Psychotherapy Relationships, Alliances, and Empiricism: Putting People First

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Reviews the book, Therapeutic Alliances in Couple and Family Therapy: An Empirically Informed Guide to Practice by Myrna L. Friedlander, Valentín Escuerdo, and Laurie Hetherington (see record 2006-02690-000). In this book, the authors define the therapeutic alliance as the combination of collaborative and effective bonds between client and therapist. The heart of the book is an empirical approach to understanding the therapeutic relationship. The authors develop the System for Observing Family Therapy Alliance (SOFTA) to study these relationships. They identify salient factors of therapeutic alliances-safety, shared purpose, empathy, and confidence in the therapist-and provide a useful and relatively simple rating scale. The SOFTA is a short questionnaire consisting of 16 items, four for each dimension. It is administered to each family member and to the therapist, and, if applicable, to other raters. The results are used to guide therapeutic interventions as well as for research purposes. Unfortunately, many current psychotherapy practices, informed by managed care economics, promote psychotherapy relationships that may negate attachment (often presented as dependency) to the psychotherapist. By contrast, however, even relatively brief experiences of attachment (and perhaps dependency) to the therapist can serve to extend gains made in the psychotherapy process. Many difficult treatments are due not to technical but to alliance errors and failures. To emphasize the centrality of the relationship, the authors offer a compendium on the therapeutic alliance. This work is both dense and broad in its appeal and applications, and in actuality the authors offer many works in one: (a) a literature review on the therapeutic alliance in both individual and family treatment; (b) a discussion of the structural complexities of the family-therapist matrix; (c) rich case examples and treatment vignettes in family therapy; (d) a commentary on variations on this theme, highlighting alliance challenges and opportunities to address such common experiences as splitting, diversity, mandated clients, zero-sum problems, countertransference, and misalliances between professional helpers; (e) a review of the authors' own research program; (f) an easily usable version of the SOFTA scale for both day-to-day clinicians and psychotherapy researchers; and (g) a cross-cultural tool that has been researched in the United States and Spain as well as a potentially rich international and multicultural perspective on family therapy interventions.

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