The legacy of Jeremy Safran: technique and relationship in psychotherapy research

The panel proposes to dedicate a tribute to Jeremy Safran, in order to encourage the theoretical and clinical reflection and research debate. His work had significant implications for the clinical practice, specifically for the management of the therapeutic empasses and rupture episodes in psychotherapy process. Jeremy Safran was able to integrate not only different roles and souls (researcher, theorist, and clinician) but also different approaches (cognitivism, interpersonal theories, and relational psychoanalysis). In his conceptualization, we find an emphasis on patients’ and therapists’ emotional experience, the interpersonal dimension of clinical work, and his attention to the here and now in the therapeutic relationship. The therapeutic alliance is not a given, nor an a priori requirement. It is a process of ongoing negotiation that in some cases, for example in the treatment of patients with severe personality disorders, can constitute the purpose of the treatment itself. The conceptualization of the therapeutic alliance proposed by Safran (together with Chris Muran) is empirically-based and grounded on task-analytic investigations, a method that allowed the construction of clinical models that describe the different ways in which the alliance breaks down (i.e., withdrawal or confrontation) and the stages that can be usually identified when those are resolved. The meaning of any technical element can therefore be only understood in the relational context in which it emerges, and the technical indications provided by the authors are not standardized manualtype prescriptions, but almost “experiences” lived in the relational frame. From this perspective, the “interpretation vs relationship” dialectic seems to be outdated, and more attention has to be dedicated to the mutual interdependence of both elements. As emphasized since the beginning by the authors of the “relational turn”, the significance of each technical intervention has to be considered in the relational context. The same technical intervention can produce a positive or negative impact on the therapeutic alliance. The therapist’s contribution to therapeutic alliance includes both relational (i.e., empathy or tact) and technical factors (reframing or interpretation). If from the one hand, the therapeutic alliance is a “curative” factor in itself, on the other it can be considered a necessary but not sufficient condition: it can be influenced by technical factors, and its influence can be different depending on the treatment approaches. The panel includes four contributions characterized by different methodologies (process-outcome studies, single case), treatment orientation (psychodynamic, cognitive), settings (individual psychotherapy, short-term therapy), and patient populations (personality disorders, clinical syndromes, such as eating, somatizing, depressive or anxious symptoms). Del Giacco et al. examine the relation between the unfolding of therapeutic alliance construction and verbal content, quality of voice and interruption behaviours along 15 sessions of a brief psychodynamic therapy of a young adult. Brasini et al. explore the role of the motivational system in the ruptures’ and resolutions’ process in a sample of 60 sessions of cognitive approach. Colli et al. investigate the association between patient’s collaboration and reflective functioning in 50 sessions of 10 patients in psychodynamic and cognitive treatment. Gentile et al. analyze the differential effect of therapist’s interventions on the alliance ruptures and resolutions in a sample of 130 psychodynamic and cognitive sessions of 65 anaclitic and introjective patients.