A relational approach to understanding change: Plurality and contextualism in a psychotherapy research program

This paper presents a relational approach to understanding the self and change that represents a convergence of theoretical perspectives and developments in the literature regarding, for example, emotion, communication, attachment, child development, intersubjectivity, and social constructionism. It introduces the Beth Israel Brief Psychotherapy Research Program as a center for the study of the therapeutic relationship, specifically alliance ruptures and impasses. The program is designed to assess change on multiple dimensions by multiple measures from multiple perspectives and on three levels of analysis: ultimate, intermediate, and immediate outcome. The paper then presents a sampling of studies illustrating the work accomplished at each level. In addition, it outlines current and future investigatory endeavors and, in the process, suggests increased efforts to study the therapist subjective experience in the context of the therapeutic relationship, especially in the resolution of therapeutic alliance ruptures.