8.2.1. Outline: Varieties of Alliance Difficulty Marker in PE Therapy
A. Confrontation Difficulty Markers:
1. Client experiences therapist behavior as damaging, attacking or disparaging:
•“I’m sure you hate me. That’s why you’re making fun of me!”
•”I feel like you’re just sitting back judging me.”
2. Client is frightened by depth/intensity of therapy:
•“I don’t feel safe with you. I don’t think it’s right to talk about such personal things with anyone. Let’s talk about something else, OK?”
•“After the session last week, I went home and got so angry that I broke a chair. I don’t want to stir up those feelings again, please!”
3. Client complains about lack of progress or getting worse:
•“I feel stuck, like I’m not progressing anymore. Maybe I'm even going backwards!”
•After beginning to work on trauma memories, client with PTSD complains that nightmares and flashbacks have gotten worse.
4. Client criticizes therapist, or approach:
•“There you go, exaggerating again. I hate it when you do that!"
•Client questions therapist’s training or credentials. ("You seem too young to be able to help someone my age. I'll bet you're the same age as my granddaughter!")
•“I still don’t see the point of going into all this emotion stuff. Like I've told you before, my problem is that I have too many emotions, and they get me in trouble!”
•Client repeatedly makes fun of therapist’s language and therapeutic approach. (“I don’t go in for all this ‘new age’ crap; you sound like you’re from California!”)
5. Client becomes angry, verbally attacks therapist:
•Shouting: “Stop laughing at me!”
•“You’re just like all the other therapists I’ve seen. You just want to use me for your own enjoyment. You don’t give a damn about anything but your own ego!”
6. Client requests or demands expert guidance from therapist.
•C: I know you’re not supposed to give advice, but I really think I need someone to tell me what to do about these fear attacks I keep having.
•C: Now that I’ve told you all these things about myself, I want your honest, professional opinion about me. What do you think is really the matter with me? What’s your expert advice about how to solve my problems?
•C: I want you to tell me: Did I do the right thing?
7. Client is intrusive, crosses therapist boundaries:
•C: Now that I’ve told you all these things about myself, I think it’s only fair that you tell me something about yourself. Are you are student here? What are you studying? How far along are you in your studies? Are you married? Do you have a boyfriend? Where do you live? etc., etc.
•Client obtains therapist’s phone number, calls therapist repeatedly.
B. Withdrawal Difficulty Markers:
1. Client refuses to do suggested active task (e.g., chair work) (see also Yontef, 1998):
T: I wonder if you be willing to imagine your father in that chair, and talk to him.
C: No, I don’t think so. I’m not a good actor. I’d be too embarrassed. I tried that before, and it just made me feel stupid.
2. Client consistently dismisses or rejects therapist responses without explicitly complaining about them:
•Reflections are met with, "Yeah, that's what I said! Who wouldn't feel that way?"
•Questions are refused ("I don't think we need to go into that") or turned back on the therapist ("Why do you want to know?").
3. Client disengages from therapy:
•Client keeps no showing, canceling at the last minute, or coming very late for sessions. When the therapist phones the client, she apologizes and insists she is still interested in therapy.
•After a couple of productive but intense exploratory sessions, the client becomes external, keeps switching topics to other people.
4. Client experiences severe loss of working distance in session:
•Client dissociates or hallucinates in session: e.g., goes into “away” state (“Things just don’t seem real.”)
5. Client communicates in a manner which therapist finds difficult to maintain attention:
•Client insists on telling long, highly detailed stories whose point is unclear.
•Client drones on in monotonous voice, without apparent interest or energy.
C. Therapist-specific Difficulty Markers:
1. Therapist feels judgmental or nonaccepting of client or client actions, even after trying usual strategies for dealing with such reactions (Lietaer, 1984):
•Client displays racist or sexist attitudes.
•Client reveals continuing involvement in petty criminal activities such as shoplifting, theft, beating up people to collect loans, torturing animals etc.
2. Therapist is impaired by tiredness or emotional distress:
•Therapist has difficulty staying awake in session.
•Therapist upset by personal or work crisis, finds attention drifting in spite of efforts to attend to client.
Materials designed to
accompany the book Learning Emotion-Focused Therapy: The
Process-Experiential Approach to Change from APA Books.
©2003 Robert Elliott, Jeanne Watson, Rhonda Goldman, and Leslie Greenberg