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Attunement and involvement: Therapeutic responses to relational needs

  • Institute for Integrative Psychotherapy & Professor of Psychology Deusto University


Eight relational needs, unique to interpersonal contact and essential factors in effective psychotherapy, are presented. Prolonged disruption in the satisfaction of relational needs is evidenced by a sense of emptiness, anxiety, frustration and aggression. Therapeutic attunement goes beyond empathy to provide a unity of interpersonal contact and the facilitation of psychological healing. Involvement is expressed by the psychotherapist's respectful inquiry into the client's experience and being fully present with the client in a way that is appropriate to the client's developmental level of functioning and current need for relationship.
Attunement and Involvement:
Therapeutic Responses to Relational Needs
Standardized protocols or treatment manuals define the practice
of psychotherapy from either a quantitative research-based
behavioral model or symptom-focused medical model
(Erskine,1998). The therapeutic relationship is not considered
central in such practice manuals. In this era of industrialization of
psychotherapy it is essential for psychotherapists to remain
mindful of the unique interpersonal relationship between therapist
and client as the central and significant factor in psychotherapy.
This article outlines several dimensions of the therapeutic
relationship that have emerged from a qualitative evaluation of the
practice of psychotherapy conducted at the Institute for Integrative
Psychotherapy in New York City.
A major premise of a relationship-oriented psychotherapy is that
the need for relationship constitutes a primary motivation of
human behavior (Fairbairn, 1952). Contact is the means by which
the need for relationship is met. In colloquial language, 'contact'
refers to the quality of the transactions between two people: the
awareness of both one's self and the other, a sensitive meeting of
the other and an authentic acknowledgement of one's self. In a
more theoretically exact meaning, 'contact' refers to the full
awareness of sensations, feelings, needs, sensorimotor
processes, thought and memories that occur within the individual,
and a shift to full awareness of external events as registered by
each sensory organ. With the capacity to oscillate between
internal and external contact, experiences are continually
integrated into a sense of self (Perls et al., 1951).
When contact is disrupted, needs are not satisfied. If the
experience of need arousal is not satisfied or closed naturally, it
must find an artificial closure that distracts from the discomfort of
unmet needs. These artificial closures are the substance of
survival reactions that become fixated defensive patterns, or
habitual behaviors that result from rigidly held beliefs about self,
others or the quality of life. They are evident in the disavowal of
affect, the loss of either internal or external awareness,
neurological inhibitions within the body, or a lack of spontaneity
and flexibility in problem-solving, health maintenance, or relating
to people. The defensive interruptions to contact impede the
fulfilment of current needs (Erskine, 1980).
The literature on human development also leads to the
understanding that the sense of self and self-esteem emerge out
of contact-in-relationship (Stern, 1985). Erikson's (1950) stages of
development over the entire life cycle describe the formation of
identity as an outgrowth of interpersonal relations (trust vs
mistrust, autonomy vs shame and doubt, etc.). Mahler's (1968;
Mahler et al, 1975) descriptions of the stages of early child
development place importance on the relationship between
mother and infant. Bowlby (1969, 1973, 1980) has emphasized
the significance of early as well as prolonged physical bonding in
the creation of a visceral core from which all experiences of self
and other emerge. When such contact does not occur in
accordance with the child's relational needs, there is a
physiological defence against the loss of contact-, poignantly
described by Fraiberg in 'Pathological Defenses of Infancy'
(1982). These developmental perspectives foster a deep
appreciation for the need for interpersonal connection and active
construction of meaning that is so much a part of who the client is.
In a relationship-oriented psychotherapy the psychotherapist's
self is used in a directed, involved way to assist the client's
process of developing and integrating full contact and the
satisfaction of relational needs. Of central significance is the
process of attunement, not just to discreet thoughts, feelings,
behaviours or physical sensations, but also to what Stern terms
'vitality affects,' such that an experience of unbroken feeling-
connectedness is created (1985, p. 156).
The client's sense of self and sense of relatedness that develop
are crucial to the process of healing and growth, particularly when
there have been specific traumas in the client's life and when
aspects of the self have been disavowed or denied because of
the cumulative failure of contact-in-relationship (Erskine, 1997).
Attunement goes beyond empathy: it is a process of communion
and unity of interpersonal contact. It is a two-part process that
begins with empathy-being sensitive to and identifying with the
other person's sensations, needs or feelings; and includes the
communication of that sensitivity to the other person. More than
just understanding (Rogers, 195 1) or vicarious introspection
(Kohut, 1971), attunement is a kinesthetic and emotional sensing
of others knowing their rhythm, affect and experience by
metaphorically being in their skin, and going beyond empathy to
create a two-person experience of unbroken feeling
connectedness by providing a reciprocal affect and/or resonating
response. Attunement is communicated by what is said as well as
by the therapist's facial or body movements that signal to the
client that his or her affect and needs are perceived, are
significant and make an impact on the therapist. It is facilitated by
the therapist's capacity to anticipate and observe the effects of his
or her behavior on the client and to decentre from his or her own
experience to focus extensively on the client's process. Yet,
effective attunement also requires that the therapist
simultaneously remains aware of the boundary between client
and therapist as well as his or her own internal processes.
The communication of attunement validates the client's needs
and feelings and lays the foundation for repairing the failures of
previous relationships (Erskine, 1997). Affective attunement, for
example, provides an interpersonal contact essential to human
relationship. It involves the resonance of one person's affect to
the other's affect. Affective attunement begins with valuing the
other person's affect as an extremely important form of
communication, being willing to be affectively aroused by the
other person and responding with the reciprocal affect. When a
client feels sad, the therapist's reciprocal affect of compassion
and compassionate acts complete the interpersonal contact.
Relationally, anger requires the reciprocal affects related to
attentiveness, seriousness and responsibility, with possible acts of
correction. The client who is afraid requires that the therapist
respond with affect and action that convey security and
protection. When clients express joy, the response from the
therapist that completes the unity of interpersonal contact is the
reciprocal vitality and expression of pleasure. Symbolically,
attunement may be pictured as one person's yin to the other's
yang that together form a unity in the relationship.
Attunement is often experienced by the client as the therapist
gently moving through the defenses that have prevented the
awareness of relationship failures and related needs and feelings.
Over time this results in a lessening of internal interruptions to
contact and a corresponding dissolving of external defenses.
Needs and feelings can increasingly be expressed with comfort
and assurance that they will receive a connecting and caring
response. Frequently, the process of attunement provides a
sense of safety and stability that enables the client to begin to
remember and endure regressing into childhood experiences.
This may bring a fuller awareness of the pain of past traumas,
shaming experiences, past failures of relationship(s) and loss of
aspects of self (Erskine, 1994).
Relational needs
Attunement also includes responding to relational needs as they
emerge in the therapeutic relationship. Relational needs are the
needs unique to interpersonal contact. They are not the basic
needs of life such as food, air or proper temperature, but are the
essential elements that enhance the quality of life and a sense of
self-in-relationship. Relational needs are the component parts of a
universal human desire for relationship.
The relational needs described in this article have emerged from
a study of transference and a qualitative investigation of the
crucial factors in significant relationships conducted at the
Institute for Integrative Psychotherapy in New York City. Although
there may be an infinite number of relational needs the eight
described in this article represent those needs that, in my
experience, clients most frequently describe as they talk about
significant relationships. Other client-therapist inter-subjective
experiences may reveal a different cluster of relational needs
beyond the eight described here. This further illustrates that the
client-therapist relationship is irreproducible. No two therapists will
produce the same therapeutic process. Some of the relational
needs described here are also described in the psychotherapy
literature as fixated needs of early childhood, indicators of
psychopathology or problematic transference. While the tendency
to pathologize dependence or transference does exist in the
psychotherapy literature, in the context of the time and theoretical
milieu, Kohut in 1971 and 1977 made strides to connect
transference to developmental needs. Kohut distinguishes
relational, developmental needs that have suffered disruption or
rupture from the classical transference based on a drive model of
psychoanalysis. Although he identifies mirroring, twinship and
idealization as problematic transferences, he also relates them to
essential needs. However, his methods remain psychoanalytic
and do not make full use of a relationship-oriented integrative
model of psychotherapy. Bach (1985), Basch (1988), Stolorow et
al. (1987) and Wolf (1988) have expanded on Kohut's concepts,
each emphasizing the importance of a relational perspective in
understanding transference. Clark's (1991) integrative perspective
on empathic transactions bridges the concepts of transference
and relational needs and emphasizes a therapy of involvement.
Relational needs are present throughout the entire life cycle from
early infancy through old age. Although present in early childhood,
relational needs are not only needs of childhood or needs that
emerge in a developmental hierarchy: they are the actual
components of relationship that are present each day of our lives.
Each relational need may become figural or conscious as a
longing or desire while the others remain out of consciousness or
as background. A satisfying response by another person to an
individual's relational need allows the pressing need to recede to
ground and another relational need to become figural as a new
interest or desire. Often it is in the absence of need satisfaction
that an individual becomes most aware of the presence of
relational needs. When relational needs are not satisfied the need
becomes more intense and is phenomenologically experienced as
longing, emptiness, a nagging loneliness, or an intense urge often
accompanied by nervousness. The continued absence of
satisfaction of relational needs may be manifested as frustration,
aggression or anger. When disruptions in relationship are
prolonged the lack of need satisfaction is manifested as a loss of
energy or hope and shows up in script beliefs such as 'No one is
there for me' or 'What the use?' (Erskine & Moursund,
1988/1998). These script beliefs are the cognitive defence against
the awareness of needs and the feelings present when needs do
not get a satisfying response from another person (Erskine,
The satisfaction of relational needs requires a contactful presence
of another who is sensitive and attuned to the relational needs
and who also provides a reciprocal response to each need.
Security is the visceral experience of having our physical and
emotional vulnerabilities protected. It involves the experience that
our variety of needs and feelings are human and natural. Security
is a sense of simultaneously being vulnerable and in harmony
with another.
Attunement involves the empathetic awareness of the other's
need for security within the relationship plus a reciprocal response
to that need. It includes respectful transactions that are non-
shaming and the absence of actual or anticipated impingement or
danger. The needed response is the provision of physical and
affective security where the individual's vulnerability is honoured
and preserved. It communicates, often non-verbally, 'Your needs
and feelings are normal and acceptable to me.' Therapeutic
attunement to the relational need for security has been described
by clients as 'total acceptance and protection,' as a
communication of 'unconditional positive regard' or 'I'm OK in this
relationship.' Attunement to the need for security involves the
therapist being sensitive to the importance of this need and
conducting him or herself both emotionally and behaviourally in a
way that provides in the relationship.
Relational needs include the need to feel validated, affirmed and
significant within a relationship. It is the need to have the other
person validate the significance and function of our intrapsychic
processes of affect, fantasy and constructing of meaning, and to
validate that our emotions are a significant intrapsychic and
interpersonal communication. It includes the need to have all of
our relational needs affirmed and accepted as natural. This need
is a relational request for the other person to be involved through
providing a quality of interpersonal contact that validates the
legitimacy of relational needs, the significance of affect and the
function of intrapsychic processes.
Attunement with a client's need for validation is conveyed through
the psychotherapist's phenomenological inquiry and contactful
presence. The therapist's affective reciprocity with the client's
feelings validates the client's affect and provides affirmation and
normalization of the client's relational needs. The
psychotherapist's focus on the psychological function -- stability,
continuity, identity, predictability-- of rigidly held beliefs or
behaviours lessens the likelihood of the client experiencing
shame while validating the psychological significance of the
beliefs or behaviours. Such validation is a necessary prerequisite
to lasting cognitive or behavioural change.
Acceptance by a stable, dependable, and protective other person
is an essential relational need. Each of us as children had the
need to look up to and rely on our parents, elders, teachers and
mentors. We need to have significant others from whom we gain
protection, encouragement and information. The relational need
for acceptance by a consistent, reliable and dependable other
person is the search for protection and guidance that may be
manifested as an idealization of the other. In psychotherapy, such
idealization is also the search for protection from a controlling,
humiliating introjected ego's intrapsychic effect on the vulnerability
of child ego states (Fairbairn, 1952; Guntrip, 1971; Erskine &
Moursund, 1988/ 1998). It can also be the search for protection
from one's own escalations of affect or exaggerations of fantasies.
The therapist protects and facilitates integration of affect by
providing an opportunity to express, contain and/or understand
the function of such dynamics. The degree to which an individual
looks to someone and hopes that he or she is reliable, consistent
and dependable is directly proportional to the quest for
intrapsychic protection, safe expression, containment, or
beneficial insight. Idealizing or depending on someone is not
necessarily pathological as implied in the popular psychology
term, “co-dependent”, or when misinterpreted as “idealizing
transference” (Kohut, 1977), or as Berne's psychological game of
“Gee, You're Wonderful,Professor”(1964). When we refer to some
clients' expressions of this need to be accepted and protected as
“a Victim looking for a Rescuer”, we depreciate or even
pathologize an essential human need for relationship that
provides a sense of stability, reliability and dependability.
In psychotherapy, attunement involves the therapist's recognition
of the importance and necessity of idealizing as an unaware
request for intrapsychic protection. Such recognition and
attunement by the therapist to the client's relational need most
often occurs in the accepting and respecting nature of the
interpersonal contact and therapeutic involvement and may not
necessarily be spoken about directly. Such a therapeutic
involvement includes both the client's sense of the
psychotherapist's interest in the client's welfare and the use of the
therapist's integrated sense of self as the most effective
therapeutic tool (Erskine, 1982; Erskine & Moursund, 1988/1998).
It is this relational need to be accepted by a stable, dependable,
and protective other person that provides a client-centred reason
to conduct our lives and psychotherapy practice ethically and
The confirmation of personal experience is also an essential
relational need. The need to have experience confirmed is
manifested through the desire to be in the presence of someone
who is similar, who understands because he or she has had a like
experience, and whose shared experience is confirming. It is the
quest for mutuality, a sense of walking the same path in life
together with a companion who is 'like me'. It is the need to have
someone appreciate and value our experience because they
phenomenologically know what that experience is like.
Affirmation of the client's experience may include the therapist
joining in or valuing the client's fantasies. Rather than define a
client's internal story-telling as “just a fantasy”, it is essential to
engage the client in the expression of the needs, hopes, relational
conflicts and protective strategies that may constitute the core of
the fantasies. Attunement to the need for affirmation of experience
may be achieved by the therapist accepting everything said by the
client, even when fantasy and reality are intertwined, much like
the telling of a dream reveals the intrapsychic process. Fantasy
images or symbols have a significant intrapsychic and
interpersonal function. When the function of the fantasy is
acknowledged, appreciated and valued the person feels affirmed
in his or her experience.
When the relational need for confirmation of personal experience
is present in a client's communication, he or she may be longing
for a model with a similar experience. An attuned psychotherapy
may include the sharing of the therapist's own experiences: telling
how he or she solved a conflict similar to the client's and providing
a sense of mutuality with the client. Attunement is provided by the
therapist valuing the need for confirmation by revealing carefully
selected personal experiences, mindfully (i.e. client-focused)
sharing vulnerabilities or similar feelings and fantasies, and by the
therapist's personal presence and vitality. The client who needs
confirmation of personal experience requires a uniquely different
reciprocal response than the client who needs validation of affect
or who needs to be accepted by a dependable and protective
other. In neither of these latter two relational needs is the sharing
of personal experience or the creating of an atmosphere of
mutuality an attuned response to the client's need.
Self-definition is the relational need to know and express one's
own uniqueness and to receive acknowledgement and
acceptance by the other. Self-definition is the communication of
one's self-chosen identity through the expression of preferences,
interests and ideas without humiliation or rejection.
In the absence of satisfying acknowledgement and acceptance,
the expression of self-definition may take unconscious adversarial
forms such as the person who begins his or her sentences with
'No' even when agreeing, or who constantly engages in
arguments or competition. People often compete to define
themselves as distinct from others. The more alike people are the
greater the thrust for self-defining competition.
Attunement begins with the therapist's sensitivity to and
understanding that adversary and competition in relationships
may be an expression of the need for self-definition with
acknowledgement and acceptance by the other. Therapeutic
attunement is in the therapist's consistent support for the client's
expression of identity and in the therapist's normalization of the
need for self-definition. It requires the therapist's consistent
presence, contactfulness and respect even in the face of
Another essential relational need is to have an impact on the
other person. Impact refers to having an influence that affects the
other in some desired way. An individual's sense of competency in
a relationship emerges from agency and efficacy-attracting the
other's attention and interest, influencing what may be of interest
to the other person, and affecting a change of affect or behaviour
in the other.
Attunement to the client's need to have an impact occurs when
the psychotherapist allows him or herself to be emotionally
impacted by the client and to respond with compassion when the
client is sad, to provide an affect of security when the client is
scared, to take the client seriously when he or she is angry, and to
be excited when the client is joyful. Attunement may include
soliciting the client's criticism of the therapist's behaviour and
making the necessary changes so the client has a sense of
impact within the therapeutic relationship.
Relationships become more personally meaningful and fulfilling
when the need to have the other initiate is satisfied. Initiation
refers to the impetus for making interpersonal contact with
another person. It is the reaching out to the other in some way
that acknowledges and validates the importance of him or her in
the relationship.
The psychotherapist may be subject to a theory-induced counter-
transference when he or she universally applies the theoretical
concepts of non-gratification, rescuing, or refraining from doing
more than 50% of the therapeutic work. While waiting for the
client to initiate the psychotherapist may not be accounting for the
fact that some behaviour that appears passive may actually be an
expression of the relational need to have the other initiate.
The therapist's attunement to this relational need requires a
sensitivity to the client's non-action and the therapist's initiation of
interpersonal contact. To respond to the client's need it may be
necessary for the therapist to initiate a dialogue, to move out of
his or her chair and sit near the client, or to make a phone call to
the client between sessions. The therapist's willingness to initiate
interpersonal contact or to take responsibility for a major share of
the therapeutic work normalizes the client's relational need to
have someone else put energy into reaching out to him or her.
Such action communicates to the client that the therapist is
involved in the relationship.
The need to express love is an important component of
relationships. Love is often expressed through quiet gratitude,
thankfulness, giving affection, or doing something for the other
person. The importance of the relational need to give love
--whether it be from children to parents, sibling or teacher, or from
a client to a therapist -- is often overlooked in the practice of
psychotherapy. When the expression of love is stymied the
expression of self-in-relationship is thwarted. Too often
psychotherapists have treated clients' expression of affection as a
manipulation, transference, or a violation of a neutral therapeutic
Attunement to the client's relational need to express love is in the
therapist's graciously accepting the client's gratitude and
expressions of affection, and in acknowledging the normal
function of love in maintaining a meaningful relationship.
Those clients for whom the absence of satisfaction of relational
needs is cumulative require a consistent and dependable
attunement and involvement by the psychotherapist that
acknowledges, validates and normalizes relational needs and
related affect. It is through the psychotherapist's sustained
contactful presence that the cumulative trauma (Khan, 1963;
Lourie, 1996) of the lack of need satisfaction can now be
addressed and the needs responded to within the therapeutic
Involvement is best understood through the client's perception-a
sense that the therapist is contactful and is truly invested in the
client's welfare. It evolves from the therapist's respectful inquiry
into the client's experience and is developed through the
therapist's attunement to the client's affect and rhythm and to the
validation of his or her needs. Involvement includes being fully
present with and for the person in a way that is appropriate to the
client's developmental level of functioning and current need for
relationship. It includes a genuine interest in the client's
intrapsychic and interpersonal world and a communication of that
interest through attentiveness, inquiry and patience.
Therapeutic involvement is maintained by the therapist's constant
vigilance to providing an environment and relationship of safety
and security. It is necessary that the therapist be constantly
attuned to the client's ability to tolerate the emerging awareness
of past experiences so that they are not overwhelmed once again
in the therapy as they may have been in a previous experience.
Therapeutic involvement that emphasizes acknowledgement,
validation, normalization and presence diminishes the internal
defensive process.
The therapist's acknowledgement of the client begins with an
attunement to his or her affect, relational needs, rhythm, and
developmental level of functioning. Through sensitivity to the
relational needs or physiological expression of emotions the
therapist can guide the client to become aware and to express
needs and feelings or to acknowledge that feelings or physical
sensations may be memory -- the only way of remembering that
may be available. In many cases of relationship failure the
person's relational needs or feelings were not acknowledged and
it may be necessary in psychotherapy to help the person gain a
vocabulary and learn to voice those feelings and needs.
Acknowledgement of physical sensations, relational needs, and
affect helps the client claim his or her own phenomenological
experience. It includes a receptive other who knows and
communicates about the existence of non-verbal movements,
tensing of muscles, affect, or even fantasy.
There may have been times in a client's life when feelings or
relational needs were acknowledged but were not validated.
Validation communicates to the client that his or her affect,
defences, physical sensations or behavioural patterns are related
to something significant in his or her experiences. Validation
makes a link between cause and effect; it values the individual's
idiosyncrasies and way of being in relationship. It diminishes the
possibility of the client internally disavowing or denying the
significance of affect, physical sensation, memory or dreams; and
it supports the client in valuing his or her phenomenological
experience and transferential communication of the needed
relationship, thereby increasing self-esteem.
The intent of normalization is to influence the way clients or others
may categorize or define their internal experience or their
behavioural attempts at coping from a pathological or
“something's-wrong-with-me” perspective to one that respects the
archaic attempts at resolution of conflicts. It may be essential for
the therapist to counter societal or parental messages such as
“You're stupid for feeling scared” with “Anyone would be scared in
that situation.” Many flashbacks, bizarre fantasies, nightmares,
confusion, panic, and defensiveness are all normal coping
phenomena in abnormal situations. It is imperative that the
therapist communicates that the client's experience is a normal
defensive reaction -- a reaction that many people would have if
they encountered similar life experiences.
Presence is provided through the psychotherapist's sustained
attuned responses to both the verbal and non-verbal expressions
of the client. It occurs when the behaviour and communication of
the psychotherapist at all times respects and enhances the
integrity of the client. Presence includes the therapist's receptivity
to the client's affect -- to be impacted by their emotions; to be
moved and yet to stay responsive to the impact of their emotions
and not to become anxious, depressed or angry. Presence is an
expression of the psychotherapist's full internal and external
contact. It communicates the psychotherapist's responsibility,
dependability and reliability. Through the therapist's full presence
the transformative potential of a relationship-oriented
psychotherapy is possible. Presence describes the therapist's
providing a safe interpersonal connection. More than just verbal
communication, presence is a communion between client and
Presence is enhanced when the therapist de-centres from his or
her own needs, feelings, fantasies or hopes and centres instead
on the client's process. Presence also includes the converse of
de-centring; that is, the therapist being fully contactful with his or
her own internal process and reactions. The therapist's history,
relational needs, sensitivities, theories, professional experience,
own psychotherapy, and reading interests all shape unique
reactions to the client. Each of these thoughts and feelings within
the therapist are an essential part of therapeutic presence. The
therapist's repertoire of knowledge and experience is a rich
resource for attunement and understanding. Presence involves
both bringing the richness of the therapist's experiences to the
therapeutic relationship as well as de-centring from the self of the
therapist and centring on the client's process.
Presence also includes allowing oneself to be manipulated and
shaped by the client in a way that provides for the client's self-
expression. As effective psychotherapists we are played with and
genuinely become the clay that is moulded and shaped to fit the
client's expression of their intrapsychic world towards the creation
of a new sense of self and self-in-relationship (Winnicott, 1965).
The dependable, attuned presence of the therapist counters the
client's sense of shame and discounting his or her self-worth. The
quality of presence creates a psychotherapy that is unique with
each client: attuned to and involved with the client's emerging
relational needs.
What gives psychotherapy its transformative effect in people's
lives is the psychotherapist's focus on the client's relational needs
and the relationship between client and therapist. Such a
relationship can never be standardized or prescribed or even
quantified by research. The uniqueness of each therapeutic
relationship emerges out of the therapist's attunement and
involvement that is responsive to the client's cluster of relational
needs -- a therapy of contact-in-relationship.
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This paper was presented as a keynote speech entitled “A Therapeutic Relationship?”
at the Ist Congress of the World Council for Psychotherapy, Vienna, Austria, 30 June to
6 July, 1996. Portions of this paper were also included in a closing address, “The
Psychotherapy Relationship”, at the 7th Annual Conference of the European
Association for Psychotherapy, Rome, Italy, 26-29 June 1997. Copyright (1998)
European Association for Psychotherapy. Reprint by permission of the International
Journal of Psychotherapy. The citation for the original article is: Erskine, R.G.(1998).
Attunement and Involvement: Therapeutic Responses to Relational Reeds.
International Journal of Psychotherapy, 3:3,p.235-244.
... Parse (1997) in describing the activity of nurses in establishing the therapeutic relationship described this as a continuous rhythmical process between nurse and patient moving toward possibilities, although it should be noted that Parse (1997) was offering a generalise view of nursing activity in this instance. A process that reflects the existence, as Erskine (1998) would have described, of an interpersonal and emotional attunement of the nurse with the patient's psyche. ...
... It indicated participant's attunement to the patient and of their needs at that specific time. Erskine (1998) had described this attunement as the sum effect of a number parts such as; empathy, mindfulness, immediacy, active listening, presence, self-awareness, experience and knowledge, and cognitive understanding, concepts that ran throughout the data offered by participants. Erskine (1998) argued that such concepts combined to enable a changing and emotional sensing of the needs of another and in turn the possibility of reacting to and matching the needs of that individual. ...
... Erskine (1998) argued that such concepts combined to enable a changing and emotional sensing of the needs of another and in turn the possibility of reacting to and matching the needs of that individual. Again, as Erskine (1998) acknowledged, a concept closely linked with Rogerian notions of the therapeutic value of relational bonding, through the sense of being understood, connected and responded to (Rogers, 1965). Erskine (1998) also noted the importance of attunement to one-self in the therapeutic encounter. ...
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This study has concerned itself with the therapeutic nature of the relationship between psychiatric nurses and the inpatients of acute psychiatric wards. In particular it sought the insights that those nurses held in relation to their strategic endeavour to form such a relationship. Existing theory was considered and a comprehensive review of the literature was undertaken; this identified a paucity of research and theory into how therapeutic relationships are formed between nurse and patient within a contemporary acute psychiatric ward. In order to answer the research question, this study adopted an interpretive phenomenological methodology. The convergent interview; with its inter-interview analytical process (Dick, 2017) was utilised as the method. The research was undertaken across four wards that make up the acute inpatient facilities of a single NHS site. A maximum variance sample was sought and seventeen interviews were conducted. Six major themes emerged from the responses of the participants: making a connection and relating to one another; the utilisation of values; appraising the situation and manoeuvring; using and working with boundaries; managing the challenges and pressures of acute psychiatric work; and work as a team. Themes were re-reviewed in the light of theory, literature and contemporary commentary and then conclusions and recommendations are made. The study concluded that the endeavour to form a therapeutic relationship is a boundaried, reflective, and altruistic driven social endeavour. One that utilises the opportunities that arise out of the relational intensity of sharing a living space, whilst one party experiences an episode of acute psychiatric illness. Such intensity requires nurses to engage in self-sustaining strategies, and to adopt a team approach if their endeavours are to be successful. The study made recommendations for recruitment practices that enable the identification of individuals with pre-existing social skill, altruistic values, an ability for personal reflection and a degree of personal resilience. Recommendations are also made for training that supports an examination of the relational impacts of power imbalances, psychiatric symptoms, professional boundaries and professional values. Additionally, the study presents it is the establishment of a relational bond alone, which most closely resembles acute psychiatric nurses’ understanding of therapeutic relationship. Hence a recommendation is made to rethink the framing of future research or measurement of the phenomena based on the tri-partite definition of bond, goal and task agreement that defines psychotherapy understandings of therapeutic relationship (Bordin, 1979). The study also makes recommendations for both further research and theoretical development.
... These findings accord with the GLM's primary good relatedness, which means having a close and mutual relationship with other people. In addition, it resembles Erskine and colleagues' (Erskine, 1998;Erskine et al., 1999) notion of relational needs. These needs can be met through social connectedness and are vital to the process of growth and healing (Erskine, 1997;Erskine et al., 1999). ...
... These needs can be met through social connectedness and are vital to the process of growth and healing (Erskine, 1997;Erskine et al., 1999). The relational need of acceptance is the need to be accepted by someone stable and dependable, someone who can provide protection, encouragement and information (Erskine, 1998). Accordingly, in this study, the participants' experience of a non-judgemental approach is in line with this relational need and with studies in music therapy showing that music, as a nonverbal and thus less judgemental means of expression, may easily address the need for acceptance via voice mirroring (Austin, 2001), music improvisation (Bright, 1999) or recognizing the individual's need to test boundaries, for example, by allowing clients to play music as loudly as they wish (Bensimon, 2020). ...
Whereas many research studies have discussed the impact of music programmes in a prison setting, few studies have investigated the impact of music programmes that take place outside the prison and are intended for formerly incarcerated individuals. The current study aims to fill this void by examining the experience of formerly incarcerated individuals who participated in a group music programme intended to assist them on their journey towards rehabilitation. Five formerly incarcerated individuals who participated in the Sounding Out Programme (SOP), a group music programme funded by the Irene Taylor Trust in London, were interviewed for this research. In addition, three programme staff members were interviewed in order to gain further perspective on the process. Content analysis of the interviews indicated the emergence of four central themes: improved social bonding, a sense of hope and life purpose, a sense of achievement, and transformation. These findings are discussed in light of the Good Lives Model (GLM). Accordingly, the SOP assisted both formerly incarcerated individuals and programme staff members in attaining the following GLM primary goods in life: community, relatedness, knowledge, spirituality, excellence in work and play, excellence in agency, and creativity.
... 351). Nevertheless, a major premise to relationship oriented and attachment informed practice lies in the belief that human behavior is motivated by the need for connection and relational safety (Erskine, 1998;Fairbairn, 1952). ...
... Schore and Schore (2008) further noted the regulation of one's affect is central to optimal human functioning and is often compromised in those who have experienced early relational trauma. Thus, being alert to the psychological and biological factors contributing to dysregulation facilitates consciously attuned responses to relational needs (Erskine, 1998). Furthermore, as pointed out by Wylie and Turner (2011) being attuned to another in the context of therapy as a secondary attachment figure, particularly in moments of dysregulation, directly contributes to the expansion of neural pathways that enhance the capacity to self-regulate when activated. ...
The Attuned School Clinician: An Advanced Clinical Practice Curriculum in Attachment Informed School-Based Mental Health for Social Workers Lauren. M. DePinto, MSW, LCSW Dissertation Chair: Joretha Bourjolly, PhD As the educational landscape in our country continues to transform and the mental health needs of our youth increases, so have the domains and demands of school social work practice. One of the most influential advancements impacting school social work has been the expansion of school-based mental health (SBMH) programs and services. This dissertation calls attention to the growing clinical role social workers play in the delivery of direct mental health services in schools. A review of the literature suggests it is timely and necessary to introduce content specific to SBMH into the social work curriculum to adequately meet the requisite needs of current MSW students entering the field. Additionally, this dissertation aims to develop an advanced clinical practice course for second-year MSW students that is grounded in the principles of attachment theory and introduces an empirically supported theoretical framework that extends a developmental and applied way of thinking, observing, examining, and interpreting behaviors in school-based clinical practice settings. This proposed advanced clinical practice course is designed to strengthen clinical practice skills and expand upon the foundations of school social work. The primary educational objectives of this course aim to introduce, broaden, and deepen students' understanding of attachment theory as a developmental framework for relationship-focused clinical school social work practice and is intended to cultivate and shape the reflective professional identity of the attuned school clinician. Course content introduced and discussed will include: the historical context of school-based mental health, the current state of SBMH and the expansion of school social work; attachment theory as a framework for relational and reflective clinical school social work practice; attachment and emotional development in the classroom; reflective practice and the shaping of professional identity; clinician secure base reflection. Keywords: school-based mental health, clinical school social work, attachment theory, relationships, reflective practice, social work education, curriculum development
... She showed readiness through being joyful and initiating more sound than the activity asked for. I remained attuned to what was happening for her and her needs in order to align with what she was ready for (Erskine, 1998). The phases were followed flexibly and helped oversee progress. ...
Full-text available
This article is presented as a clinical case study in research and the arts that explores the journey of a 7-year-old girl with selective mutism, and her growth through an integrative intervention that combined dramatherapy, systemic, behavioral, and attachment-informed approaches. Sessions took place in Shanghai, China. Gorla et al. (2017) [Without words. Different children in different contexts (Trans.). A.G. Editions] and Perednik (2016) [The selective mutism treatment guide: Manuals for parents, teachers, and therapists: Still waters run deep. Oaklands] propose that the significant others of a person with selective mutism can become therapeutic agents of change, and through this lens, the child’s family, peers, and school staff became involved. Through the use of play and the therapeutic relationship and the coming together of specialties and community, it is posited that the client found her voice again, enhancing her relationships and embarking on a journey of lasting change. The dramatherapy-based, multimodal intervention provides an example of clinical practice intended to assist therapists, parents, schools, and practitioners looking to support an individual with selective mutism.
... The authors believe that the therapist's attunement with their client may help deepen the therapeutic alliance. This potential co-relation between the two is rooted in mutual trust, appropriate self-disclosure, communicative intentions and has been widely cited in scholarly literature in attachment-related psychotherapy and interpersonal communication research (Erskine, 1998;González et al., 2019;Talia et al., 2019). Likewise, one of the participants directly spoke to using kinesthetic empathy as it plays an "integral role in fostering relational connections" between the client and the therapist. ...
Full-text available
Dance/movement therapy is an embodied healing practice which has been found to foster recovery from depression and boost quality of life. Although kinesthetic empathy holds great potential for addressing emotional dysregulation, it is an under-utilized dance/movement therapy intervention in health optimization, especially in adults living with treatment-resistant depression. The aim of this study was to collect data from dance/movement therapist on how they use kinesthetic empathy to foster self-regulation in adults living with treatment-resistant depression. A survey design was used to obtain this data. Eight dance/movement therapists (practicing in India, Philippines, Barbados, and the United States of America) were recruited. The participant demographics of the survey challenges the centrality of master's level trained dance/movement therapists primarily practicing in Eurocentric cultures. The survey included open answer questions, and responses received were grouped into four categories: (i) dance/movement therapists' rationale for using kinesthetic empathy (ii) therapist-described client responses to kinesthetic empathy, (iii) changes in self-regulation patterns of clients, and (iv) potential links between employing kinesthetic empathy as an intervention and witnessing emotional regulation in clients. Overall, kinesthetic empathy was described as a core part of the participants' dance/movement therapy practice with this population. The identified client responses to kinesthetic empathy were categorized based on deWitte's et al. (Frontiers in Psychology, 2021) therapeutic factors of change. 'Observable client responses', such as, use of metaphors, verbalization of body sensations and engaging in mirroring were categorized under specific therapeutic factors of dance/movement therapy. Alternatively, 'emotionally felt client responses' such as, increase in safety and trust within the therapeutic alliance were categorized under both 'specific' and 'mixed-type' factors based on the model. Finally, this article discusses movement interventions that may be incorporated by dance/movement therapists while working with this population. Further research is required to identify the long-term effect/s of kinesthetic empathy as an intentional intervention to foster self-regulation in adults living with treatment-resistant depression. Supplementary information: The online version contains supplementary material available at 10.1007/s10465-022-09371-4.
... connected to others (La Guardia and Patrick, 2008;Ryan and Deci, 2017). Within the specific framework of integrative relational psychotherapy and transactional analysis, the relational needs model developed by Erskine (1996Erskine ( , 1997Erskine ( , 1998 is widely recognized (Pourová et al., 2020). This model emerged from a study of transference in psychotherapy and a qualitative investigation of the crucial factors in significant relationships conducted at the Institute for Integrative Psychotherapy in New York City in the early 1990s. ...
Full-text available
This article aims to adapt to Spanish the Relational Needs Satisfaction Scale (RNSS) and to test the factor structure with a clinical and a non-clinical sample. A total of 459 individuals completed the RNSS, a measure of life satisfaction and of psychological wellbeing. Results showed that the translation was adequate. An exploratory and confirmatory factor analysis was conducted followed by the test of three models that confirmed the five-factor structure and the second-order global factor proposed in the original study, and in adaptations to other languages. The advantages and disadvantages of these models are discussed. Correlations of the RNSS with life satisfaction and psychological wellbeing measures were in the expected direction, providing evidence of convergent validity. The Spanish version of the RNSS is a valid and reliable measure of the construct it was intended to measure, though some improvements in item wording could be incorporated and tested (for instance, item 18 should be positively worded as the rest of the items in order to avoid the effect of negative wording).
... Stern (20) observerte, beskrev og eksemplifiserte inntoning i ulike samspillstyper (20). I en terapeutisk kontekst vil inntoning innebaere å forsøke og komme så naer den andres opplevelse som mulig, og å formidle dette til den andre, nonverbalt eller/ og verbalt (20,21). Inntoning vil kunne bidra til at pasienten opplever samspillet med den profesjonelle som positivt terapeutisk, og at en med dette danner grunnlaget for en terapeutisk relasjon. ...
This article introduces an integrative framework for working with clinical disorders and maladaptive behaviors. This framework is based on the author’s experience working with eating and weight issues. The term “eating disorders” is used to refer to both undereating and overeating or obesity. Existing psychotherapy approaches to eating disorders and weight-related issues are explored, and the transactional analysis literature on eating disorders is evaluated. The author presents a framework she has found useful, which she calls Nourish. She has developed this model following heuristic research with 19 long-term clients with eating disorders and weight issues, especially anorexia nervosa, bulimia, binge eating, and obesity. This integrative, holistic framework combines classical TA theory and a relational approach to working clinically with eating and weight and focuses on supporting therapists in private practice as well as in clinical teams.
How Change Happens in Equine-Assisted Interventions gives clinicians and researchers an intervention theory on the mechanisms of change during psychotherapy and other interventions that incorporate horses. Chapters introduce the concept of intervention theory, present a theory of the problem (what the client comes with), theories explaining the intervention (what is done during a session), and theories of change (what happens in the mind of a client), with each theory’s function described. Using an autoethnographic approach, the authors describe, deconstruct, and analyze personal experiences as clients during an equine-assisted intervention. Then the authors present and apply a unique intervention theory by linking it to the thoughts and experiences of clients in and after a session. Practitioners will come away from this book with a unique perspective on the field and with an increased understanding of what their clients are thinking both in and out of session. Researchers will have an explanatory theory from which to draw testable hypotheses when studying interventions incorporating horses.
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