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The corrective emotional experience: A relational perspective and critique

It has become a commonplace assumption in many psychother-
apy traditions that a corrective emotional experience (CEE; Alexander,
1950; Alexander & French, 1946) is an important mechanism of thera-
peutic action (Goldfried, 1980). In this chapter, we present a contem-
porary relational perspective on the CEE (Aron, 1996; Bromberg, 1998,
2006; Mitchell, 1988, 1993, 1997). We also present Safran and Muran’s
(2003) model of therapeutic alliance rupture and repair as an example of
an empirical research program that has been informed by the relational
perspective on the CEE. We begin by outlining Franz Alexander’s original
conceptualization of the CEE, and the theoretical controversies that it
engendered. We also provide a retrospective account of some sociopolitical
factors that led to its marginalization within mainstream psychoanalysis
at the time. We then proceed to discuss a more contemporary psycho-
analytic perspective on the CEE, with a particular emphasis on relational
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At the age of 30, Franz Alexander was the first graduate of the Berlin
Psychoanalytic Institute. He was also the founder of the second oldest psycho-
analytic institute in the United States—the Chicago Institute for Psycho-
analysis, established only 5 months after the New York Psychoanalytic
Institute. Freud considered Alexander to be one of the more “promising of
the younger generations of analysts” (Marmor, n.d., p. 5), and he wrote of
the young Alexander in a letter (Freud, 1925) to Ferenczi: “The boy is cer-
tainly something extraordinarily good.” Indeed, with the development of the
CEE, Alexander advanced one of the most disputed ideas in psychoanalytic
His influential article of 1950, “Analysis of the Therapeutic Factors in
Psychoanalytic Treatment,” stood as a critical reevaluation of how psycho-
analysis was thought to achieve its clinical aims. This important article
explored methods of shortening the duration of therapy and developing spe-
cific techniques that would keep treatments from drifting into what Alexander
and French (1946) deemed “interminable analyses” and “insoluble transfer-
ence neuroses.” Alexander began his controversial treatise with questions
about the process that takes place in psychoanalysis that accounts for mean-
ingful change. Are the changes observed in protracted treatments the prod-
uct of intellectual insight, expression of emotions, feelings in relation to the
therapist, or simply due to the passage of time as events in a person’s life
transpire over the course of a long psychotherapy?
Before his 1950 article, Alexander had used the term corrective emotional
experience in a ta lk d eli ver ed t o th e Am eri can Soc iet y fo r Research in Psycho-
somatic Problems in 1945 and then, a year later, in the article “Individual
Psychotherapy” in the Journal of Psychosomatic Medicine (1946). In this sel-
domly cited work, drawing on Freud’s (1912/1953) ideas about the role that
transference plays in treatment, Alexander (1946) argued that the “revival
of the original conflicts in the transference situation gives the ego a new
opportunity to grapple with the unresolved conflicts of the past” (p. 112).
In relationship with the therapist, the client could now reexperience the
thoughts, desires, and impulses that existed earlier in life in relation to his or
her parents that, for a variety of reasons, had been repressed. Treatment offered
the client an opportunity to bring the repressed material in line with an ego
that in its present time was more mature and less easily overwhelmed than it
was at the time of repression. It entailed what Alexander (1946) described as
an “emotional training” that gave the ego “an opportunity to face again and
again, in smaller or larger doses, formerly unbearable emotional situations and
to deal with them in a different manner than in the past” (p. 115).
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According to Alexander (1946), several features make transference
usable. One is that the intensity of the repressed material itself is diminished
when reexperienced in the transference as compared with when repression
was initially mobilized. Furthermore, the therapist represents a less frighten-
ing object in the present than the parents did to the client’s less resourceful
ego at the time of repression. In the course of analysis, and in relationship
with the less dangerous therapist, the client has the chance to confirm or
disconfirm his or her fears regarding the consequences of expressing what
had hitherto been repressed or otherwise defended against. In this process,
Alexander (1946) believed that “intellectual insight alone is not sufficient”
(p. 115). Only the actual experiencing of a new outcome, an outcome that
was the exact opposite of the client’s expectation, could “give the patient the
conviction that a new solution is possible and induces him to give up the old
neurotic patterns” (p. 115). For this new experience to be curative, the thera-
pist’s response needed to be deliberately aimed at correcting the pathogenic
effects of the parental attitudes; They should reverse “the adverse influences
in the patient’s past” (Alexander, 1950, p. 500).
Although the term corrective emotional experience was introduced
in 1946, the basic ideas underlying this construct had been spelled out by
Alexander (1925) in a much earlier article, “A Metapsychological Descrip-
tion of the Process of Cure.” Here, Alexander maintained that “the task of all
future psycho-analytic therapy” (p. 32) was to analyze and dissipate the tyran-
nical superego as it became experienced in relation to the therapist. His focus
on undoing the effects of the introjected “educational code” from the parents
and taming the harshness of the superego would be themes taken up a decade
later by Strachey (1934) in his classic article “The Nature of the Therapeutic
Action of Psychoanalysis,” one in which Strachey credited Alexander’s influ-
ence. However, different from Strachey, Alexander (1946) argued that it was
not enough for the therapist to assume a neutral stance that would throw into
sharp relief the distortion between the client’s expectations of the therapist
(i.e., transference) and the therapist’s actual behavior. For Alexander, what
was required was an active assumption of a role designed to lean in the exact
opposite direction of the client’s expectations. Alexander (1946) wrote:
The intimidating influence of a tyrannical father can frequently be cor-
rected in a relatively short time by the consistently permissive and pro-
nounced encouraging attitude of the therapist but only after the patient
has transferred to the therapist his typical emotional reactions originally
directed towards the father. (p. 114)
Alexander (1946, 1950) disagreed with the main tenets of ego psychol-
ogy by recommending a type of analytic action or activity to be assumed by
the therapist that could be characterized as concrete demonstrations rather
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than the insight achieved through the type of interpretation on which ego
psychology traditionally relied. In Alexander’s (1950) model, the client is
awakened from his or her transference-induced somber, not just, or even
mainly, by an interpretation, but by the therapist’s overt attitude crafted as if
to say, “Look, I’m different from the father or the mother that you expected.”
This new experience leads to a type of learning that could not have occurred
outside the treatment setting. After all, it’s unlikely that every past object in
the client’s life should have behaved in exactly the same distressing way as
his or her parents. Only a therapist, by virtue of the transference with which
he or she is invested, was now in a position to both inhabit the parent’s role
and undo the parent’s iatrogenic impact. Furthermore, and herein lies a
second highly contentious issue, this active stance of the therapist would
lead, Alexander (1950) believed, to “speedy” results, bypassing the process,
considered critical in classical psychoanalysis, of working through—a process
that entails repeatedly applying psychoanalytically obtained insight across
multiple situations over an extended period of time.
From the perspective of ego psychology, the dominant psychoanalytic
tradition in North America during Alexander’s lifetime (and until the 1980s),
the concept of the CEE threatened “the very heart of the psychoanalytic
enterprise” (Wallerstein, 1995, p. 55), challenging the mutative primacy of
interpretation and insight. As Blum (1979) put it, “insight is the sine qua non
of psychoanalysis” (p. 43) and “interpretation leading to insight is the spe-
cific and most powerful agent of the psychoanalytic curative process” (p. 43).
The reliance on interpretation as opposed to the therapeutic relationship
and the emphasis on insight in the context of heightened affect were fun-
damental tenets that defined psychoanalysis and distinguished it from other
forms of therapy. Loewenstein (1951), commenting on Alexander’s (1950)
ideas shortly after they were published, asserted that the notion of a CEE was
“a devaluation of what is specifically psychoanalytic: i.e., of the dynamic of
changes produced by insight gained from interpretations” (p. 3).
Alexander’s (1950) recommendation that the therapist assume a role
that was designed to counter that of the parents raised concerns among main-
stream therapists that he was attempting to change the client through the
intentional use of the therapeutic relationship, considered by some as a form
of technical manipulation, rather than through the process of showing the
client the nature of his or her intrapsychic conflicts and the corresponding
attempts at solutions. Why was this considered so controversial? When Freud
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first began developing his approach at the turn of the century, he had used
hypnosis to help his clients recover repressed memories (and associated emo-
tions) of traumatic events. After a few years, Freud abandoned the use of hyp-
nosis, because of its unreliability as a method, but more important, because
he came to distrust the reliability of the recovered memories themselves.
Over time, Freud (1916) and the early therapists came to believe that it was
vital to make a clear distinction between psychoanalysis and the tradition of
hypnosis out of which it had emerged. Although it was common in the early
20th century for both charismatic healers and many members of the medical
profession to use hypnosis and various forms of suggestion to treat psychologi-
cal and psychosomatic problems, hypnosis had not yet completely shed its
public image as a form of quackery. Freud and his colleagues were thus eager
to establish psychoanalysis as a treatment that, unlike hypnosis, was based
on true scientific principles (Safran, 2011). By doing so, Freud sought to
dispel the accusation put forth by critics who charged that changes in psycho-
analysis were nothing more than the result of suggestion and manipulation.
Henceforth, a belief in the value of autonomy as a therapeutic goal and a
disciplined effort to avoid imposing personal influence of any kind that would
compromise the client’s growth in an autonomous direction became a cen-
tral tenet of psychoanalysis—one that Alexander’s (1946, 1950) approach
seemed to challenge as he proposed the use of the therapeutic relationship to
bring about change.
To some, Alexander’s (1950) recommendations were radical altera-
tions to standard analytic method: the shortening of treatment, the use of
overt action in place of interpretation to achieve therapeutic change, and a
re-assessment of the value of working through. Despite the magnitude of these
changes, some argued that the intense opposition to Alexander’s recommen-
dations had much less to do with his specific clinical suggestions than with
the impression, perhaps an accurate one, that psychoanalysis as an enterprise
was being undermined with the promise of briefer, alternative forms of treat-
ment, the likes of which threatened to erode the boundary between psycho-
analysis and psychotherapy.
Alexander, the most promising of the young generation of analysts, had
managed to unsettle the psychoanalytic establishment, and in response to a
perceived threat, the psychoanalytic establishment became more rigid. Eisold
(2005) pointed out that the notion of “parameters” introduced by Eissler in
1953 was meant to draw the line between what was acceptable, standard
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technique in response to Alexander’s (1950) “flexibility” (p. 500): “I define the
parameter of a technique as the deviation, both quantitative and qualitative,
from the basic model technique, that is to say, from a technique which requires
interpretation as the exclusive tool” (Eissler, 1953, p. 110).
A CEE was considered by many as an alloyed version of the true gold of
psychoanalysis, diluted, as Freud (1919/1953) described it, “with the copper
of direct suggestion” (p. 168) and fated to become part of the cadre of support-
ive and brief psychotherapies. Leading figures in ego psychology, including
Rangell (1954), argued that although the maneuvers of a CEE may occa-
sionally be indicated, they “distinctly constitute dynamic psychotherapy
in contrast to psychoanalysis” (p. 743). Similarly, Gill (1954) stated that
analysis “results in the development of a regressive transference neurosis and
the ultimate resolution of this neurosis by technique of interpretation alone”
(p. 775). Wallerstein (1989) concluded that the CEE would be deemed appro-
priate in supportive therapies, along with advice giving, and reeducation, but
serve as a clear contrast to “interpretation leading to insight as the central
mechanism in the expressive psychotherapeutic approaches” (p. 138).
Paralleling the valuing of insight in psychoanalysis was a concurrent
devaluing of action. Traditionally, action was discussed on the part of the client
and deemed anathema to the goals of psychoanalysis, which emphasized the
suppression of action in the service of recollection. Roughton (1996) noted that
“from the very beginning of ‘the talking cure,’ there has been a strong tendency
to exclude action, both in fact and in theory, from this mostly verbal process”
(p. 130). The client was thought to “act out” that which he or she wished not
to remember. If psychoanalysis was to be a successful form of treatment, it was
necessary that the client be capable of refraining from action in favor of thinking
and remembering. Freud (1914/1953) wrote that the client repeats “without, of
course, knowing that he is repeating it” (p. 150). Action serves both to com-
municate what cannot be recalled and to avoid full recollection by acting out.
These ambivalent views of action and of the action-prone client also
applied to the therapist. If treatment was to be considered psychoanalytic, the
therapist’s action needed to be limited to interpretation. The ego psycholo-
gist’s aim was to help the client move from privileging and valuing action to
a more cognitive place that privileged the value of insight and the client’s
ego capacity for refraining from action and discharge, in favor of reasoning.1
1For an incisive look at the ways in which psychoanalysis is grounded in the Enlightenment, see Eagle (2011).
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To Alexander’s (1946) refrain that intellectual insight alone was not enough,
ego psychologists would rejoin that emotional experience without insight
was without therapeutic value at best and counterproductive at worst—
counterproductive, that is, to the extent that action served as a resistance
to self-knowledge, the true aim of psychoanalysis. By the mid 1970s, the fate
of Alexander’s CEE was all but sealed.
By the 1980s, the unified psychoanalytic mainstream in North America
was beginning to splinter into different factions, and a new era of psycho-
analytic pluralism was beginning to emerge (Wallerstein, 2002). There were
many factors responsible for this, but certainly one of the more important
ones was the growing influence of Heinz Kohut’s (1971, 1977) self psycho-
logy. Kohut, who had established solid credentials as a psychoanalytic
insider, gradually developed a psychoanalytic approach that increasingly
came to diverge in fundamental ways from the mainstream. Central to his
thinking was the pivotal role that empathic mirroring plays in helping the indi-
vidual develop a cohesive sense of self, as well as the role that working through
empathic failures plays in the change process.
Although interpretation always remained a critically important thera-
peutic tool for Kohut, he increasingly came to emphasize the role of the
therapeutic relationship as a central mechanism of change in and of itself.
From his perspective, the critical turning points in treatment occur when
inevitable periods of misattunement take place between the therapist and
client, and when the therapist and client are able to work through these
potentially traumatic experiences in a constructive fashion. Without going
into the details of Kohut’s (1984) thinking about the precise mechanisms
through which these periods of relational miscoordination and repair lead to
change, suffice to say that there is something about a constructive relational
experience at play here.
Kohut’s (1984) emphasis on the importance of working through
potentially traumatic events in the therapeutic relationship, or therapeu-
tic impasses, had been prefigured in the psychoanalytic literature as early as
the 1930s by Freud’s close colleague Sándor Ferenczi. Although ultimately
marginalized by the psychoanalytic mainstream, the influence of Ferenczi’s
thinking operated as an underground current that influenced the thinking of
many subsequent psychoanalysts, including contemporary relational psycho-
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In some essential respects, Alexander’s ideas about the role of the thera-
peutic relationship were no different from what Kohut would in time pro-
pose. In fact, the language that Kohut and Alexander used to describe the
relational aspects of treatment was often indistinguishable. Kohut (1984),
for instance, asserted that the therapist’s protracted and consistent endeavor
to understand the client leads to results that are analogous to the outcome
of childhood development. The client comes to realize that “contrary to
his experience in childhood, the sustaining echo of empathic resonance is
available in this world” (p. 78). Note that here Kohut is not emphasizing
change that occurs as a consequence of interpretation and ensuing insight,
but rather, a change that occurs in response to an analytic attitude. Kohut
concurred with Alexander that the working through in psychoanalysis is a
process by which the client revisits old conflicts with a more mature psyche,
and in 1968, Kohut granted that on certain occasions, with certain clients,
the analyst must indulge a transference wish of the analysand; specifi-
cally, that the client had not received the necessary emotional echo or
approval from the depressive mother, and that the analyst must now give
it to her in order to provide a “corrective emotional experience.” (p. 111)
Early on, Kohut (1968) envisioned the use of a CEE as an auxiliary element
of treatment but not the predicate of therapeutic change, and he was quick
to add that the “true analytic aim is not indulgence but mastery based on
insight, achieved in a setting of (tolerable) analytic abstinence” (p. 111).
Yet, in time, Kohut’s (1984) views about the role of insight shifted,
falling more in line with that of Alexander, who relegated insight to a gen-
eral category of factors that accounted for change in treatment but was not
the principal factor as ego psychology insisted. By 1984, in his last book,
anticipating obvious comparisons to Alexander, Kohut responded that if the
charge is that “I both believe in the curative effect of the ‘corrective emo-
tional experience’ and equate such experience with analysis, I could only
reply: so be it” (p. 78). The defensive tone of Kohut’s statement attests to the
level of controversy that had accrued around the concept of a CEE.
With the emergence of the interpersonal and relational perspectives
in North America, Alexander’s ideas would find some support in the chal-
lenge that they represented to the preeminent status afforded to insight in
the analytic process. Few analysts disagree with Alexander’s (1946) premise
that insight is not enough and that therapeutic change relies on relational
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elements of psychoanalysis. Aron (1990), for example, asserted that “for rela-
tional model theorists, relationship along with insight are thought to be the
central therapeutic factors” (p. 443). Yet, despite areas of overlap, specifically
as it pertains to Alexander elevating the mutative role of the analytic relation-
ship, interpersonalists and relationists disagree with Alexander’s views on the
nature of the relationship as Alexander envisioned, by virtue of how Alexander
privileges the therapist’s authority as the one who supposedly knows precisely
what type of experience is, in fact, corrective. Cooper (2007) stated, “More
than any other writer/analyst I have encountered, [Alexander] believes in the
value and power of the analyst’s ability to be objective and neutral” (p. 1091).
From a relational perspective, there are two interdependent issues at the heart
of the disagreement with Alexander’s (1950) position. The first concerns the
relational critique of the classical psychoanalytic perspective, which assumes
that the therapist has a privileged perspective on reality and on what the cli-
ent needs. This critique is related to the relational position on analytic author-
ity and the emphasis on deconstructing the role of power in the therapeutic
relationship (Safran, 2011). The second issue is the relational assumption that
the therapist is always part of a bipersonal field constituted by the therapist–
client relationship, and a related skepticism about the therapist’s ability to
ever step completely outside of this field and look at the client with some
degree of objectivity. This, in turn, is related to the relational perspective on
the process through which any type of corrective experience (more broadly
defined) can actually take place in the treatment.
Many relationists contend that it is inevitable that clients and thera-
pists will become embedded in repetitive relational scenarios that reflect the
unconscious contributions of both client and therapist. These repetitive,
bipersonal scenarios, referred to as enactments, are viewed as both one of
the most challenging aspects of working with more difficult clients and an
important potential source of understanding about the client and an oppor-
tunity for change. Through the process of participating in these inevitable
enactments, the therapist is able to develop a lived sense of what it is like
to be part of the client’s relational world. By reflecting on the nature of his
or her participation in these enactments, the therapist is ultimately able to
disembed himself or herself and begin acting in a different way. This process
is the relational equivalent of a CEE; that is, the process of disembedding and
finding a new way of being with the client, which will hopefully provide the
client with a relational experience that is sufficiently different from the repet-
itive and unreflected-on scenarios that the client consistently enacts in his
relationships with others. With these new experiences, the client’s view of
what might actually be possible in the interpersonal realm begins to change
(Aron, 1996; Bromberg, 1998, 2006; Mitchell, 1988, 1993). The contempo-
rary relational perspective is thus very much in harmony with Alexander’s
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emphasis on the relational and experiential aspect of treatment. Where it
differs, however, is in its sense of (a) whether the therapist is capable of deter-
mining in advance what type of relational stance on his or her part might be
desirable and (b) whether it is desirable to intentionally play a certain role
with the client, even if it were possible.
Alexander’s (1950) view of how the relationship was curative would, in
time, clash with the emphasis that relational thinking places on the uncon-
scious nature of enactments. Sandler (1976), for example, clearly articulated
how the therapist responds to the client’s demands and how this role respon-
siveness develops both interpersonally and outside of conscious awareness of
both participants. This is in sharp contrast with Alexander’s (1950) purpose-
ful therapeutic strategy, which Aron (1992) described as a curative “role-
playing” (p. 494), one that would inevitably taint the therapist’s responses
to the client with an element of disingenuousness. For relationists and inter-
personalists, it was critical that the therapist’s response to the client not
be deliberate or staged. Enactments, as Lionells (1995) aptly pointed out,
are only “potent when they occur spontaneously so they may be studied as
emerging, unconscious interpersonal paradigms” (p. 229). Similarly, Sandler
(1976) wrote,
very often the irrational response of the analyst, which his professional
conscience leads him to see entirely as a blind spot of his own, may some-
times be usefully regarded as a compromise-formation between his own
tendencies and his reflexive acceptance of the role which the patient is
forcing on him. (p. 46)
It is the unintended quality of the enactment that is important in the
client–therapist relationship to the extent that it creates a space for the
unconscious processes emanating from both participants to be analyzed. Katz
(1998) labeled the process as the enacted dimension of psychoanalysis, which
he believed
occurs naturally and inevitably, without conscious awareness or inten-
tion. It exists alongside, and in concert with, the treatment’s verbally
symbolized content, an ongoing and evolving realm of analytic process
with features unique to each analytic dyad. In these terms, the thera-
peutic action of psychoanalysis may be considered a function of two inter-
woven and inextricable treatment processes: transference experienced
enactively and insight symbolized verbally. (p. 1132)
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In the wake of the controversies attendant to Alexander’s (1950) ideas
about the role of action in psychoanalysis and the role of the person of the
therapist as an agent of change, insight became increasingly pitted against
the analytic relationship. Although this argument is largely recognized as a
straw man by most analysts today, who would readily agree that insight is only
transformative in the context of an affectively charged and meaningful rela-
tionship with the therapist, the question becomes an empirical one. After all,
the real challenge that a CEE poses to classical psychoanalysis is the idea that
meaningful change can occur in treatment irrespective of the development of
insight as traditionally defined, that is, in terms of semantic knowledge. Many
of the arguments for and against Alexander’s (1946, 1950) model have been
made on theoretical grounds.
A line of research that has some bearing on contemporary views of
the CEE has been carried out by Safran and Muran (1990, 1996, 2003;
Safran, Muran, & Eubancks-Carter, 2011; Safran, Muran, Wallner Samstag,
& Stevens, 2001) on the negotiation of the therapeutic alliance and rupture
resolutions strategies in psychotherapy. Drawing on the recognized impor-
tance of a therapeutic alliance in the treatment process, Safran and Muran
(2003) proposed a method for assessing how clients respond to ruptures in
the alliance that can aid our understanding of how and why such ruptures
emerge, and the means by which they are repaired. The relational theoretical
perspective on which this line of research rests converges in some important
respects with Alexander and French’s (1946) notion of the corrective emo-
tional experience.
Over the past 2 decades, Safran and colleagues (Safran, 1993; Safran,
Crocker, McMain, & Murray, 1990; Safran & Muran, 1996, 2003) have
placed particular emphasis on the role that repairing ruptures in the thera-
peutic alliance can play in facilitating a CEE. Building on developmental
research on affect miscoordination and repair (e.g., Tronick, 2007), Safran
et al. (1990) suggested that the process of repairing ruptures in the therapeu-
tic alliance may help clients to develop a representation of self as capable of
reestablishing interpersonal connection and the other as potentially avail-
able, even in the face of life’s inevitable disruptions in interpersonal related-
ness. Safran (1993) explicitly linked the mechanism of change associated
with repairing alliance ruptures to Alexander’s (1946) notion of the CEE,
and traced the origins of this line of thinking back to the early influence of
Ferenczi (1933/1980) and the subsequent influence of his protégé Michael
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Balint (1968). Safran and Muran (2003) conceptualized the therapeutic alli-
ance as a process of ongoing negotiation between therapist and client, which
can provide the client with a vital opportunity to learn to negotiate the dia-
lectical tension between his or her own needs for agency versus relatedness.
In their research program, Safran and Muran (2003) have found it use-
ful to identify ruptures in the alliance in terms of specific client behaviors or
communication and have organized these ruptures into two general subtypes:
withdrawal and confrontation. In ruptures marked by withdrawal, the client
withdraws or partially disengages from the therapist, his or her own emo-
tions, or some aspect of the therapeutic process. In confrontation-type rup-
tures, the client directly expresses anger, resentment, or dissatisfaction with
the therapist or some aspect of the therapy, with variations in terms of how
directly or indirectly the confrontation is initially expressed. Withdrawal and
confrontation reflect different ways of coping with the dialectical tension
between the needs for agency and relatedness. In withdrawal ruptures, the cli-
ent strives for relatedness at the cost of the need for agency or self-definition.
In confrontation ruptures, the client negotiates the conflict by favoring the
need for agency or self-definition over the need for relatedness.
Working through alliance ruptures involves a process of clarifying both
underlying needs that are dissociated and tacit fears and expectations that
lead clients to dissociate these needs. If the therapist is able to maintain a
curious and nondefensive stance, a CEE takes place in which clients learn
that the relevant fears are unwarranted and that it is safe to express dissoci-
ated needs and wishes in the therapeutic relationship.
The process of working through withdrawal ruptures in a constructive
way thus constitutes a form of CEE through the process of helping clients learn
that they can express dissociated needs for self-assertion or agency without
destroying relationships. The process of working through confrontation rup-
tures can provide clients with a type of CEE by virtue of the fact that (a) clients
can learn that the therapist can tolerate and survive their aggression and
(b) dissociated needs for dependency and nurturance are safe to express.
Consistent with a contemporary relational perspective, Safran and
Muran (2006) do not believe that clients have one core maladaptive schema
that is activated in therapy and then challenged by an intentional effort by
the therapist to assume an interpersonal stance that challenges this schema.
Instead, they conceptualized the therapeutic process as an ongoing cycle of
mutual enactment and disembedding. Therapists unwittingly become partners
in enactments, or interpersonal dances, that reflect the unique intersection
of unconscious aspects of both clients’ and therapists’ subjectivities. It is only
through the process of collaboratively exploring what is taking place at such
times that both therapists and clients can begin to understand the nature of
the enactments that are taking place. This process of developing an experien-
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tially based awareness of what is taking place helps the client and therapist to
disembed, or unhook, from the dance in which they are trapped. This process of
disembedding functions as a CEE insofar as it challenges the client’s stereotypes
expectations of the way relationships will play out.
For example, a therapist gradually becomes aware that he has been feel-
ing frustrated and angry with his client and unconsciously expressing aggres-
sive feelings toward him. By acknowledging and exploring this aspect of his
contribution to the interaction, the therapist is able to reposition himself
into a more genuinely sympathetic role vis-à-vis the client’s experience of
being a persecuted victim and the therapist’s recognition of his participation
in a role-responsive enactment. This process in turn paves the way for the
client to begin the process of becoming aware of the way in which his expec-
tations that others will exploit him lead him to act in a passive–aggressive
fashion that elicits sadistic responses from others. It is critical to emphasize
that this process of collaboratively making sense of what is taking place in
the therapeutic relationship constitutes a contemporary version of a CEE—
one that stresses the unconscious dimensions that determine the therapist’s
and client’s participation in the enacted dimension of treatment that can
potentially render, once recognized and explored, the relational process in
treatment as a clinically significant mechanism of change.
Today, when the concept of a CEE is invoked in psychoanalytic think-
ing, it tends to be stripped of the elements that made the original concept so
controversial. The idea that the therapist should manipulate the transference
so as to overtly behave in a way that is opposite to that of the client’s past
objects has virtually disappeared from most discussions of a CEE for reasons
that we elucidated in this chapter. Instead, what has been preserved in the
current usage of the term is the idea that there is something curative about
the relationship with the therapist that works alongside interpretation and
insight, and by now, this idea has become an unobjectionable and, in fact,
widely accepted tenet across theoretical orientations.
What remains controversial among psychoanalysts is the question of
the particular mechanisms through which CEEs contribute to the change
process. Is some form of conceptual understanding on the client’s part neces-
sary for significant therapeutic change to occur in therapy, or is there some-
thing about the experience with the therapist that, in and of itself, suffices
to bring about meaningful change? Can insight encompass or be defined by
learning that occurs at a procedural, implicit, or subsymbolic level, which
is not dependent on its verbal expression for it to have lasting therapeutic
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... The third pathway is an expressive pathway that centers the rupture and makes it the focus of the therapeutic work, at least for a time. We stress that all of these pathways can facilitate repair of the rupture as well as a corrective experience for the patient (Christian et al., 2012), and increasingly we are attending more to how patients contribute to these repair efforts. In AFT we often focus on the third pathway as it is usually the one trainees are least familiar with and most apprehensive about. ...
... Volume 19, Module 2, Article 3, pp. 160-173, 04-17-23 [copyright by author] 168 conflict with another who is meeting them with genuine empathy, curiosity, and respect, which may directly contradict previous interpersonal experiences (Christian et al., 2012;Muran & Eubanks, 2020). ...
Full-text available
The case of Chris (Yunusova, 2023) details an 8-session Accelerated Experiential-Dynamic Psychotherapy (AEDP) treatment delivered in the context of a university clinic. Chris is a 30-year-old white male who had nearly completed a doctoral program at the time of treatment. He presented to treatment with the goals of addressing loneliness and depressive thought patterns in the context of the expectation that his emotions were overwhelming and noxious to others. The case illustrates the active role that avoidance and exposure can play in AEDP, with emphasis on affective exposure by way of AEDP's efforts to increase the patient's tolerance of their own emotions as well as those of others. The following discussion applies the integrative notion of principles of change in psychotherapy to the case of Chris, with an explicit focus on the therapeutic alliance and the emergence of alliance rupture markers in the development of the case.
... With help of therapeutic interventions, such as schema therapeutic interventions and limiting reparenting, which provides new corrective emotional experiences of acceptance and safety (Arntz and Van Genderen 2020;Christian et al. 2012), Jill is invited to re-write her narrative, and to define her identity no longer in terms of a shameful sinner. Instead of attributing all guilt and shame to herself, she gradually learns to notice the guilt and negligence of others. ...
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This article argues how the clinical psychology of religion can support mental health and mental health care. The starting point is an ecological–existential approach to mental health, that stresses the interactions between person and environment, with an emphasis on the existential dimension of interactions. This approach will be related to religion and spirituality (R/S) and the study of R/S and mental health. To show the added value of an ecological–existential approach, the emotion of shame will be discussed as an illustrative case. Finally, implications for clinical psychology of religion and mental health care will be outlined and a clinical case report will be presented.
... Ruptures present challenges for treatment, as they mark moments of poor patient-therapist collaboration and, if left unrepaired, predict premature dropout and poor treatment outcome; at the same time, rupture repair is associated with good treatment outcome, and this association is not moderated by patient PD diagnosis [32]. Repairing an alliance rupture can provide a valuable corrective experience for patients who may be accustomed to experiencing criticism, rejection, or abandonment in their interpersonal relationships [33]. ...
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Purpose of Review Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Recent Findings Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. Summary We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy.
... By contrast, it has been argued that the therapeutic relationship is helpful because interacting with a dependable, non-judgmental, empathetic other provides a corrective emotional experience to unpredictable, abusive and/or dismissive parental behavior one was exposed to while growing up (Alexander, 1980;Christian et al., 2012). It is likely that this new experience sheds a different light on past experiences. ...
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Objective: As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes. Method: Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment. Results: After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge. Conclusion: The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.
... This shift changes the intersubjective field. In particular, the welcome the client now finds in his therapist becomes the emotional and relational ground necessary to dare to take a step into the unknown (previously impossible) and live a new experience (Alexander 1946;Hycner and Jacobs 1995;Bernier and Dozier 2002;Christian, Safran and Muran 2012). Translating the phenomenological approach into the language of affects and, for example, replacing "the intentionality of the encounter"-"intentionality" in a field perspective, taking into account the mutual presence of therapist and client-by "listening to the secret longing" has, in our opinion, the primary virtue of shedding light on the session and reorienting the wandering practitioner toward an authentic encounter with his client. ...
From the perspective of relational and field Gestalt therapy, the authors shed light on the phenomenology of clinical intervention by showing that the therapist’s main activity consists in adjusting his or her own resonance to the movement toward contact—to the impulse—which informs the therapeutic encounter itself. The therapist “positions” himself in order to “hear” better. And it is this change in the therapist that leads toward change in the patient. A clinical example illustrates the different moments in this process. By designating the intentionality at work in the encounter as a secret longing, the authors introduce a new concept, offering practitioners a sensitive compass that allows them to orientate themselves and persevere in their efforts to adjust to patients and maintain their aim of reaching them.
... Second, a rupture presents an opportunity to identify and address the patient's interpersonal schemas (Safran & Muran, 2000;Safran & Segal, 1990). Collaboratively working through a rupture with a therapist who models adaptive interpersonal skills can provide the patient with a corrective experience that expands their understanding of how to navigate relational conflicts (Christian et al., 2012). A corrective repair experience may also strengthen the alliance, resulting in more patientand perhaps also therapist-engagement in therapy. ...
A strong therapeutic relationship provides the optimal context for CBT, and an important component of this relationship is the alliance. An alliance rupture is a difficulty or deterioration in the alliance manifested by a lack of collaboration on therapy tasks or goals or a strain in the bond. The process of rupture repair can facilitate the work of therapy by renewing collaboration and strengthening the bond. Rupture repair can also provide the opportunity for a corrective experience of successfully navigating interpersonal conflict. A review of research on rupture repair in CBT treatments highlights that ruptures are common, and that failure to repair ruptures is associated with poor outcome and premature dropout. Therapists can reduce the likelihood of contributing to ruptures by adhering to the principle of collaborative empiricism. Therapists can facilitate rupture repair by recognizing ruptures when they occur and employing repair strategies: immediate repair strategies such as modifying the treatment task, or expressive repair strategies such as metacommunicating about the rupture and exploring the interpersonal schemas that underlie it. Training in rupture repair has demonstrated benefits for CBT therapists, particularly trainees.
This chapter provides an overview of the major theories of behavior and their applications, beginning with the first mention of mental illness in Egyptian records in 1550 BC (see Fig. 5.1). In the following decades and centuries, mentions of depression and mental illness began to increase, creating a rich lode for further developments as societies became more advanced and could utilize more resources for healthcare. By 1879, the first experimental psychology laboratory was founded. The beginning of the twentieth century bore witness to great conceptual progress through Freud’s radical innovations regarding the unconscious mind and psychotherapy. In the 1920s, Piaget developed the first systematic account of developmental psychology. Freud and Piaget were followed by a myriad of other psychological theories, including behaviorism, classical conditioning, Gestalt psychology, and attachment theory. The second half of the twentieth century had three major waves of new psychotherapies and psychosocial interventions. The first wave consisted of behavioral therapies that evolved to promote a more scientific approach to therapy grounded in experimental behavioral science. A second wave focused on cognitive distortions as a driver of pathology, leading to the development of cognitive behavioral therapy (CBT). The third wave of therapies has emerged in the last two decades partly in response to the concern that – though CBT techniques are fairly well validated – the link between cognitive therapy and cognitive science continues to be weak. Mindfulness-based interventions, for example, rather than challenge the validity of automatic thoughts, seek to help the patient achieve a state of present focus and to acknowledge and accept the flow of sensations, emotions, and thoughts without avoidance or negative judgment. In the more recent decades, other therapeutic modalities, such as interpersonal psychotherapy, dialectical behavioral therapy, and behavioral activation, have gained prominence.
In Awakening the Dreamer: Clinical Journeys, Philip Bromberg continues the illuminating explorations into dissociation and clinical process begun in Standing in the Spaces (1998). Bromberg is among our most gifted clinical writers, especially in his unique ability to record peripheral variations in relatedness - those subtle, split-second changes that capture the powerful workings of dissociation and chart the changing self-states that analyst and patient bring to the moment.