Negotiating the Therapeutic Alliance

Jeremy D. Safran, PhD, until his death in 2018, was Professor of Psychology at the New School for Social Research, where he served for many years as Director of Clinical Training, and Senior Research Scientist at New York's Beth Israel Medical Center. A renowned psychotherapy researcher, clinician, teacher, and mentor, Dr. Safran was past president of the International Association for Relational Psychoanalysis and Psychotherapy. He was a recipient of honors including the Senior Distinguished Research Career Award from the Society for Psychotherapy Research and the Scholarship and Research Award from Division 39 of the American Psychological Association.J. Christopher Muran, PhD, is Chief Psychologist and Director of the Brief Psychotherapy Research Program at Beth Israel Medical Center, where he maintains a private practice. He is also Associate Professor of Psychiatry at Albert Einstein College of Medicine. He completed a fellowship in cognitive-behavioral therapy at the Clarke Institute of Psychiatry, University of Toronto, as well as analytic training in the New York University Postdoctoral Program. He received the Early Career Award from the Society for Psychotherapy Research, and serves as an advisory editor for Psychotherapy Research. He is the coeditor of The Therapeutic Alliance in Brief Psychotherapy and editor of the forthcoming Self-Relations in the Psychotherapy Process.

While clinical research has demonstrated the efficacy of a variety of psychotherapeutic procedures, what is often overlooked is the critical role played by the 'common factors' of psychotherapy. This important book details procedures for optimizing the therapeutic alliance and maximizing treatment effectiveness. It should be read by all clinicians. --David H. Barlow, PhD, Professor and Director Center for Anxiety and Related Disorders, Boston UniversityThis is a splendid book, expertly written by two exceptionally creative psychotherapy theorists and researchers. Its strength lies in drawing out the implications for practice of the relational perspective, and doing so in both a scholarly and practical way. It is broad and integrative, bringing together psychoanalytic and experiential perspectives as well as Western and Eastern outlooks. The clinical vignettes are excellent, as is the coverage of procedures for teaching and training. All therapists will benefit enormously from learning about this exciting and powerful approach. --Stanley B. Messer, PhD, Professor and Chair, Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers UniversityA remarkable achievement. This masterfully crafted guide to relational psychotherapy is one of only a handful of books that have bridged the chasm between empirical research and improvements in psychotherapeutic technique. It represents one of the few genuine advances in psychotherapeutic technique over the last quarter-century. Focusing on the difficult-to-engage patient, the authors provide a wise, detailed, and comprehensive guide to effective psychotherapy intervention which always remains firmly grounded in theory and research. All therapists, novices and experts, will improve the quality and effectiveness of their work having read this book. --Peter Fonagy PhD, Freud Memorial Professor of Psychoanalysis, University of LondonThis forward-looking book documents significant changes in psychodynamic theory and practice as relational thinking is superseding the classical drive model. The emphasis on therapist training and clinical illustrations is particularly helpful. --Hans H. Strupp, PhD, Distinguished Professor of Psychology, Emeritus, Vanderbilt UniversityThis book is an unparalleled achievement that transcends many of the usual dichotomies in the field. Structured as a treatment manual, the book elaborates detailed interventions and techniques, but it is also personal and experiential, emphasizing procedural knowledge, self-awareness, and reflection-in-action. It is among the few comprehensive texts that truly integrates ongoing empirical research with cutting-edge developments in clinical psychoanalysis, as well as elements of other therapeutic modalities. It outlines broad theoretical and philosophical principles, yet at the same time provides clear-cut intervention strategies, illustrated with lively and meaningful clinical material. On top of all this it is clearly and engagingly written, well organized, and even includes a creative chapter on the largely unexamined area of training issues and supervision. This book will be used both as a classroom text and as a sourcebook for working clinicians, researchers, and theorists. --Lewis Aron, PhD, Director, Postdoctoral Program in Psychotherapy and Psychoanalysis, New York UniversityThis is a brilliant book. Informed by the authors' internationally recognized research program on ruptures in the therapeutic alliance, the book is enlightening in two major ways. First, its focus on ruptures opens a route to understanding the nature and utility of the therapeutic alliance. Second, the authors show how to negotiate ruptures, offering a veritable guide to moving from rupture to healing. Focusing on an important and neglected area of clinical training, this is an invaluable text for beginning and advanced psychotherapy courses. --Lester Luborsky, PhD, Professor of Psychology in Psychiatry, Department of Psychiatry, University of Pennsylvania- The quality of the therapeutic alliance is the most powerful predictor of success in psychotherapy. Given the inevitability of stresses, strains, and breakdowns in that alliance, the identification and repair of these difficulties are among the most important skills for the psychotherapist to acquire....[This book] belongs in the library of every mental health professional who practices or teaches psychotherapy. --American Journal of Psychiatry, 5/24/2003

• Contents1. The Therapeutic Alliance Reconsidered2. Fundamental Assumptions and Principles3. Understanding Alliance Ruptures and Therapeutic Impasses4. Therapeutic Metacommunication: Mindfulness in Action5. Stage-Process Models of Alliance Rupture Resolution6. Brief Relational Therapy7. A Relational Approach to Training and SupervisionAfterwordReferences