The therapeutic alliance negotiation in the “Here and Now”: therapists’ mindfulness and its influence in the psychotherapeutic process
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2025
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Abstract
Therapeutic alliance ruptures have been understood as a lack of cooperation in the tasks or objectives, or tension in the affective bond, including drastic breakdowns in collaboration, understanding, or communication, and lesser tensions of which one or both participants may remain not fully aware (Muran & Eubanks, 2020; Salgado, 2016). They are presented through behaviors in which the patient or the therapist directly expresses rage, resentment, or dissatisfaction with some aspects of the therapy or with the other, and/or the patient and/or therapist disconnects or distances from the other, from their own emotions, or certain aspects of the psychotherapeutic process. A large body of research has highlighted the importance of the recognition, agreement, and resolution of ruptures for therapeutic change and positive therapy outcomes, as well as the influence of some therapists’ factors that contribute to this process. Even though mindfulness has been proposed extensively as a facilitative factor when therapists need to deal with difficult moments in the psychotherapeutic process, there are some gaps in how mindfulness is displayed during the psychotherapeutic process, particularly at times when therapists require full attention to what is going on with their patients, while regulating their reactions and how it could be associated with the therapeutic alliance negotiation and the patient’s experience. This work aims to evaluate the association between the therapist’s mindfulness, the process of the therapeutic alliance negotiation between patient and therapist, and the session’s impact on the patient through a therapeutic naturalistic micro process study in a sample of 6 therapeutic dyads. For this purpose, mindfulness state and in action, therapeutic alliance negotiation, and patient experience measures were taken. Mindfulness state showed to have a relationship with the emotional state at the end of the sessions for patients, but not with the assessment of them. Also, the mindfulness state did not show a significant influence on the process of therapeutic alliance ruptures and resolution, and only a few mindfulness-in-action indicators showed a higher probability of predicting different types of ruptures. Less evidence was found about the potential of the prediction of mindfulness in action on resolution strategies. However, these results provide preliminary evidence about how therapists use different characteristics of mindfulness during critical moments in therapy and about the importance of moving from intrapersonal mindfulness to interpersonal or relational mindfulness in the training of therapists.The results should be taken with caution given the small sample size and the lack of control of other variables that may influence this study.
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Tesis (Ph.D. in Psychotherapy)--Pontificia Universidad Católica de Chile, 2025