Healing through mirroring the other: a single case on sharing vulnerability in the therapeutic relationship

Research in psychotherapy has tried to identify which elements favor and hinder the therapeutic alliance. However, few studies have analyzed how these processes come into play when patients and therapists share the same psychological vulnerability factors. The innovation of this contribution is twofold: 1. For the first time, patient and therapist expose, in a single work, their point of view in moments of impasse regarding their respective roles in the relationship and the emotions and tendencies to action activated by each other; 2. The Cognitive Model of Pathological Affective Dependencies (Pugliese et al., 2023), which focuses on the frustration of basic needs as an antecedent for traumatic relationships, is first applied to therapeutic alliance breakdowns. In relational trauma, there are feelings of distrust, a perception of the world as dangerous and unpredictable, and, concerning others, a belief in unlovability prevails. While the therapeutic relationship provides the basis for processing traumatic experiences through a new relational experience, it is the patient's compromised capacity for trust that makes it difficult to achieve stability. The feeling of powerlessness and helplessness underlying the trauma leads the relationship to oscillate between needs for closeness and distance, triggering an emotional spiral that leads to the interruption of emotional expressiveness, communication, and intimacy. Through a single case, we illustrate the complexity that the therapeutic relationship assumes when it is embedded in a disabling interpersonal cycle in which the patient feels drawn to destroy the therapist's image, even though she feels the need for the relationship and the pain resulting from its loss. The need for security and attachment, coupled with the terrifying fear of losing the other, activates attempts at a solution based on control and the use of power that will constitute the leading cause of the break of the bond and the primary factor in maintaining a long impasse in the therapeutic process, leading to a collapse of metacognition and confusion of roles. The therapeutic setting takes the form of a courtroom in which the patient and therapist remain for a long time trying, through their clinical expertise, to find answers to a single question: Who is the abuser, and who is the victim? This contribution allows careful analysis of interpersonal cycles in relational trauma through an integrated clinical reading of the patient and therapist, supporting the progress of research in psychotherapy aimed at developing increasingly precise strategies to ensure effectiveness.