DEN »TILSTRÆKKELIGT GODE« TERAPEUTS HÅNDTERINGAF BRUD PÅ DEN TERAPEUTISKE ALLIANCE

En kvalitativ enkeltcasestudie

Abstract

Today it is generally agreed - and empirically validated – that the therapeutic alliance is of major importance for treatment outcome. New psychodynamic conceptions of treatment indicates that the therapist`s way of handling difficulties emerging in the therapeutic relationship – in itself contains important agents of change. It is therefore
important to reach a better understanding of the means by which the therapist can make positive contributions to the establishment and maintenance of the therapeutic alliance. The article presents findings from a single case pilot study of a long term psychodynamic psychotherapy. The case has been selected according to the following two principles: (1) the reached treatment outcome was distinctively higher than expected from a treatment prognosis based on commonly used criteria of suitability for the offered long term psychodynamic psychotherapy. And (2) the interpersonal process in
the therapy was characterized by high intensity and several serious ruptures in the treatment alliance. The main focus of the study is the interpersonal process – and particularly the therapist`s ability to handle and heal the arisen difficulties in the therapeutic alliance. Quantitative analysis of the interpersonal process as well as qualitative data from a series of interviews with the therapist are included. Finally a theoretical model for handling difficulties in the therapeutic relationship is outlined.