糖心传媒

by Rebecca Endres and Bonnie Eissner

Why do patients drop out of psychotherapy or fail to improve? What causes ruptures in the therapeutic relationship? How can these be addressed and resolved?

J. Christopher Muran, Ph.D., associate dean of and the recently elected general vice president of the International Society for Psychotherapy Research, has been tackling these issues since 1990, when he became the director of the . And this fall, the extensive video collection from his research鈥攖aped psychotherapy sessions from roughly 1,000 cases over two decades鈥攚ill come to Adelphi, to be archived and studied by psychology doctoral students.

鈥淥ur videotape sessions are precious; they鈥檙e not easy to come by,鈥� Dr. Muran said.

The tapes are the raw data of a comprehensive, precedent-setting study of the therapeutic process. The concept is to examine鈥攙ia videotaped sessions and various measures鈥攖ime-limited psychotherapy in action and how it affects patient outcomes. As the research program director, Dr. Muran has honed in on ruptures鈥攔elational difficulties or impasses鈥攂etween therapists and their patients, in an effort to understand what causes them and how to resolve them.

鈥淥ur thinking is that the ruptures reflect something about the patient鈥檚 history, presentation and personality,鈥� Dr. Muran said. 鈥淏ut it also reflects something about the therapist as well.鈥�

Dr. Muran offered an example: 鈥淥ftentimes a therapist can be oblivious to the patient鈥檚 distress because of their own anxiety. It鈥檚 fascinating when you look at the research to see how often therapists miss cues from patients.鈥� He described how anxiety can diminish a therapists鈥� empathy and literally become contagious.

To address this issue and related ones, Dr. Muran and his colleagues have devised innovative training techniques, including role playing and mindfulness meditation, which improve therapists鈥� metacognitive capacities. All of the training is conducted in a group format.

鈥淚 like to think it鈥檚 pretty innovative,鈥� Dr. Muran said. 鈥淭ypical approaches to training have been more didactic鈥�Our angle is not to tell you you鈥檙e anxious but to help you discover your anxiety.鈥� He added: 鈥淢indfulness is something being practiced all over now; at the time [when we started] we were the only ones doing it to train therapists.鈥�

In their book, (The Guilford Press, 2000), Dr. Muran and his coauthor Jeremy Safran, describe various principles and models of intervention and training from their study of the therapeutic relationship. 鈥�This book鈥�belongs in the library of every mental health professional who practices or teaches psychotherapy,鈥� wrote a reviewer in. Dr. Muran and Dr. Safran continue to collaborate and refine their thinking.

鈥淚 think the consensus continues to grow that so much comes down to the therapeutic relationship and the therapist鈥檚 ability to negotiate that relationship,鈥� Dr. Muran said. 鈥淧eople recognize how important it is and, as much as there is written about it, there are still so many questions to answer.鈥�