Year: 2025
Type: article
Abstract: though the patient -because of difficulties, emotional scars, and dependency -may constantly want and try to get the therapist to do so.A primary feature of the therapist's action is to show the patient this critical paradox of the therapeutic situation.Although patient and therapist have contracted only for a defined structure, with the patient's benefit as the primary goal, the patient repeatedly tries (usually unconsciously) to subvert that very structure.A patient does this by attempting to get love and commitment from the therapist, by trying to get him/her to intervene in the patient's difficulties with other people, and otherwise attempting to get the therapist to solve both mild and serious problems rather than doing that himself.Also, the patient comes late to therapy, misses therapy sessions, calls the therapist outside of designated times, and otherwise challenges the therapist's commitment to the principle and agreement about defined structure.Almost invariably, a patient tests whether a therapist accepts or rejects his explicit and implicit thoughts or behavior on the basis of alterations in structure.Telling interesting and important stories and bringing up disturbing feelings just as a session is about to close are instances of such testing.If a therapist resists and does not extend the length of those sessions, he maintains the therapy as a trial domain where the patient's behavior within a session, whether negative or positive, has no concrete or real consequences.Attempts by the patient to alter the structural agreement are matters to be looked at and understood because the agreement was designed primarily to help the patient.Understanding deviations, therefore, aids in clarifying ubiquitous patient self-defeating tendencies.When the therapist is responsible for altering the structure by actions ranging from necessaryabsence patients properly have feelings about such interruptions and may often experience them, realistically or unrealistically, as produced by their own behavior.There are exceptions and limits to the principle of a structured trial domain.Both soon and late, there are consequences in the real non-therapeutic world, but these are produced by the patient's behavioral changes and not the direct action or intervention on the patient's behalf by the therapist.Also, inflexibility of structure can become so artificial that it has no impact or meaning.Nonetheless, as a result of experiences within the therapeutic structure, the patient alters his perception of him or herself and others and hopefully brings about positive real consequences.As for the nature of the structure decided upon, 50-or 45-minute sessions have, of course, been traditionally used in individual psychotherapy.Although there is nothing magically effective about that duration of time, experience has shown it to be workable for transformative therapy.Other time periods may surely be used, but it is important to note that different forms and structures, as well as different types of sequences, result from 30-, or from 15-minute, sessions and from session frequencies of one, or two, or three, or four times weekly.Development of a meaningful relationship, the appearance of insight, the expression and acceptance of feelings, alteration of self-defeating thoughts and behavior and understanding of the effects of the past on the present all depend on, and in some degree arise from the structural nature of psychotherapy.Patient insight into the effects of the past on the present derives from awareness of the discrepancies between wishes or expectations and the nature of the therapeutic structural contract.Also, acceptance and expression of feelings are promoted by the therapist's essential neutrality.In those therapies in which structure is not specifically contracted or fixed, exploration and working-through are seldom possible or desired because a trial domain of interpersonal behavior is not established.The therapist provides variable lengths of time, gives directives and advice, and otherwise does not delimit the therapeutic structure.However, even in these, there are some implicit limits on time and therapist involvement that constitute variable degrees of structure.Interpretation, insight, and some important working-through frequently occurs.
Author: Albert Rothenberg
Institution: Harvard University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4410864271