I. THERAPEUTIC ALLIANCE

{The term "goal" refers to the physical, psychological and social states that might be expected to result from therapy. These can be considered in terms of ultimate and mediating goals.}

 

1. To what extent do you feel you have been able to work toward mutually shared goals with this patient ?

a. How easy did you find it to come to an agreement with the patient over the goals of therapy?

b. What goals do you feel that you share with the patient?

c. What goals does the patient have which you do not share?

d. What goals do you have that the patient does not share?

e. How far have the goals of therapy been achieved?

f. How optimistic are you about achieving the goals?

B. The Patients Role.

{The term "role" is used in this document to refer to the complex of actions (thoughts, feelings and behaviours) associated with the "positions" of therapist and patient.}

 

1. How far do you feel that this patient has been able to adopt a role which is likely to help him\her achieve the goals of the therapy.

a. Describe the patients view of his/her role in therapy. ( Eg the patient should "say whatever comes into his/her mind" or "explore his/her feelings").

b. Do you feel that the way the patient views his/her role is likely to help him\her achieve his/her goals?

c. What changes do you think that the patient will need to make in his/her role behaviour if he\she is to achieve:-

(1) His/her own goals?

(2) Your goals, if they are different?

d. In what ways have you tried to influence the patient's role behaviour?

(1) How difficult did you find this?

(2) How successful have you been?

1. How far do you feel that you have been able to adopt a role which is likely to help him\her achieve the goals of the therapy.

 

a. Ideally, what would your role be with this patient?

b. How would the patient like you to be?

c. How does your actual role differ from what you would like to be?

d. Describe the ways that the patient prevents you from achieving your ideal role?

e. To what extent, and in what way, do you feel that it is your own lack of skill which prevents you from achieving your ideal role?

f. To what extent, and in what way, do you feel that role insecurity influences your role behaviour? (see section below on role security)

 

D. The Therapeutic Contract.

{The contract refers to the organisation of therapy and the physical setting. It also involves issues like drug/alcohol taking whether prescribed or not.}

 

1. Do you feel you have been able to establish an effective contract with this patient?

a. Did you find it easy to establish a contract with the patient ?

b. What is the nature of your contract with this patient?

c. How does the actual contract differ from that which you would ideally like to have established?

d. Is the contract kept?

e. If broken by the patient what do you do?

f. If broken by the therapist why?

II. THE CORE ELEMENTS OF THERAPY

{By the "core" elements we mean those qualities of the therapeutic process which are known to be associated with a good alliance and a good outcome. When referring to understanding below we are concerned only with simple elements and not with complex processes.}

 

1. How far do you feel that you can understand the way this patient feels about important issues and people in his/her life ?

a. How far do you feel able to understand the way the patient feels?

b. How far do you feel the patient understands the way he\she feels?

c. How effectively do you convey your understanding of his/her feelings to the patient?

d. Give some examples of the things you have said to the patient about his/her feelings.

2. How far do you feel that you can understand the way this patient thinks about important issues and people in his/her life ?

a. How far do you feel able to understand the way the patient thinks?

b. How far do you feel the patient understands the way he\she thinks?

c. How effectively do you convey your understanding of his/her thinking to the patient?

d. Give some examples of things you have said to this patient about the way he\she thinks.

3. How far do you feel that you can understand the way this patient relates to important people in his/her life ?

a. How far do you feel able to understand the way the patient relates to others?

b. How far do you feel the patient understands the way he\she relates to others?

c. How effectively do you convey your understanding of his/her relationships to the patient?

d. Give examples of some of the things that you have said to this patient about the ways he\she relates to others.

4. Are you able to adopt a neutral attitude to this patient?

a. What do you like and dislike about this patient?

b. Give examples of any things about this patient which make you angry.

c. Give examples of any things about this patient which make you feel anxious.

d. Give examples of any things about this patient which make you feel sad.

e. Give examples of any things about this patient which make you feel happy.

f. Give examples of any things about this patient of which you approve.

g. How do your feelings about this patient influence your behaviour with them?

5. Do you feel authentic with this patient?

 

a. Do you feel at ease and natural with this patient?

b. If not

(1) Why do you feel uneasy?

(2) In what way does this influence your behaviour with the patient?

III. TRANSFERENCE COUNTERTRANSFERENCE AND ROLE SECURITY

{Specify how you are using the term transference in your response}

 

1. So far, what are the main transference features of this therapy?

a. Describe any transference interventions that you have made?

b. What effect did these have on the patient.

{Specify how you are using the term counter transference. If you are referring to projective identifications make this clear. Distinguish between Counter transference and role insecurity (see below).}

1. What counter transference issues have arisen for you during this therapy?

a. How have you dealt with these?

b. What impact have they had on the therapy?

{This refers to anxieties that arise from feelings about yourself as a therapist.)

 

1. What are the main sources of role insecurity that you experience as a therapist?

a. How do you deal with these?

b. What impact have they had on the therapy?

IV. RESISTANCE.

1. What forms, if any, does this patients resistance take?

a. What do you see as the main reasons for this patients resisting?

b. How and why have you responded to this aspect of the patients behaviour?

V. FORMULATIONS.

(For clarity formulations are divided into Dynamic Hypothesis and Developmental Hypothesis. It assumed that the developmental hypotheses will to some extent explain the dynamic hypotheses. You may have several formulations for a given patient, if so, select the one you feel is most apparent at the present)

A. DYNAMIC HYPOTHESES.

(A dynamic hypothesis attempts to link up the conflicting aspects of the patients experience in the here and now. It is usually concerned with the interplay between the patients wishes, anxieties, defences and the consequences of these. It would involve repeated patterns and may involve transference material.

1. Describe your dynamic hypotheses for this patient?

a. Give two samples of the clinical material on which it is based?

b. How conscious is the patient of this material?

c. How have you used this formulation with the patient?

B. DEVELOPMENTAL HYPOTHESES

{A developmental hypothesis is one where phenomena which are the focus of either transference or dynamic hypothesis are explained in terms of the patients past experiences. They relate to the classical concept of "reconstruction" but may include conscious and preconscious experiences about which the patient knows.}

 

1. Do you have any clear developmental hypotheses about this patient? If so describe them.

a. Have you put any of these too the patient ? If so what have you said?

VI. METAPSYCHOLOGY.

{In this context the term metapsychology refers to an abstract perspective {Eg developmental/structural/economic/dynamic} offered by an analytical theorist. {Eg Klein, Freud or Kohut}. This would refer to the patient in formal terms. {eg paranoid/schizoid features, oedipal features etc}

 

1. Describe this patient from a metapsychological perspective?

a. What significant features of this patients behaviour do not fit into this perspective?

b. Can these features be better described from a different perspective?