A mixed methods case study examination of the role of the therapeutic alliance in EMDR within primary care

The therapeutic relationship within psychotherapy is well recognised as a pertinent component of successful treatments. In particular, the alliance component of the therapeutic relationship has demonstrated a moderate and robust correlation to positive outcomes. The alliance is considered the change mechanism within the more relationally focused therapies (e.g., psychodynamic). In contrast, therapies that focus on specific techniques related to underlying theory regarding the development and amelioration of mental health difficulties, prioritise the protocols as the change mechanism. Mental health services can be seen to have moved towards offering more time-limited, protocol driven therapies (e.g., CBT) to widen access to therapy and to meet financial incentives. EMDR is a relatively new psychotherapy which has amassed evidence of efficacy since its development by Francine Shapiro in the 1980s and is now recommended within the NICE guidelines. EMDR is predominantly a protocol driven therapy based on its underlying theory which suggests that mental health difficulties are a result of dysfunctionally stored memories. Currently, little is known about the role of therapeutic relationship within EMDR and whether additional focus on relational aspects within the therapy could enhance outcomes. A single-case design with two therapist-client dyads was used to explore the therapeutic alliance within two EMDR therapy cases in a primary care setting. The study had three aims; to investigate the relationship between the therapeutic alliance and outcome; to investigate the fluctuations of the alliance throughout EMDR; and to explore how the alliance is experienced by the client and therapist during EMDR treatment. The principal findings, presented via visual analysis, display a strong alliance and positive outcomes in the two EMDR cases, suggesting the presence of the alliancewithin a predominantly protocolised therapy. This is further supported by the qualitative data, in which the alliance was a highly valued aspect by therapist and clients in both cases. Whilst this study is limited by generalisability given the small sample size and correlational design, it draws researchers' and clinicians' attention to the paucity of information guiding the practice of EMDR in terms of the relational imperative.

Dissertation/Thesis

English

Deborah J. Skinner

Skinner, D. J. (2017). A mixed methods case study examination of the role of the therapeutic alliance in EMDR within primary care. (Doctoral dissertation, University of Nottingham)