Pitfalls and Opportunities of the Therapist’s Metacommunication : A Self-determination Perspective

Édua Holmström*, Virpi Liisa Kykyri, Frank Martela

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Psychotherapy research identifies alliance ruptures and their resolutions as significant events in psychotherapy, influencing outcome. However, we know little about the process how such events influence outcomes, only assuming if clients stay in therapy that the rupture was resolved, and the outcome will be positive. The purpose of this paper is to problematize this assumption against the backdrop of self-determination theory, introducing motivation and relational positioning as relevant theoretical concepts for understanding rupture resolution and the effect on outcome. A therapeutic transcript demonstrating best practice for alliance rupture resolution in a brief integrative therapy is critically examined, calling the attention of both clinicians and researchers to the risk of prescribing and blindly following techniques during therapeutic impasses. Our analysis of metacommunication demonstrates how the therapist’s use of a certain technique for resolving threats to the therapeutic alliance can lead to the client’s external motivation and compliance, negatively influencing therapeutic outcome. Focusing on the therapist’s relational positioning we present two alternative courses of therapeutic action, ‘mindfulness in action’ and ‘embracing the patient’s ambivalence’, for supporting the client’s autonomous motivation for the therapy process.

Original languageEnglish
Pages (from-to)9-18
Number of pages10
JournalJournal of Contemporary Psychotherapy
Volume54
Issue number1
Early online date20 Sept 2023
DOIs
Publication statusPublished - Mar 2024
MoE publication typeA1 Journal article-refereed

Keywords

  • Alliance rupture resolution
  • Compliance
  • Relational psychoanalytic theory
  • Self-determination theory
  • Therapist’s metacommunication

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