Beyond the mask of deference: exploring the relationship between ruptures and transference in a single-case study
AbstractThe relationship between transference and therapeutic alliance has been long discussed. It is only recently, however, that empirical evidence has provided support for a tight correspondence between several transference dimensions and rupture and resolution processes. In the present single-case study, we used alliance ruptures as a key dimension to understand patientâ€™s transference dynamics. This was achieved in a particular form of patientâ€™s behavior, i.e., patientâ€™s deference and acquiescent behavior, which describes a significant submission to assertions, skills, judgments and point of views of another person. Therapeutic process was measured by means of the Rupture Resolution Rating Scale, the Core Conflictual Relationship Theme and the Defense Mechanism Rating Scales, whereas therapeutic outcome was measured by means of the Shedler-Westen Assessment Procedure-200. Results of sequential analysis yielded a significant correspondence between rupture markers, characterized by avoidance and shifting of sessionâ€™s topic, and patientâ€™s narrations. Furthermore, a systematic correspondence between alliance ruptures and patientâ€™s avoidant functioning, which emerged both in transference relationship and in the quality of the defense structure, was found. Together, these findings indicate that patientâ€™s deference inhibits the expression of relational themes, with ruptures in alliance that seem to be supported by a strong defensive structure. In particular, patientâ€™s avoidance played a double role in the treatment. On the one hand, avoidance was the main characteristic of her transference structure, based on extreme intellectualization and emotional closure. On the other hand, it contributed to create an impasse in the treatment, based on a withdrawal ruptures model and on obsessive level defences.
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Copyright (c) 2016 Francesca Locati, Pietro De Carli, Emanuele Tarasconi, Margherita Lang, Laura Parolin
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