Relational Patterns and the Development of the Alliance: A Systematic Comparison of two Cases

Emanuel Schattner, Orya Tishby, Hadas Wiseman

Research output: Contribution to journalArticlepeer-review


A systematic case study approach was taken to explore the impact of client and therapist relational patterns on the development of the therapeutic alliance and symptom reduction in two cases of psychodynamic psychotherapy treated by the same therapist. The cases were selected from a larger sample and represent two distinct trajectories of alliance development: improvement versus deterioration. The comparison was based on participants' ongoing narratives about each other and about significant others, using the Relationship Anecdote Paradigm (RAP) interview. The qualitative findings were triangulated with process and outcome measures assessed at four time points during the year of treatment. We hypothesized that different therapeutic processes, including different handling by the therapist of interpersonal difficulties as they arose in treatment, could explain the two distinct trajectories of alliance development and symptom change within the caseload of one therapist. Results indicate two linked elements that may explain a steady increase in alliance and decrease in symptoms in one case, compared with the second case that started with an increase in alliance and symptom improvement, but gradually reached an impasse and a setback in symptoms. One element was the extent to which client's and therapist's relational patterns clashed, impacting each other negatively. The second was the extent to which differences and disagreements were stated openly and negotiated so that the therapist could flexibly adapt to meet the client's relational patterns in one case versus inability to do so in the other. Implications for training and other psychotherapy orientations are discussed.

Original languageEnglish
Pages (from-to)555-568
Number of pages14
JournalClinical Psychology and Psychotherapy
Issue number2
StatePublished - 1 Mar 2017

Bibliographical note

Publisher Copyright:
Copyright © 2016 John Wiley & Sons, Ltd.


  • Alliance
  • Psychodynamic Psychotherapy
  • Qualitative
  • Relational Narrative
  • Systematic Case Study

ASJC Scopus subject areas

  • Clinical Psychology


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