The therapeutic alliance consists of three components: the consent of the patient and the therapist to the therapeutic goals (ie, “Where do you want to go?”), The consent of the patient and the therapist to the therapeutic tasks (ie, “What do we need to do to get where we want to go?”), And a component. The relationship between the patient and the therapist (the positive contact, mutual trust, acceptance and confidence). The clearer the goals and tasks, and agreed upon by the patient and therapist, and the more powerful the component of the relationship, the better the outcomes of the treatment are likely to be.
The relationship between the patient and the therapist, the third component in the therapeutic alliance, does not mean the therapist’s full response to the patient’s needs. Like any other psychological parameter, in the context of the relationship “too little” (a therapist who is not attentive to the patient at all) it is “not good”, and “too much” (a therapist who fully responds to the patient) it is also “not good”. There is an optimum space, a space that is between the minimum and the maximum, where the therapist is devoted to the patient, but occasionally, whether you know it or not, frustrates him. This frustration, the place where friction is created, is a tower. It requires the patient to “move forward”, to create internal levers in order to complete for himself what the therapist did not recognize (or recognized, but decided to challenge the patient with). Violation of the contact element in the therapeutic alliance, beyond the fact that it “simply occurs” (since the therapist cannot meet all the patient’s needs), is magnifying. It causes the patient to move forward, forces him to complete what the therapist does not give him, and expands his ownership of his world, and his future.
To what extent should the component of the relationship between the patient and the therapist be challenged? Of course there is no “generic” answer to this question. It depends on the patient, the therapist, the relationship between them, the specific period in which the treatment is, and more. But, as with many questions about “how much? …” the question of the frustration of the therapeutic relationship also has a “frame of answer”: the relationship between the patient and the therapist should range from the minimum limit (if the relationship is too challenging, there will be no progress) to the maximum limit (if The relationship is too frustrating it may fall apart, and the patient will not survive the treatment). These are the “boundaries of frustration” of frustration: more than “nothing,” and less than “too much.” Between these boundaries the relationship frustration should be managed. The treatment that “falls asleep” to it is slowly below the minimum, excessive turbulent treatment is above the maximum, and managed treatment (that is, treatment in which one talks about frustration, examines its sources, funds it) is “what is needed.”
How do you know if a treatment is below the minimum threshold of relationship frustration, or above its maximum threshold? Should we wait for results (i.e., the treatment will “fall asleep” when it is below the minimum threshold, or will “explode” when it is above the maximum threshold)? The answer is, of course, no. Therapy can be aided by various tools, through which the therapist can assess whether there is a connection between the minimum and the frustrating maximum. One can, for example, ask the opinion of the patient and the therapist on the matter (with the help of questionnaires examining the therapeutic alliance), but this method is awkward, and impairs the natural “flow” of the treatment. Other methods try to identify patient-to-patient synchronization (and a violation of this synchronization) by other means, for example – through voice analysis or analysis of the body gestures of the two, but these do not directly relate to the heart of the treatment – the content, the words.
The matrix is a tool that allows you to analyze, continuously, the degree of resonance and violation that exists between the patient and the therapist during the treatment hour. Since the tool analyzes the time continuously, that is, indicates in the code each statement in the treatment, it is possible to examine the degree of conformity (reverberation) and the degree of non-conformity (violation, refraction) that takes place in the hour. The matrix examines the resonance and violation in two parameters, which are the most significant in the treatment: ” Who is it about?” And ” What is it about?”. When a session “ran” and the patient tells about himself, and the therapist refers to the patient’s experiences, they both talk about the patient, and both refer to “something happening to him.” The session moves, therefore, out of the reverberation of trees. But if the meeting continues to move solely out of the same resonance, nothing will happen; Beyond the attack (“I understand you
feel that …”) nothing will happen. Therefore, at some point in the meeting there will be an act of violation. This can be in one of two parameters: or in the parameter of “Who is this about?” (For example, the therapist will refer not to the patient, but to the therapist himself, or to the connection between the patient and the therapist), or in the parameter of “what is it about?” (For example, the therapist will move from validating the experience to advocacy, or say something about the patient’s ability to experience things other than those he is experiencing). Such a movement, of the cow, is the heart of the treatment. This is the decisive movement, which adds to the existing. If it is done carefully, sensitively, and gently (i.e., in a way that the patient can “digest it,” “be you,” “treat it”), then the violation was committed in a proactive, expansive, and enriching manner; If it is done bluntly and with too much force (that is, in a way that the patient converges on his own, moves away, and in fact – disengages from the course of the session), then the violation was committed in an abusive and destructive manner. Since the matrix continuously monitors the time, it also examines the results of the violations it has. He analyzes, therefore, not only the violation itself, but also the way in which the patient responds to it, and therefore, teaches about its quality.
The movements of getting closer and farther between the patient and the therapist are at the center of mental therapy. As a more general statement, these movements are essential to the “human”, to the developing baby, to the growing child, to the adolescent boy, to the relationship, to parenthood, to the maturity of the third age. In-depth observation of these movements in psychotherapy allows the therapist to pinpoint them, and edit them in a beneficial, proactive and safe way.
