Free Paper ISSPD Congress 2023

Therapists’ perception of the therapeutic alliance and the therapeutic frame with complex patients: rethinking Bordin’s alliance conceptualization (17692)

Paula Errazuirz 1 , Candice Fischer 1 , Stephanie Vaccarezza 1 , Alberto Lopez 2 , Sebastián Opazo 3
  1. Pontificia Universidad de Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, RM, Chile
  2. Psicología, Universidad de Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, RM, Chile
  3. Fundacion PsiConecta, Santiago, RM, Chile

A good therapeutic alliance requires a positive emotional bond between patient and therapist and an agreement about the goals of the therapy and the tasks that are required to accomplish them (Bordin, 1979). Safran and Muran (2003) emphasize the relevance of the negotiation regarding the tasks and goals of therapy. This process not only establishes the necessary conditions for change, but is also an intrinsic part of the change process.

Our qualitative research with 15 therapists that treat complex patients -many of which meet criteria for a personality disorder- in the public health system in Chile, finds that it is important to: A) Explain and discuss the therapeutic frame (i.e., schedule, tardiness, missed sessions, fees, and communication between sessions) and ensure its compliance. For the effectiveness of treatment, the therapeutic frame must be explicit for the client and the therapist; B) Establish a balance between flexibility and structure in the therapeutic frame; C) Address therapeutic impasses and repair alliance ruptures, which can be beneficial opportunities for treatment; and D) Address the transgression of the limits of the therapeutic frame and restore it, either when the client or the therapist transgress it.

Since paying attention to, and negotiating, the therapeutic frame is specially necessary with complex patients, we conclude suggesting that the conceptualization of the therapeutic alliance should also include the agreement between patient and therapist of the therapeutic frame (in addition to goals and tasks). In addition, we suggest that research measures, such as the Working Alliance Inventory (Hatcher & Gillaspy, 2006), should also measure the agreement on the therapeutic frame.