Two examples of strains in the therapeutic alliance in an integrative cognitive therapy

Two case examples are presented to illustrate methods of recognizing and working with strains in the therapeutic alliance in an integrative cognitive therapy. I argue that developmental, personality, and therapy-readiness constructs are useful in understanding strains in the alliance and whether to confront such strains directly. Attachment theory was relevant to understanding the therapeutic alliance in the first case, when the client reacted to the possibility of termination in an insecure manner. Direct discussion of the alliance strain was useful in this case. The client in the second case was resistant to interpersonal influence. I did not address strains directly because the client would probably not have seen this work as relevant to his goals. In this case, a focus on strains could have weakened our alliance rather than strengthened it.