Advanced Psychopathology

Sunday, March 26, 2006


The Relational Model: Implications for Diagnosis & Treatment

Relational theorists contend that psychopathology results when individuals become wedded to dysfunctional relational patterns that originate in childhood. These patterns are so rigidly held that they color social interactions well into adulthood. Stephen Mitchell, a significant contributor to the interpersonal-relational school, contends that children learn from a young age just how to interact with parental figures in a way that minimizes anxiety. These patterns then become pathological templates, maintained simply because the child knows no other way of interacting. If tension between particular relational patterns and the main “self-shaping” patterns occurs, they will find ways of expressing themselves covertly and give rise to neurosis. It could be suggested that paranoia, for example, is the product of parental failure to confirm reality and a child’s normal reactions. Instead of feeling validation, the child is filled with shame, fear and confusion that he or she carries into adulthood.

The process of relational psychotherapy is entirely different than that of classical psychoanalysis, particularly because of the very active role in which the therapist is cast. The task for the relational therapist is to understand the subjective world of the patient and to assist in broadening his or her interpersonal interactions despite the limits imposed by childhood experiences. The patient is also encouraged to examine why the chosen manner of relating is seen as the only way to forge a bond with the therapist. In contrast with classical analysis, the emphasis of the relational style is on current social relationships as well as the interactions occurring within the therapeutic context. The connection between therapist and patient is socially constructed by the two parties, neither of whom is the “expert”. Self-disclosure is not limited to the patient and transference is understood not as a simple projection but as an authentic social reaction to the therapist. Grand interpretations are unnecessary; the vehicle through which change occurs is therapist participation. Progress and healing take place through the shared experience, which teaches the patient that his modes of relating need not be so restricted. In other words, successful relational therapy results in the patient’s ability to understand and experience a range of relationships in a variety of ways.

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