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How can we evaluate the subjective and objective aspects of effectiveness in the therapeutic alliance?


By Dr Elya Steinberg

In this article, I propose that there are fundamental limitations to current scientific mainstream methods of writing about therapeutic processes that in fact hinder our ability to both write about our therapeutic process and to learn from other clinicians’ and researchers’ writings.

In my view, these limitations may partially be compensated for by allowing creative writing, poetry and other forms of art to be the major part of a case study, where the objective measures must be integrated into the subjective frame of writing. Creative writing conveys its truth by acknowledging the intense subjective complexity originating from sensations and emotions accompanying the actual objective memory. Therefore, describing only the client and therapist’s narrative itself or material that is only observable by external senses, heavily compromises the quality of the therapeutic process.

By therapeutic process, I am including all interactions that a person has concerning any aspects of their health, whether with a medical doctor, therapist, psychotherapist, body-psychotherapist, psychologist, physiotherapist etc. In this article, for simplicity I will call all those from whom the person seeks support the Therapist and the seeker a Client rather than a patient. In some other places, when I think that the important aspect of the experience is simply human and is not dependent in a particular function or the differentiation between therapist and client I use Person or Participants.

These fundamental limitations to current scientific mainstream methods of writing about therapeutic processes prevent full understanding of the quality of the therapeutic encounter and create a situation whereby the writing is potentially disloyal to the personal truth of the participants. For example, the measure of well-being, pleasant/ unpleasant or pain/ no-pain are clearly an individual perception and sensation. Those reflexive individual perceptions of well-being, pleasure and pain are complex multidimensional experiences that have defied our understanding for centuries. The reflexive awareness of those qualities of human consciousness, i.e. sensations, emotions and feelings, originate from the internal visceral aspects of the body (Damasio, 1999b, 2013). Still most case studies do not reflect on those important internal embodied experiences of the self of any of the two participants. At the end of the day, the efficacy of therapeutic intervention can be judged mainly by the clients only and deeply embedded in their inner motivation and their perception of themselves in their internal world, which is based on the maps of our visceral function as well as the external world.

To read Dr Steinberg’s paper, click here

Dr. Elya Steinberg, MD, is Co-Director of the Centre for Biodynamic Psychotherapy (London School of Biodynamic Psychotherapy). She is a medical doctor and biodynamic psychotherapist who integrates body-psychotherapy, Gerda Boyesen methods and bioenergy with psychological trauma work, martial arts, conventional allopathic medicine and complementary medicine. She interweaves alternative and conventional approaches to allow a person to grow as a holistic complex and improve their well-being. In partnership with Gerhard Payrhuber she facilitates the group ‘Attending to the Silence’ for second and third generation Shoah survivors, perpetrators and bystanders.
[email protected]; www.biodynamic-bodypsychotherapy.co.uk