The therapeutic alliance: Exploring the concept of ‘safety’ from a neuropsychotherapeutic perspective

The role of the therapeutic relationship in the counselling process has been extensively demonstrated within literature. Less is known about the neurobiology of this relationship and the critical role of facilitating safety to enhance therapeutic outcomes, compliance and relapse prevention. This need for a safe space has deeply rooted neurobiological markers that are well described by Seymour Epstein’s cognitiveexperiential self-theory and Klaus Grawe’s neuropsychotherapeutic model. Epstein demonstrated how the needs for attachment and for control are two of the basic human needs that must be fulfilled to facilitate change. These mental conditions must be obtained in order for the human species to flourish. Grawe demonstrated how these needs play a vital role in the therapeutic relationship. Allan Shore, Richard Davidson and Eric Kandel posited that the right hemisphere of the brain is generally responsible for appraising safety and danger of others and organising the sense of emotional self. It is this appraisal of events that may result in the development of motivational avoidance or approach schemas that have been developed in the course of one’s life, to satisfy basic needs. This thesis explores the fundamental neurobiological markers that need to be addressed in the therapy process. Without effective regulation of these primitive neurobiological markers, the therapeutic process may be jeopardised. The therapeutic relationship captures these key indicators. Clients who seek counselling not only have difficulties with the presenting problem; they also need a safe space to effectively address these issues. For people experiencing distress, their experience of safety, is an area of critical importance yet little research has addressed this. In the context of this thesis, the focus will be upon the need for attachment and for control. These needs will be discussed in relation to their dual function in facilitating safety within the therapeutic alliance