Looking at the therapeutic alliance, how does psychotherapy work? This is an excerpt from my thesis (Chew-Helbig, 2017).
The therapeutic relationship is multifaceted. Many authors like Clarkson (2003) have attempted to describe the different aspects of the therapeutic alliance. One may rightfully argue that separating an alliance in this manner is arbitrary. There exists no clear separation between the aspects— the working alliance; the transferential/countertransferential relationship; the reparative/developmentally needed relationship; the person-to-person relationship; the transpersonal relationship. (See https://nikhelbig.at/levels-in-a-psychotherapeutic-relationship/)
These parts exist as a whole and are essential to the psychotherapeutic alliance. It makes for a safe, professional setting in which very sensitive work between people can be done. It is not unlike a surgical room, whereby the environment is set up so that the surgeons can focus and have their instruments at hand and the room is safe from contamination.
These parts put together can also be compared to a pharmaceutical product. If we take a box of medicinal capsules, we’d first see the box with its labels. Inside this box, one may find a paper pamphlet, and there would be bubble pack(s), usually made of plastic and aluminium foil in which the capsules are enclosed. Capsules are made of gelatin and contain powder. A large proportion of this powder is a starch carrier. Mixed into this starch carrier is a microgram of the active ingredient. We can perhaps also see that the different aspects of psychotherapy as the important support for and carrier for the active ingredient in psychotherapy. The question is then, what is the active ingredient?
Like an active ingredient of pharmaceutical medicine, the transpersonal is the most intangible part. It also requires the other parts to package and support its use.
We can also see in pharmaceutics, how the same active ingredient can be packed differently and can look very different. The same ingredient can come in the form of capsules, tablets, syrup, inhalants, injectables etc. These various forms exist so that the active ingredient can be administered to the patient effectively, depending on the need of the patient and the uptake of the drug. In psychotherapy, we could perhaps see that these different forms of administering an active ingredient represent the different modalities of psychotherapy. The active ingredient itself, in all modalities, then could be the same. This is perhaps where psychotherapy research can focus.
References
Chew-Helbig, N. (2017). The Psychotherapeutic Alliance and Change: A discussion on the healing aspects in a psychotherapeutic relationship. Bachelor Thesis.
Clarkson, P. (2003). The Therapeutic Relationship. London: Whurr Publishers.