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Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy

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Abstract

The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.

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References

  • Brattland, H., Høiseth, J. R., Burkeland, O., Inderhaug, T. S., Binder, P. E., & Iversen, V. C. (2016). Learning from clients: A qualitative investigation of psychotherapists’ reactions to negative verbal feedback. Psychotherapy Research. https://doi.org/10.1080/10503307.2016.1246768.

    Article  PubMed  Google Scholar 

  • Charmaz, K. (2017). Continuities, contradictions and critical inquiry in grounded theory. International Journal of Qualitative Methods, 16, 1–8.

    Article  Google Scholar 

  • Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing Grounded Theory (3rd. edn.). London: Sage.

    Book  Google Scholar 

  • Cordoba, J. V., & Scott, R. L. (2001). Intimacy. A behavioral interpretation. The Behavior Analyst, 24, 75–86.

    Article  Google Scholar 

  • Dryden, W. (2012). The therapeutic relationship in CBT. In W. Dryden & R. Branch, The CBT handbook (pp. 83–100). London: Sage.

    Google Scholar 

  • Fresno, D. M. (2013). Tending the garden and harvesting the fruits of behavior therapy. Behavior Therapy, 44, 177–179.

    Article  Google Scholar 

  • Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. Washington: American Psychological Association.

    Book  Google Scholar 

  • Gelso, C. J., Rojas, A. E. P., & Marmosh, C. (2014). Love and sexuality in the therapeutic relationship. Journal of Clinical Psychology, 70, 123–134.

    Article  Google Scholar 

  • Glaser, B. (2007). Remodeling grounded theory. Historical Social Research, 19, 47–68.

    Google Scholar 

  • Hatcher, S. L., Kipper-Smith, A., Waddell, M., Uhe, M., West, J. S., et al. (2012). What therapists learn from psychotherapy clients: Effects on personal and professional lives. The Qualitative Report, 17(48), 1–21.

    Google Scholar 

  • Henwood, K. L., & Pidgeon, N. (2006). Grounded theory. In G. Breakwell, S. Hammond, C. Fife-Shaw & J. Smith (Eds.), Research methods (pp. 342–365). London: Sage.

    Google Scholar 

  • Holman, G., Kanter, J., Tsai, M., & Kohlenberg, R. J. (2017). Functional analytic psychotherapy made simple: A clinician’s guide to using the Awareness-Courage-Love (ACL) model in session. Oakland: New Harbringer.

    Google Scholar 

  • Jeffrey, M. K., & Tweed, A. E. (2015). Clinician self-disclosure or clinician self- concealment. Lesbian, gay and bisexual mental health practitioners’ experiences of disclosure in therapeutic relationships. Counselling and Psychotherapy Research, 15, 41–49.

    Article  Google Scholar 

  • Kazantizis, N., Cronin, T. J., Dattilio, F. M., & Dobson, K. S. (2013). Introduction: Using techniques via the therapeutic relationship. Cognitive and Behavioral Practice, 20, 385–389.

    Article  Google Scholar 

  • Kelly, A. E., & Rodriguez, R. R. (2007). Do therapists self-disclose more to clients with greater symptomatology? Psychotherapy, 44, 470–475.

    Article  Google Scholar 

  • Kohlenberg, R. J., Kohlenberg, B. S., & Tsai, M. (2008). Intimacy. In M. Tsai, R. J. Kohlenberg, J. Kanter, B. S. Kohlenberg, W. C. Follette & G. M. Callaghan (Eds.), A guide to functional analytic psychotherapy (pp. 131–144). New York: Springer.

    Google Scholar 

  • Levitt, H. M., Minami, T., Greenspan, S. B., Puckett, J. A., Henretty, J. R., Reich, C. M., & Berman, J. S. (2016). How therapist self-disclosure relates to alliance and outcomes: A naturalistic study. Counselling Psycholgy Quarterly, 29, 7–28.

    Article  Google Scholar 

  • Linehan, M. M. (2015). Cognitive-behavioral treatment of borderline personality disorder (2nd edn.). New York: Guilford.

    Google Scholar 

  • Nissen-Lie, H., Rønnestad, M., Høglend, P., Havik, O., Solbakken, O., Stiles, T., & Monsen, J. (2017). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24, 48–60.

    Article  Google Scholar 

  • Pierson, H., & Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in cognitive behavior therapy (pp. 205–228). London: Routledge.

    Google Scholar 

  • Pietkiewicz, I. J., & Wlodarczyk, M. (2014). Crossing the boundaries of privacy in accidental encounters: Interpretative phenomenological analysis of therapists’ experiences. Clinical Psychology and Psychotherapy, 22, 708–721.

    Article  Google Scholar 

  • Pope, K. S., & Keith-Spiegel (2008). A practical approach to boundaries in psychotherapy: Making decisions, bypassing blunders and mending fences. Journal of Clinical Psychology, 64, 638–652.

    Article  Google Scholar 

  • Råbu, M., Moltu, C., Binder, P.-E., & McLeod, J. (2015). How does practicing psychotherapy affect the personal life of the therapist? A qualitative inquiry of senior therapists’ experiences. Psychotherapy Research, 26, 737–749.

    Article  Google Scholar 

  • Rupert, P. A., Miller, A. O., & Dorociak, K. E. (2015). Preventing burnout: What does the research tell us? Professional Psychology, 46, 168–174.

    Article  Google Scholar 

  • Safran, J. D., Muran, C., & Shaker, M. A. (2014). Research on therapeutic impasses and ruptures in the therapeutic alliance. Contemporary Psychoanalysis, 50, 211–232.

    Article  Google Scholar 

  • Schröder, T., Wiseman, H., H. & Orlinsky, D. (2009). “You were always on my mind”: Therapists’ intersession experiences in relation to their therapeutic practice, professional characteristics, and quality of life. Psychotherapy Research, 19, 42–53.

    Article  Google Scholar 

  • Stahl, J. V., Hill, C. E., Jacobs, T., Kleinman, S., Isenberg, D., & Stern, A. (2009). When the shoe is on the other foot: A qualitative study of intern-level trainees’ perceived learning from clients. Psychotherapy, 46, 376–389.

    Article  Google Scholar 

  • Swales, M. A., & Heard, H. L. (2007). The therapy relationship in dialectical behavior therapy. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 185–204). New York: Routledge.

    Google Scholar 

  • Tsai, M., Callaghan, G. M., & Kohlenberg, R. J. (2013). The use of awareness, courage, therapeutic love and behavioral interpretation in functional analytic psychotherapy. Psychotherapy, 50, 366–370.

    Article  Google Scholar 

  • Vandenberghe, L., & Silveira, J. M. (2013). Therapist self-as-context and the curative relationship. Journal of Contemporary Psychotherapy, 43, 159–167.

    Article  Google Scholar 

  • Villatte, M., Villatte, J. L., & Hayes, S. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.

    Google Scholar 

  • Wilson, K. G., & Merwin, R. M. (2008). Therapeutic relationship. In M. Hersen (Ed.), Encyclopedia of behavior modification and behavior therapy with adult clinical applications (pp. 586–590). Thousand Oaks: Sage.

    Google Scholar 

  • Wilson, K. G., & Sandoz, E. K. (2008). Mindfulness, values, and the therapeutic relationship in acceptance and commitment therapy. In S. F. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship (pp. 89–106). New York: Guilford Press.

    Google Scholar 

  • Young, J. E., Klosko, J. S., & Weishaar, M. (2003). Schema therapy: A practitioner’s guide. New York: Guilford.

    Google Scholar 

  • Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations. Washington: American Psychological Association.

    Book  Google Scholar 

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Correspondence to Luc Vandenberghe.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Vandenberghe, L., Coppede, A.M. & Bittencourt, M.V. Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy. J Contemp Psychother 48, 215–223 (2018). https://doi.org/10.1007/s10879-018-9388-9

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  • DOI: https://doi.org/10.1007/s10879-018-9388-9

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