In Relational Psychotherapy, Dr. Jeremy D. Safran demonstrates his integrative approach to therapy. Relational psychotherapy explores client relationship patterns, both inside and outside of the therapy room itself. The task of therapy is to work collaboratively to understand what is going on between the therapist and client and to look for the relational meaning in everything that arises in therapy, from responses to interventions to client–therapist interaction.
In this session, Dr. Safran works with a woman in her 30s who separated from her husband but is considering giving her marriage another try. Dr. Safran and the client discuss her marriage and explore past trauma that may continue to affect her current relationships.
Relational psychotherapy reflects a number of different influences including: interpersonal psychoanalysis, object relations theory, self psychology, feminist and postmodern thinking, infant–mother developmental research (including research on attachment theory), developments in emotion theory and research, and both theory and research on therapeutic impasses.
Relational approaches to psychotherapy start with the assumption that therapists inevitably influence the phenomenon they are observing through their own participation in the relational field. Patient and therapist are always influencing one another in both conscious and unconscious ways. This ongoing process of mutual influence results in repetitive relational patterns (also referred to as enactments) that reflect the unique personal histories, conflicts, and ways of relating to the world of both patient and therapist.
While these enactments are likely to have some similarities to repetitive relational patterns that are problematic for patients in their everyday lives, one cannot assume that there will be an exact parallel. These enactments can vary in kind from more subtle patterns that are difficult to become aware of, to more intense enactments that can be associated with therapeutic impasses or stalemates. While enactments and therapeutic impasses can be destructive if they are not addressed, they also afford tremendous opportunities for change, if they are worked through in a constructive fashion.
Working with patients to help them become aware of their contributions (both intrapsychic and interpersonal) to these inevitable enactments helps them to develop the kind of self-reflective skills that will be useful for purposes of becoming aware of and deautomating their unconscious, self-defeating relational patterns. Moreover, to the extent that therapists are able to collaborate with their patients in a process of observing and disembedding from these enactments, patients are able to participate in a new type of relational experience with their therapists that can, over time, modify the type of presymbolic, implicit relational knowing that shapes their everyday interactions.
In treatment there is often an ongoing process of rupture and repair in the relationship between patient and therapist that is similar in some respects to the ongoing process of disruption and repair that developmental researchers observe in mother–infant interactions. The process of acknowledging and working through these ruptures plays a critical role in helping patients to develop an internal representation of self as capable of negotiating the inevitable tensions that emerge in relationships with others, and of others as available and open to working things through. This therapeutic process typically has a conceptual or reflective dimension to it, but it is important to emphasize that much of the learning takes place at a bodily-felt, affective level.
Although the therapeutic relationship is often an explicit focus of exploration in relational psychotherapy, it does not have to be. In fact, interventions from a range of different therapeutic approaches can be compatible with relational psychotherapy: for example, the use of various interventions for exploring and deepening emotional experience, exploring defenses, interpretation, cognitive and affective restructuring, suggesting activities between sessions, or simply providing guidance or reassurance. It is important to remember, however, that all interventions are inseparable from their relational meaning, and that any intervention may be part of an enactment.
The distinguishing features of relational psychotherapy are thus the recognition that every intervention has a relational meaning to both patient and therapist and the emphasis on the therapist's ongoing efforts to attend to and reflect (either verbally or internally) on what is transpiring in the therapeutic relationship in an ongoing fashion, in an effort to make sense of and disembed from enactments as they emerge.
Dr. Safran would like to acknowledge the many friends, colleagues, and mentors who have played leading roles in the development of relational psychoanalysis and psychotherapy. These include: Stephen Mitchell, Neil Altman, Lewis Aron, Anthony Bass, Jessica Benjamin, Margaret Black, Philip Bromberg, Jody Messler Davies, Muriel Dimen, Emmanuel Ghent, Jay Greenberg, Adrienne Harris, Irwin Hoffman, Spyros Orfanos, Stuart Pizer, and Donnel Stern.
Jeremy D. Safran, PhD, is professor of psychology and director of clinical training at the New School for Social Research. He is also senior research scientist at Beth Israel Medical Center. In addition, he is a faculty member at the New York University postdoctoral program in Psychotherapy and Psychoanalysis, and a faculty member at the Stephen A. Mitchell Center for Relational Studies. He is also a member of the board of directors of the International Association for Relational Psychoanalysis and Psychotherapy.
He is on the editorial board of Psychotherapy Research and is an associate editor of the journal Psychoanalytic Dialogues. Dr. Safran has published more than 100 articles and chapters and several books, including Emotion in Psychotherapy, Negotiating the Therapeutic Alliance: A Relational Treatment Guide, The Therapeutic Alliance in Brief Psychotherapy, Interpersonal Process in Cognitive Therapy, and Psychoanalysis and Buddhism: An Unfolding Dialogue. He and his colleagues have conducted research on the topic of therapeutic impasses for the past 2 decades.
Dr. Safran is also known for his work on the topic of emotion in psychotherapy and for his integration of principles from Buddhist psychology into Western psychotherapy.
- Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy. New York: Guilford Press.
- Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness. Psychotherapy, 30, 11–24.
- Safran, J. D. (1999). Faith, will and despair in psychoanalysis. Contemporary Psychoanalysis, 35, 5–23.
- Safran, J. D. (2002). Brief relational psychoanalytic treatment. Psychoanalytic Dialogues, 12, 171–196.
- Safran, J. D. (Ed.). (2003). Psychoanalysis and Buddhism: An unfolding dialogue. Boston: Wisdom Publications.
- Safran, J. D. (2003). The relational turn, the therapeutic alliance and psychotherapy research: Strange bedfellows or postmodern marriage? Contemporary Psychoanalysis, 39, 449–475.
- Safran, J. D. (2006). Before the ass has gone the horse has already arrived. Contemporary Psychoanalysis, 42, 197–212.
- Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford.
- Safran, J. D., Muran, J. C., Wallner Samstag, L., & Stevens, C. (2002). Repairing therapeutic alliance ruptures. In J. C. Norcross (Ed.), A guide to psychotherapy relationships that work: Effective elements of the therapy relationship (pp. 235–244). New York: Oxford.
- Safran, J. D., & Segal, Z. V. (1990/1996). Interpersonal process in cognitive therapy (2nd ed.). New York: Basic Books.
Other Relevant References
- Altman, N. (1995). The analyst in the inner city: Race, class and culture through a psychoanalytic lens. Hillsdale, NJ: Analytic Press.
- Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ: Analytic Press.
- Benjamin, J. (1988). The bonds of love. New York: Pantheon Books.
- Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: Analytic Press.
- Davies, J. M., & Frawley, M. G. (1994). Treating the adult survivor of sexual abuse. New York: Basic Books.
- Dimen, M. (2003). Sexuality, intimacy, and power. Hillsdale, NJ: Analytic Press.
- Ehrenberg, D. (1992). The intimate edge. New York: Norton.
- Ghent, E. (1989). Credo: The dialectics of one-person and two-person psychologies. Contemporary Psychoanalysis, 25, 169–211.
- Greenberg, J., & Mitchell, S. A. (1983). Object relations in psychoanalytic theory. Cambridge, MA: Harvard University Press.
- Harris, A. (2005). Gender as soft assembly. Hillsdale, NJ: Analytic Press.
- Hoffman, I. Z. (1998). Ritual and spontaneity in the psychoanalytic process: A dialectical-constructivist view. Hillsdale, NJ: Analytic Press.
- Kiesler, D. J. (1996). Contemporary interpersonal theory and research: Personality, psychopathology, and psychotherapy. New York: John Wiley.
- Levenson, E. (1983). The ambiguity of change. New York: Basic Books.
- Mitchell, S. A. (1988). Relational concepts in psychoanalysis. Cambridge, MA: Harvard University Press.
- Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York: Basic Books.
- Pizer, S. A. (1998). Building bridges: The negotiation of paradox in psychoanalysis. Hillsdale, NJ: Analytic Press.
- Stern, D. B. (1997). Unformulated experience. Hillsdale, NJ: Analytic Press.
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