Through flow and swirls: modifying implicit relational knowledge and disconfirming pathogenic beliefs within the therapeutic process

The aim of this paper is to describe and discuss the models of the process of change in psychotherapy developed by the Boston Change Process Study Group (2010), and by the San Francisco Psychotherapy Research Group (Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson, & the Mount Zion Psychotherapy Research Group, 1986). The first model is centered on change in implicit relational knowledge and describes the process of change as being composed of “moving along” phases interspersed by “now moments” that can become “moments of meeting” if the clinician is able to give authentic and specifically fitted responses. A moment of meeting opens up space for a change in the implicit relational knowledge of the patient. The second model is centered on the idea that patients come to therapy with an unconscious plan to master traumas, pursue healthy and adaptive goals, and disprove their pathogenic beliefs, and points to how patients test their pathogenic beliefs in the relationship with the therapist, coaching the therapist about what they need. Passing patients’ tests means helping them disconfirm or undermine pathogenic beliefs that hopefully will lead to disproving them. This second model focuses on the subjective meaning of the therapeutic process as seen from the perspective of the patient. We will also try to show, using clinical examples, how these two models can be integrated and how their integration may give us a more comprehensive, tridimensional vision of the therapeutic process.