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The flip side of collaborative alliance: a single-case study.

Francesca Locati1, Pietro De Carli1,2, Margherita Lang1

  • 1Department of Psychology, University of Milan-Bicocca, Milan.

Research in Psychotherapy (Milano)
|September 11, 2020
PubMed
Summary

This case study reveals that a seemingly positive collaboration in therapy can mask dysfunctional patient schemas, creating a pseudo-alliance. This highlights the need to look beyond adaptive collaboration for a complete understanding of the therapeutic relationship.

Keywords:
Defense mechanismPsychodynamic therapyPsychotherapy processPsychotherapy relationshipTherapeutic alliance

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Area of Science:

  • Psychology
  • Psychotherapy Research

Background:

  • Traditional views often define therapeutic collaboration solely as an adaptive relationship.
  • This perspective may limit a comprehensive understanding of the therapeutic process and its underlying dynamics.

Purpose of the Study:

  • To investigate whether positive collaboration can conceal a patient's dysfunctional interpersonal schemas.
  • To explore the concept of non-authentic or pseudo-collaboration within psychotherapy.

Main Methods:

  • Employed an intersubjective approach integrating specific and non-specific therapeutic factors.
  • Assessed constructs including therapeutic alliance, interventions, defense mechanisms, and the overall therapeutic relationship.
  • Utilized statistical methods for micro- and macro-analytic process investigation in a single case study (Sara).

Main Results:

  • The patient's collaborative functioning concealed critical aspects of her psychological state.
  • The observed collaboration did not align with the conventional positive definition of therapeutic collaboration.
  • Sara's therapeutic alliance functioned primarily as a pseudo-alliance.

Conclusions:

  • A positive collaborative facade can mask underlying patient issues.
  • Rethinking the definition of collaboration is crucial for a deeper insight into therapeutic relationships.
  • The study underscores the importance of identifying pseudo-alliances in clinical practice.