The Treatment Relationship
Derlega and colleagues (1991) have delineated specific mental health applications of social psychological research on interpersonal relationships. For instance, they suggest that principles from social exchange theory can be applied to clinical formulation of the patient–therapist relationship dynamics, including the influence of rewards and costs on decisions to initiate a therapy relationship, levels of satisfaction with and commitment to the relationship, and the overall quality of an ongoing therapeutic relationship. They also point out that application of findings from interpersonal attraction research can enhance clinical understanding of the goodness of fit and working alliance between a therapist and patient. For example, patient attraction to the therapist may be influenced by the extent to which the therapist is perceived as similar on domains that the patient considers highly significant (e.g., gender, cultural background, beliefs and values, personality style). The therapist’s experience of rapport with the patient may be similarly influenced. The attraction between therapist and patient is likely strengthened by the extent to which time is shared, as increased experience allows for greater mutual understanding, which in turn enhances the experience of interpersonal attraction and compatibility. Different types of therapeutic alliances tend differentially to influence the course and nature of the treatment. Finally, Derlega and colleagues (1991) point out that social psychological models of relationship development, such as social penetration theory, can provide some insight into the understanding of how therapeutic relationships unfold and deepen.
The benefits of social support for psychological well-being have been clearly established in the research literature (Stroebe and Stroebe, 1996). It follows, therefore, that an important objective of therapy is to assist patients in building adequate social support. Further, it is useful also to conceptualize the therapeutic relationship itself as a source of social support for the patient. Among the therapist activities that can be regarded as aspects of social support are the communication of positive feelings toward the patient, attending to patient feelings and beliefs, encouraging patient expression and providing help with solving problems and completing tasks (Derlega et al., 1991).
Attachment theory and the associated empirical findings have useful clinical implications for assessing and treating dysfunctional parent–child, peer, dyadic romantic and family relationships, and for understanding therapist–patient rela-tionships (Doane and Diamond, 1994; Sperling and Berman, 1994). Attachment theory also provides a meaningful frame-work for conceptualizing various psychiatric disorders in in-dividuals and families (Doane and Diamond, 1994; Sperling and Berman, 1994). In an attachment theory based approach to psychotherapy, the therapist provides new and more adap-tive models of relating such that individuals may move from insecure and/or anxious attachments to the development and maintenance of secure attachments (West and Sheldon-Keller, 1994). This process is facilitated by the therapist’s provision of a secure base, examination of relationships and expectations of significant people in the patient’s life, exploration of the thera-pist–patient relationship, reflection on links between parental expectations and the patient’s working models of relationships, and development of an understanding of the appropriateness of these working models for guiding current and future relationships (Bowlby, 1988)