TWO The Therapeutic Alliance and Case Formulation
Alec Grant, Jem Mills, Ronan Mulhern and Nigel Short
After reading this chapter and completing the activities at the end of it you should be able to: 1 outline key aspects of the historical significance of the therapeutic alliance in the CB approach 2 describe the main alliance issues related to maximising the potential of the approach 3 understand the historical development and significance of the case formulation concept in CB work 4 describe the relationship between thought, emotion, behaviour, physical reactions and environment in case formulation 5 outline models of case formulation used in the CB approach 6 describe the main issues involved in enhancing client motivation for the approach.
The therapeutic alliance in the CB approach
The notion that the CB approach fails to attach importance to the quality of the therapeutic relationship (sometimes called ‘therapeutic alliance’) is an enduring myth (Leahy, 2001). A brief and highly selective look at the relevant literature of the last decade suggests that authors and practitioners have been increasingly concerned about factors in the therapeutic alliance that may negatively impact on CB interventions.
Warmth and friendliness versus control
Wright and Davis (1994), summarising relevant contemporary research, argued that the therapeutic relationship and techniques were integrated aspects of a
8 Cognitive Behavioural Therapy in Mental Health Care
Forms of resistance • • The client fails to complete agreed homework tasks. The client reacts to improvement with scepticism. The client shows high levels of expressed emotion towards the CB practitioner. The client subtly avoids things within sessions. • •
Appropriate considerations for practitioners What function does the client’s resistance serve? How does the specific form of...