Academic journal article American Journal of Psychotherapy

Neuroanalysis of Therapeutic Alliance in the Symptomatically Anxious: The Physiological Connection Revealed between Therapist and Client

Academic journal article American Journal of Psychotherapy

Neuroanalysis of Therapeutic Alliance in the Symptomatically Anxious: The Physiological Connection Revealed between Therapist and Client

Article excerpt

This study was an attempt to establish neurophysiological correlates, particularly brain activity, during high therapeutic alliance (TA) between client and therapist. The aim was to assess electroencephalography (EEG) activity in clients with symptomatic anxiety during high TA using skin conductance resonance measurements from both client and therapist. Thirty clients, aged 43.8 ± 11.5 years (males: n = 15 females: n = 15), underwent six, weekly, 1-hour sessions (180 hours of repeated measures). The EEG activity was measured from the prefrontal, temporal, parietal and occipital sites during the sessions. State and trait anxiety, Working Alliance Inventory (WAI) and heart rate measures were obtained before and after each session. Prefrontal, parietal and occipital sites were associated with TA. Anxiety and heart rate were found to decrease after therapy, and for both the client and the therapist, the WAI score increased significantly in later sessions. The results are discussed from the perspective of further understanding the neurophysiological associations to TA.

KEYWORDS: anxiety, therapeutic alliance, electroencephalography, psychotherapy, heart rate

INTRODUCTION

The core concept of therapeutic alliance (TA) is a key component of psychotherapy. It was defined by Freud (1912), as the sine qua non of therapy, now referred to as empathy, which is both a state of being and a therapeutic skill (McLeod, 1998). Freud understood TA to be closely linked with transference (Sandler, Dare ¿5c Holder, 1973). The transferential aspect was eventually separated from TA, with the alliance becoming known as the "working alliance" (Greenson, 1967). Inadequate and empirically inept methods kept the therapeutic alliance from being extensively investigated as a clinical construct until the mid 1970s (Horvath & Greenberg, 1994). The term, therapeutic alliance, contextualizes the relational dimension between client and therapist (Horvath, Gaston & Luborsky, 1993) and encompasses the therapeutic framework and mutual responsibilities between therapist and client which are crucial to a positive clinical outcome (Meissner, 1992). It is described as the intersubjective relational field in which evolutionary growth is seen as an outcome (Stolorow, Brandchaft & Atwood, 1987). Lewis, Amini and Lannon (2000) call therapeutic alliance a deep empathie state emanating from the limbic part of the brain, which allows us to be aware of the emotional state of others. The limbic system of the brain is involved with recording and accessing emotional memory, learning, and the mediation of our primitive flight/fight avoidant responses (Patterson & Schmidt, 2003). The limbic brain stores emotional experiences in the unconscious creating implicit or unconscious memory which is not under cortical control (Stolorow, 1994; Lewis, Amini & Lannon, 2000). Through TA therapists access this implicit memory which helps clients to access and regulate their emotions and ultimately revise their lives (Schore, 1994; Caspi, McLeay & Poulton, 2002). It is only in this type of therapeutic relationship that the client can redefine the concept of self by opening to the possibility of evolutionary change (Yalom, 1980) or healing the self-system (Kohut, 1977). To create this moment of meeting' (Stern, 2004), or intersubjective system of reciprocal mutual authority (Stolorow, 1994), therapists need to access their intuitive subjective responses as well as their objective theoretical knowledge (Schore, 2003b).

A successful therapeutic relationship engenders a positive mood regulating context that encourages development in the instinctive right brain of both the therapist and client, in which out-of-conscious meaning making evolves (Schore, 2003a, p. 38). The relationship between client and therapist during the therapeutic alliance is both empathie and dynamic, where interpersonal problems are confronted (Howard et al., 2006). This essential corrective interpersonal experience with the therapist can be challenging (Paivio & Shimp, 1998), involving the expression of both positive and negative emotions (Gottman & Krokoff, 1989). …

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