Compliance as a threat to the therapeutic alliance: a relational perspective

This thesis builds on the basic theoretical tenets of relational psychoanalytic theory for examining therapeutic transcript depicting cognitive analytic therapy’s model for resolving threats to the therapeutic alliance. Building on the work of prominent relational theorists, the thesis problematizes the attainment of the resolution of the therapeutic impasse in the examined transcript. The analysis contends that the resolution presented in the transcript might in fact be resolution by compliance, possibly leading to the external motivation of the patient, curtailing long-standing psychic change. A relational alternative to the presented threat to the alliance is presented, relying on the therapeutic techniques of mindfulness in action and embracing ambivalence, as well as metacommunicational principles grounded in the theoretical tenets and clinical practice of relational psychoanalytic theory.

The thesis questions the clinical usefulness of considering the avoidance of collusion with the patient’s problematic relational configuration the primary aim for the therapist. The thesis argues that this bears the risk of diverting attention away from the here and now of the therapeutic relationship, blinding the therapist from possible new adverse dynamics.

The results of the analysis also point to a need for discussion regarding the extent to which cognitive analytic therapy regards itself as aligning with a social-constructivist epistemology. The thesis argues that while cognitive analytic therapy aligns with social constructivism in its theory of personality development and theory of self, it does not extend this social constructionism to its theory of clinical practice.

Édua Holmström: Compliance as a threat to the therapeutic alliance: a relational perspective

Kognitiivis-analyyttisen yksilöpsykoterapian koulutusohjelma 2019-2022