Therapeutic relationship, motivation to treatment and interpersonal cycles: A case of obsessive-compulsive disorder
Viviana Balestrini, Barbara Barcaccia, Angelo Maria Saliani
Building up a sound therapeutic relationship is the cornerstone in order to enhance the collaboration
to treatment. This is particularly true in the case of Exposure with Response Prevention (E/RP), a
highly effective treatment, but at the same time very uncomfortable for the patients, so much so that
many patients refuse to undergo the E/RP treatment.
In the case of Prudente, the high level of interpersonal oppositivity made it difficult for the patient to
adhere to any information proposed by the psychotherapist. A specific modulation of the therapeutic
relationship was adopted for this reason; particular attention was paid to the shared case formulation
and to the key role played by some typical interpersonal cycles in maintaining the disorder. In
particular, the identification of the interpersonal cycles enabled the therapist to modulate the
therapeutic relationship in a more subtle and effective way and also enabled the therapist to avoid
being caught in the traps represented by these cycles, which can easily occur again also between the
patient and therapist.
Moreover, the recognition and the shared understanding of the interpersonal cycles with the patient
provided helpful information for psycho-educational interventions both with Prudente and with
Prudente’s family members and contributed to enhance the motivation to treatment, favoured the
process of risk acceptance and compliance with the response prevention procedures.
Keywords
Therapeutic relationship, compliance to treatment, interpersonal cycles,
acceptance of risk, obsessive-compulsive disorder, response prevention.
