THE THERAPEUTIC CONTEXT - PRECONDITIONS FOR CHANGE IN PSYCHOTHERAPY

Therapeutic context is defined as the interpersonal context in which the treatment takes place, encompassing those factors that set the stage for therapeutic change. This article discusses four aspects of therapeutic context: therapeutic alliance, client's expectations of change, treatment rationale, and therapeutic impact. To illustrate the central role of the therapeutic context in treatment outcome, a clinical case is discussed in which systematic desensitization was used to treat a choking phobia. Throughout the therapy process, there was minimal client collaboration and the treatment failed to produce any symptom change. However, significant improvement did occur subsequent to an event high in therapeutic impact which provided a plausible treatment rationale to the client, increased the client's expectation of change, and established a therapeutic alliance. This case illustrates the importance of relationship and context in psychotherapeutic change.