Therapeutic Alliance Quotes

Client-therapist disagreement about the goals and tasks of therapy may impair the therapeutic alliance.† This issue is not restricted to group therapy. Client-therapist discrepancies on therapeutic factors also occur in individual psychotherapy. A large study of psychoanalytically oriented therapy found that clients attributed their successful therapy to relationship factors, whereas their therapists gave precedence to technical skills and techniques.84 In general, analytic therapists value the coming to consciousness of unconscious factors and the subsequent linkage between childhood experiences and present symptoms far more than do their clients, who deny the importance or even the existence of these elements in therapy; instead they emphasize the personal elements of the relationship and the encounter with a new, accepting type of authority figure.

unfolds will often reflect the degree of resolution they have achieved. We can use our bodies and emotions to sense the subjective experience of their wounds, and our insight to understand the ramifications for brain integration. This experience is very far from what is usually called “history taking.” Instead, it is a whole-person to whole-person joining experience that quickly lays the foundation for a powerful therapeutic alliance at many levels.

I believe that all learning is relational. Teachers who try to teach without first having created a positive relationship with their students may only be wasting much of their great knowledge. Establish an encouraging relationship with a child, and you can teach him or her almost anything. Establish a strong therapeutic alliance with your client, and he or she might even be willing to build new neuronal pathways that indicate that trust, love, and unconditional worth are possible for him or her too.

Many critics have seen Tolkien's writings as a response to the trauma of the First World War, even going so far as to see The Lord of the Rings as a "war novel", rather than as pure high fantasy. Tolkien himself admitted there were connections with the First World War, but denied vehemently there were any to the second: Sauron is not Hitler; the One Ring is not the atomic bomb. There is a middle ground: The Silmarillion and The Lord of the Rings, along with many other of his writings, was to large degree a therapeutic process in which he faced up to and attempted to purge the trauma inflicted on him and his peers at the Somme.... Who knows, then, what Tolkien might have made of the War of the Last Alliance had he written its tale in full? There are hints of the grandeur and terror it might have achieved: The Somme-like Battle of Dagorlad with the ill-considered charge of the Galadhrim and the swamp of dead bodies left behind in the Dead Marshes; the grueling seven-year siege and the climactic, gruesome duel on the slopes of Mount Doom. What we do have, however, is an intriguing, almost medieval-style chronicle of its main events and manoeuvres - more than enough, then, to feed our imaginations.

• No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We will talk about almost anyone about our physical health, even our sex lives, but bring depression, anxiety or grief , and the expression on the other person would probably be "get me out of this conversation" • We can distract our feelings with too much wine, food or surfing the internet, • Therapy is far from one-sided; it happens in a parallel process. Everyday patients are opening up questions that we have to think about for ourselves, • "The only way out is through" the only way to get out of the tunnel is to go through, not around it • Study after study shows that the most important factor in the success of your treatment is your relationship with the therapist, your experience of "feeling felt" • Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in peoples relationships too, influencing the kind of partners they pick, (stable or less stable), how they behave in a relationship (needy, distant, or volatile) and how the relationship tend to end (wistfully, amiably, or with an explosion) • The presenting problem, the issue somebody comes with, is often just one aspect of a larger problem, if not a red herring entirely. • "Help me understand more about the relationship" Here, here's trying to establish what’s known as a therapeutic alliance, trust that has to develop before any work can get done. • In early sessions is always more important for patients to feel understood than it is for them to gain any insight or make changes. • We can complain for free with a friend or family member, People make faulty narratives to make themselves feel better or look better in the moment, even thought it makes them feel worse over time, and that sometimes they need somebody else to read between the lines. • Here-and-now, it is when we work on what’s happening in the room, rather than focusing on patient's stories. • She didn't call him on his bullshit, which this makes patients feel unsafe, like children's whose parent's don’t hold them accountable • What is this going to feel like to the person I’m speaking to? • Neuroscientists discovered that humans have brain cells called mirror neurons, that cause them to mimic others, and when people are in a heightened state of emotion, a soothing voice can calm their nervous system and help them stay present • Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth. • The things we protest against the most are often the very things we need to look at • How easy it is, I thought, to break someone’s heart, even when you take great care not to. • The purpose on inquiring about people's parent s is not to join them in blaming, judging or criticizing their parents. In fact it is not about their parents at all. It is solely about understanding how their early experiences informed who they are as adults so that they can separate the past from the present (and not wear psychological clothing that no longer fits) • But personality disorders lie on a spectrum. People with borderline personality disorder are terrified of abandonment, but for some that might mean feeling anxious when their partners don’t respond to texts right away; for others that may mean choosing to stay in volatile, dysfunctional relationships rather than being alone. • In therapy we aim for self compassion (am I a human?) versus self esteem (Am I good or bad: a judgment) • The techniques we use are a bit like the type of brain surgery in which the patient remains awake throughout the procedure, as the surgeons operate, they keep checking in with the patient: can you feel this? can you say this words? They are constantly calibrating how close they are to sensitive regions of the brain, and if they hit one, they back up so as not to damage it.

Researchers have found that the therapeutic alliance between therapist and client is what plays the greatest role in effectiveness of treatment.

Schore emphasized that when the caregiver is unable to help the child to regulate either a specific emotion or intense emotions in general, or – worse – that she exacerbates the dysregulation, the child will start to go into a state of hypoaroused dissociation as soon as a threat of dysregulation arises. This temporaily reduces conscious emotional pain in the child living with chronic trauma, but those who characterologically use the emotion-deadening defense of dissociation to cope with stressful interpersonal events subsequently dissociate to defend against both daily stresses, and the stress caused when implicitly held memories of trauma are triggered. In the developing brain, repeated neurological states become traits, so dissociative defense mechanisms are embedded into the core structure of the evolving personality, and become a part of who a person is, rather than what a person does. Dissociation, which appears in the first month of life, seems to be a last resort survival strategy. It represents detachment from an unbearable situation. The infant withdraws into an inner world, avoids eye contact and stares into space. Dissociation triggered by a hypoaroused state results in a constricted state of consciousness, and a void of subjectivity. Being cut off from our emotions impacts our sense of who we are as a person. Our subjective sense of self derives from our unconscious experience of bodily-based emotions and is neurologically constructed in the right brain. If we cannot connect to our bodily emotions then our sense of self is built on fragile foundations. Many who suffered early relational trauma have a disturbed sense of their bodies and of what is happening within them physiologically as well as emotionally. The interview moved along to the topic of how we can possibly master these adverse and potentially damaging relational experiences. Schore replied by explaining that the human brain remains plastic and capable of learning throughout the entire life span, and that with the right therapeutic help and intervention we can move beyond dissociation as our primary defense mechanism, and begin to regulate our emotions more appropriately. When the relationship between the therapist and the client develops enough safety, the therapeutic alliance can act as a growth-facilitating environment that offers a corrective emotional experience via “rewiring” the right brain and associated neurocircuits.

right brain and associated neurocircuits. This is predicated on the formation of a trusting relationship between the patient and therapist, who must be sensitive enough to receive the patient’s underlying negative state, and implicitly empathically resonate with what is going on within the client’s right brain and within his body. All therapeutic techniques sit on top of the therapist’s ability to access the implicit realm via right-brain-to-right-brain communications. A strong therapeutic alliance depends on the therapist’s knowledge about the patient from the inside out, rather than from the top down. The patient’s emotional growth depends on the therapist’s ability to move, and to be moved by, those that come to him for help. The therapist has to help patients to learn how to regulate feeling associated with trauma so that the patient can integrate them into his emotional life, rather than having to dissociate when they arise. When a patient is catapulted into a hyperaroused state and subjectively experiences the therapist through the lens of the previous insecure internal working models, this is the expression of “negative transference.” For a patient who is in the midst of a negative transference the therapeutic alliance is severely ruptured, and the therapist is seen as an analogue of the early misattuned other and is experienced as source of dysregulation rather than interactive regulation. However, if the therapist can maintain an attuned connection to the client, then the door opens to working with what was laid down early in the patient’s life and reorganization becomes a possibility. A problem may arise if the therapist cannot contain the negative emotions created in negative transference and in projective identification. There is an old adage in therapy that no patient can achieve a greater level of healing than the therapist has achieved. With modern scientific knowledge we can be more specific: the patient’s unconscious right brain can develop only as far as the therapist’s right brain can take them. For a therapist to stay with a dissociating patient who is projecting his trauma onto

final problem of cognitive therapy is that it is generally a short-term treatment so it is unable to build a strong enough therapeutic alliance to allow the patient to experience the corrective emotional experience. Deep change does not happen when a patient is consciously reflecting on an emotion. Rather it happens when the patient actively experiences the emotion and when a resonating emotionally present therapist recognizes and regulates that emotion, thereby modeling new ways of being with another while one is under stress. There is no interpersonal space for this repair of attachment ruptures in current models of cognitive therapy, where left brain insight dominates over right brain interactive regulation. Coming to the end, Sieff asked Schore what message he would like people to take home from this interview. Schore answered that the earliest stages of life are critical as they form the foundation of everything that follows. Our early attachment relationships, for better or worse, shape our right brain unconscious system and have lifelong consequences. An attuned early attachment relationship enables us to grow an interconnected, well-developed right brain and sets us up to become secure individuals, open to new social and emotional experiences. A traumatic early attachment relationship impairs the development of a healthy right brain and locks us into an emotionally dysregulated, amygdala-driven emotional world. As a result, our only way to defend against intense unregulated emotions is via the over reliance on repression and/or pathological characterological dissociation. Faced with relational stress, we are cut off from the world, from other people, from our emotions, from our bodies and from our sense of self. Our right brains cannot further develop or grow emotionally from our interactions with other right brains. Too many people suffer alone with their desperate pain due to their early relational trauma. For somebody struggling with such emotional dysregulation, the way to emotional security, and to a more vital, alive, and fulfilling life, does not come from making the unconscious conscious – which is essentially a left brain process

Relationship elements with the strongest correlation to successful therapeutic outcomes (Norcross, 2010) Useful questions for building relationships at an individual and team level Empathy “Involves entering the private, perceptual world of the other” and “communicating that understanding back to the client in ways that can be received and appreciated” (p. 118). How well do you really listen (listening like they are the most important person in the world)? Do you listen to the whole person (beyond their words)? How well do you sensitively communicate back your understanding of how you think the other person is feeling (feeling with another)? Alliance “The quality and strength of the collaborative relationship” (p. 120) How strong is your emotional bond to the other person? What can you do to strengthen it? What could be getting in the way of a stronger bond? Cohesion (in groups) “The forces that cause members to remain in the group” (p. 121) How do you help the team develop cohesion? What do you do that decreases team cohesion? What could you do more of to develop team cohesion? Goal Consensus and Collaboration “The therapist and client journey together toward a mutual destination” (p. 122) Does the relationship have a joint overriding purpose from which goals can be derived? What do you want to achieve together that you cannot do separately? What would success for this relationship look like? Adapted from Norcross (2010: 118–25)

The most crucial aspect of therapy is the development of a good therapeutic alliance with a therapist who is trauma-informed and has a Spiritually open mindset. With this we create a place of safety where we offer information, make sure our clients are grounded, feel empowered, have a way to regulate emotions and feel cared for and respected.