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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
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. Acknowledgments |
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