Rupturas en la alianza terapeutica: un ambito para negociar una autentica relacion.


  • Jeremy D. Safram New School for Social Research, New York


Palabras clave:

alianza terapéutica, relación terapéutica, cambio terapéutico, eficacia terapéutica, ruptura de alianza terapéutica, experiencia emocional correctora, self, otros


En este artículo sostengo que la clarificación de los procesos involucrados en el trabajo con las rupturas en la alianza terapéutica, es una tarea de vital importancia para los teóricos e investigadores en psicoterapia. Propongo que estos problemas inevitables en la alianza terapéutica, proporcionan oportunidades importantes para clarificar los factores que pueden crear verdaderas barreras en las relaciones cotidianas de los pacientes. Además, el trabajar sobre estos problemas puede proporcionar a los pacientes una experiencia en la importante tarea de conciliar las necesidades de relación y participación, para terminar aceptando ambas, el self y el otro. La importancia central de estas tareas en el ser humano ha sido reconocida a lo largo de los años y en todas las culturas. El paradigma actual cambia la teoría y práctica psicoterapéutica hacia perspectivas más relacionales y constructivistas, estableciendo un ambiente particularmente apropiado para aumentar nuestro conocimiento de la relación terapeuta-paciente a través de una exploración diferenciada de estos aspectos.


Los datos de descargas todavía no están disponibles.


Alexander, F. & French, T.M. (1946). Psychoanalytic therapy: Principles and application. Ronald.

Arbus, D. (1972). Diane Arbus. Aperture Monograph.

Arkowitz, H. & Hannah, M.T. (1989). Cognitive, behavioral and psychodynamic therapies: Converging or diverging pathways to change?. In A. Freeman, K.M. Simon, L.E. Beutler, and Arkowitz (Eds.) Comprehensive handbook of Cognitive Therapy (pp.143-167). Plenum.

Arnkoff, D.G. (1983). Common and specific factors in Cognitive Therapy. In M.J. Lambert (Ed.), Psychotherapy and patient relationship. Dorsey.

Bacal, H.A. & Newman, K.M. (1990). Theories of object relations: Bridges to self psychology. Columbia University Press.

Balint, M. (1935). Pregenital organization of the libido. In Primary love and the psychoanalytic techniques. Liveright.

Batchelor, (1979). A guide to the Bodhisattva’s way of live. English translation of Shantideva’s Bodhisattvacharyavatara. Indraprastha Press.

Beebe, B. (1985). Mother-infant mutual influence and precursors of self and object representations. In J. Masling (Ed.), Empirical studies of psychoanalytic theories, 2. Lawrence Erlbaum.

Bergin, A.E. (1970). The deterioration effect: A reply to Braucht. Journal of Abnormal Pyschology, 75, 300-302.

Bollas, C (1989). Forces of destiny: Psychoanalysis and human idiom. Free Association Books.

Bordin E. (1979). The generalizabillity of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252-260.

Bowlby, J. (1969). Attachment and loss. 1, Attachment. Basic.

Buber, M. (1973). Meetings. La Salle, Illinois: Open Court Publishing. M. Friedman (Trans.)

Buber, M. (1958). I and thou (2ª Edition). Scribner. (R. Gregor Smith, Trans.).

Carson, R.C. (1969). Interaction concepts of personality. Aldine.

Cashdan, S. (1988). Object relations therapy. W.W. Norton.

Eagle, M.N. (1984). Recent developments in psychoanalysis. McGraw-Hill.

Fairbairn, W.R.D. (1952). Psychoanalysis studies of the personality. Tavistock Publications & Routledge & Kegan Paul.

Ferenczi, S. (1931). Child analysis in the analysis of adults. In Final contributions to the theory and technique of psychoanalysis. (pp.126-42)

Foreman, S.A. & Marmar, C.R. (1985). Therapist actions that address initially poor therapeutic alliances in psychotherapy. American Journal of Psychiatry, 142, 922-926.

Gendlin, E.T. (1991). In J.D. Safran and L.S. Greenberg (Eds.), Emotion, psychotherapy and change. Guildford.

Gill, M. (1982). Analysis of transference, 1. International Universities Press.

Goldfried, M.R. & Davison, G.C. (1976). Clinical behavior therapy. Rinehart and Winston.

Greenberg, J.R. & Mitchell, S.A.(1984). Object relations in psychoanalytic theory. Harvard University Press.

Greenberg, L.S. & Safran, J.D. (1987). Emotion in psychohterapy. Guildford.

Greenberg, J.R. (1991). Countertransference and reality. Psychoanalytic dialogues, 1(1), 52-73.

Greeson, R.R. (1967). The technique and practice of psychoanalysis, 1. International University Press.

Guidano, V.F. (1991). Affective change events in a cognitive therapy system approach. In J.D. Safran and L.S. Greenberg (Eds.), Emotion, psychohterapy and change (pp.50-78). New York: Guildford.

Guntrip, H. (1969). Schizoid phenomena, object relations and the self. International Universities Press.

Harvey, A. (1988). Love’s fire: Re-creations of Rumi. Meeramma.

Haynal, A. (1988). Controversies in psychoanalytic method. New York University Press.

Henry, W.P., Schacht, T.E. & Strupp, H.H. (1990). Patient and therapist introject, interpersonal process, and differential psychotherapy outcome. Journal of Consulting and Clinical Psychology, 58(6), 768-774.

Henry, W. P., Schacht, T.E. & Strupp, H.H. (1986). Structural analysis of social behavior: Application to a study of interpersonal process in differential psychotherapy outcome. Journal of Consulting and Clinical Psychology, 54, 27-31.

Hill,C. & Safran, J.D. (1993). Assessing interpersonal schemas: Anticipated responses of significant others. [Manuscript submitted for publication].

Hoffman, I.Z. (1991). Discussion: Toward a social-constructivist view of the psychoanalytic situation. Psychoanalytic Dialogues, 1(1), 74-105.

Horney, K. (1945). Our inner conflicts. W.W. Norton.

Horowitz, M.J. & Marmar, C. (1985). The therapeutic alliance with difficult patients. In A.J. Frances and R.E. Hales (Eds.), Review of psychiatry, 4, 573-585. American Psychiatric Press.

Horvath, A.O. & Greenberg, L. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223-233.

Horvath, A.O. & Symonds, B.D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139-149.

Jacobson, N.S. (1989). The therapist-client relationship in cognitive behavior therapy: Implications for treating depression. Journal of Cognitive Psychotherapy, 3, 85-96.

Kiesler, D.J. (1986). Interpersonal methods of diagnosis and treatment. In J.D. Cavenar (Ed.), Psychiatry.

Kouth, H. (1984). In A. Goldberg and P. Stephansky (Eds.), How does analysis cure? Chicago University of Chicago Press.

Lacan, J. (1964). The four fundamental concepts of psychoanalysis. J.A. Miller, Ed.

Lambert, M.J. (1989). The individual therapist’s contribution to psychohterapy process and outcome. Clinical Psychology Review, 9, 469-485.

Lambert, M.J. (1983). Psychotherapy and patient relationships. Dorsey

Lang, P.J. (1983). Cognition in emotion: Concept and action. In C. Izard, J.Kagen and R. Zajonc (Eds.), Emotion cognition and behavior. Cambridge University Press.

Levenson, E. (1983). The ambiguity of change. Basic.

Leventhal, H. (1984). A perceptual-motor theory of emotion. In L. Berkowitz (Ed.), Advances in experimental social psychology. Academic.

Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual of supportive-expressive treatment. Basic.

Luborsky, L., McLellan, A.T., Wppdy, G.E., O’Brian, C.P. & Auerbach, A. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602-611.

Luborsky, L., Singer, B. & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “Everyone has won and all must have prizes”?. Archives of General Psychiatry, 32, 995-1008

Luborsky, L., Crits-Christoph, P., McLellan, A.T., Woody, G., Piper, W., Liberman, B.S. & Rilkonis, P. (1986). Do therapists very much in their success. American Journal of Orthopsychiatry, 56, 501-512

Mahler, M. (1974). Symbiosis and individuation: The psychological birth of the human infant. In The selected papers of Margaret S. Mahler (Vol.2). Jason Aronson.

Mahoney, M.J. (1991). Human change processes. Basic.

Main, M., Kaplan, N. & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: a move to the level of representation. Monographs of the Society for Research in child Development, 209,50, (1-2). University of Chicago Press.

Marmar, C.R., Weis, D.S. & Gaston, L. (1989). Towards the validation of the California Therapeutic Alliance Rating System. Journal of Consulting and Clinical Psychology, 1, 46-52.

Mead, G.H. (1934). Mind, self and society. Chicago: University of Chicago Press.

Menaker, E. (1989). Appointment in Vienna. St. Martin’s Press.

Mitchell, S.A. (1988). Relational concepts in psychoanalysis: An integration. Harvard University Press.

Moyne, J. & Barks, C. (1986). Unseen rain: Quatrains of Rumi. Threshold.

MUurphy, C.M. & Messer, D.J. (1977). Mothers, infants and pointing: A study of gesture. In H.R. Schaffer (Ed.), Studies in mother-infant interaction. Academic.

Nelson, K. & Gerundel, J.M. (1981). Generalized event representations: Basic building blocks of cognitive development. In M.E. Lamb and A.L. Brown (Eds.D, Advances in Developmental Psychology, 1. Erlbaum.

Ogden, T.H. (1986). The matrix of the mind. Jason Aronson.

Orlinsky, D.E. & Howard, R.I. (1986). The relation of process to outcome in psychotherapy. In S.L. Gardfield and A.E. Bergin (Eds.) Handbook of psychotherapy and behavior change, (3rd ed). John Wiley.

Perls, F.S, Hefferlin, R. & Goodman, P. (1951). Gestalt therapy. Dell.

Racker, H. (1968). Transference and countertransference. International Universities Press.

Rank, O. (1929). The trauma of birth. Harper and Row.

Rank (1945). Will therapy and truth and reality. Knopf.

Reich, W. (1942). The function of the orgasm. Orgone Institute.

Reich, W. (1949). Character analysis. Noonday.

Ricks, D.F. (1974). Supershrink: Methods of a therapist judged successful on the basis of adult outcomes of adolescent patients. In D.F. Ricks, M. Roff, and A. Thomas (Ed.), Life history research in psychopathology. University of Minnesota Press.

Rilke (1903). Letters to a young poet. Vintage Books, 1986. S. Mitchell, Ed. and Trans .

Rogers, C.R. (1951). Client centered therapy. Houghton Mifflin.

Safran, J.D. (1993). The therapeutic alliance rupture as a transtheoretical phenomenon: Definitional and conceptual issues. Journal of Psychotherapy Integration, 3, 33-49

Safran, J.D. (1984a). Assesting the cognitive interpersonal cycle. Cognitive Therapy and Research, 87, 333-348 SAFRAN, J.D. (1984b). Some implications of Sullivan’s interpersonal theory for cognitive therapy. In M.A. Reda and M.J. Mahoney (Eds.), Cognitive psychotherapies: Recent developments in theory, research and

practice. Ballinger.

Safran, J.D. (1990a). Towards a refinement of cognitive therapy in light of interpersonal theory: I. Theory. Clinical Psychology Review, 10, 87-105.

Safran, J.D. (1990b). Towards a refinement of cognitive therapy in light of interpersonal theory: II. Practice. Clinical Psychology Review, 10, 107-121.

Safran, J.D., Croker, P., McMain, S. & Murray,P. (1990). The therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27(2), 154-165.

Safran, J.D. & Greenberg, L.S. (Eds.) (1991). Emotion, psychotherapy and change. Guildford.

Safran, J.D., Muran, C. & Wallner, L. (1991b). Research on therapeutic alliance ruptures. Symposium presented at the Society of Psychotherapy Research Conference. Lyon.

Safran, J.D., Muran, C. & Wallner, L. Modelling the processes involved in the resolution of therapeutic alliance ruptures. In A.O. Horvath and L.S. Greenberg (Eds.), The working alliance: Theroy, research and practice. John Wiley.

Safran, J.D. & Segal, L.S. (1990). Interpersonal process in cognitive therapy. Basic.

Sandler, J. & Sandler, A.M. (1978). On the development of object relationships and affects. International Journal of Psychoanalysis, 59, 285-296.

Shapiro, D.A. (1985). Recent applications of meta-analysis in clinical research. Clinical Psychology Review, 5(1), 13-34.

Smith, M.J. & Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752-760.

Spitz, R. (1965). The first year of life. International Universities Press.

Sterba, R. (1934). The fate of the ego in analytic therapy. International Journal of Psychoanalysis, 15, 117-126

Stern, D.N. (1985). The interpersonal world of the infant. Basic.

Stolorow, R. (1988). Intersubjectivity, psychoanalytic knowing and reality. Contemporary Psychoanalysis, 24, 331-338.

Stone, L. (1961). The psychoanalytic situation. International Universities Press.

Strupp, H.H. (1980). Success and failure in time limited psychotherapy: A systematic comparison of two cases. Archives of General Psychiatry, 37, 595-603.

Strupp, H.H. & Binder, J.L. (1984). Psychotherapy in a new key: A guide to time limited dynamic therapy. Basic.

Such, C.S. O’Malley, S.S., Strupp, H.H. & Johnson, M.E. (1989). The Vanderbilt Psychotherapy Process Scale (VOOS). Journal of Cognitive Psychotherapy: An international Quartely, 3(2), 123-154.

Sullivan,H.S. (1953). The interpersonal theory of psychiatry. W.W. Norton.

Tansey, M.J. & Burke, W.F. (1989). Understanding countertransference. Analytic.

Trevarthan, C. & Hubley, P. (1978). Secondary intersubjectivity. Confidence, confiders and acts of meaning in the first year. In A. Lock (Ed.). Action, gesture and symbol. Academic.

Tronick, E.Z. (1989). Emotions and emotional communication in infants. American Psychologist, 44, 112-119

Wachtel, P.L. (1977). Psychoanalysis and behavior therapy. Basic.

Weiss, J., Sampson, H. & The Mount Zion Psychotherapy Research Group (1987). The psychoanalytic process: Theory, clinical observation and empirical research. Guildford.

Winnicott, D.W. (1965). The maturational process and the facilitating enviroment. Hogarth.

Zetzel, E. (1956). Current concepts of transference. International Journal of Psychoanalysis, 37, 369-376.




Cómo citar

D. Safram, J. (1994). Rupturas en la alianza terapeutica: un ambito para negociar una autentica relacion. Revista de Psicoterapia, 5(20), 69–91.