Therapeutic Alliance in Personality Disorders Therapy from the Perspective of Transactional Analysis

Abstract

The present research on the effectiveness of psychotherapy demonstrates that it is dependent to a great extent on both specific and common treatment factors, i.e. on the quality of the therapeutic relationship and alliance. Therapeutic alliance within the transtheoretical approach is defined in terms of the therapist-patient bond as well as the agreed therapy goals and tasks (Bordin, 1994). Since persons with personality disorders from clusters A, B and C according to DSM-5 (APA, 2013) for various reasons have great difficulties in maintaining stable interpersonal relationships, which is reflected in building and maintaining of the adequate level of the therapeutic alliance.

We have assumed that the conception of overt and ulterior transactions in Transactional Analy- sis allows a novel description and explanation of problems related to the fluctuations of the thera- peutic alliance with patients suffering from different personality disorders. The considerations pre- sented in the article aim at: 1) the description of difficulties in the therapeutic relationship charac- teristic of patients with personality disorders from clusters A, B and C; 2) the indication to typical transactional games between patients with various personality disorders and the therapist and their influence on the fluctuation of the strength of alliance and 3) the presentation of Paul Ware’s (1985) conception of “open door, target door and trap door” in psychotherapy along with the re- sulting recommendations as regards the order of applied therapeutic strategies.