Dialectic: Eight Hermeneutical Studies on Plato. Trans. and ed. by P. Christopher Smith. New Haven, CT: Yale University Press, 1980.

Gomez, L. (2004) Humanistic or psychodynamic - what is the difference and do we have to make a choice? In: Self & Society Vol. 31 No.6 Feb/Mar 2004

Greenson, R. R. (1967) The Technique and Practice of Psychoanalysis. New York: International Universities Press.

Miller, A. (2008) The Drama of the Gifted Child: The Search for the True Self. Basic Books (3 Rev Upd edition)

Mitchell, S. (1988) Relational Concepts in Psychoanalysis. Harvard University Press.

Stark, M. (1999) Modes of Therapeutic Action. Jason Aronson.

Soth, M. (1998) The Client’s Conflict becomes the Therapist’s Conflict; accessed online 15/11/2015: http://www.integra-cpd.co.uk/cpd-resources/the-clients-conflict-becomes-the-therapists-conflict-1998/

Soth, M. (2004) Integrating humanistic techniques into a transference-countertransference perspective - A Response to ‘Humanistic or psychodynamic - what is the difference and do we have to make a choice ?’ by Lavinia Gomez. In: Self & Society, 32(1), Apr./May 2004, p. 44 - 52

Soth, M. (2013) ‘We are all relational, but are some more relational than others?’ - completing the paradigm shift towards relationality. In: Transactional Analysis Journal April 2013 vol. 43 no. 2 p. 122-137

Soth, M. (2015) Commentary and critique of introductory chapter of Martha Stark’s 1999 “Modes of Therapeutic Action”; accessed online 15/11/2015: http://www.integra-cpd.co.uk/commentary-and-critique-of-introductory-chapter-of-martha-starks-1999-modes-of-therapeutic-action/

To follow:

Part 2: The ‘Diamond Model’: relational modalities as a force field around the central paradox of working alliance versus enactment

Footnotes:

[1] in fact, it spread so widely that Petruska found it necessary to publish an open letter in 2002, reminding people to attribute the model to her because she felt that her authorship was being forgotten

[2] As some people who worked closely with Petruska have pointed out, some of the proposals I offer were already part and parcel of what she taught at the time (which is quite different from how the model was understood, used, applied and taught by many others).

[3] “It may need to be recognised in psychotherapy trainings that experience and supervision are required to distinguish between the different forms of psychotherapeutic relationship and in assessing and evaluating the usefulness of each at different stages of psychotherapy. Equally, different modes may be indicated for individuals with characteristic ways of relating so that there is not a slipshod vacillation due to error or collusive countertransference. Confusion and lack of clarity abound when types of psychotherapeutic relationship are confused with each other or if one is used as if substituting for the other. It is possible that all of these forms of relating are needed some of the time, or for some patients, and that psychotherapists with flexibility and range can become skilful in the appropriate choices.” Clarkson

[4] “the relatively non-neurotic, rational, and realistic attitudes of the patient toward 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)

[5] a summary hand-out, including references, can be found here: http://www.integra-cpd.co.uk/cpd-resource/the-therapists-relational-stance-200320102015/
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