Strengthening the Therapeutic Bond: A Conversation With Catherine Eubanks, PhD

Even the strongest therapeutic relationships can hit rough patches-what psychologists call "ruptures." A new grant-funded study at the Gordon F. Derner School of Psychology is seeking evidence that these moments aren't failures, but opportunities for growth.

As a professor of psychology and principal investigator for the Adelphi University portion of a new $5.2 million initiative funded by the John Templeton Foundation, Catherine Eubanks, PhD, is spearheading research into alliance-focused training (AFT). By exploring how "relational virtues" like humility and curiosity can transform clinical supervision and patient outcomes, she and her team are paving the way for more resilient mental health care. It's one piece of the larger, multisite research effort seeking to address the current mental health crisis by enhancing the clinical training and practice of mental health professionals.

We asked Dr. Eubanks to share the details of this project and how it aims to help therapists-and their patients-flourish when the connection gets complicated.

The Gordon F. Derner School of Psychology was selected as one of a number of research partners for a $5.2 million grant from the John Templeton Foundation. What is the focus of the Adelphi portion of this project?

The primary aim of the Adelphi site project is to comprehensively examine the impact of Alliance-Focused Training (AFT) on supervisor, therapist and patient relational virtues such as humility, curiosity and compassion, which are integral to successful repair of ruptures in the therapeutic alliance (any impairment in the therapist-client connection, including disagreements on goals or tasks).

A novel aspect of this study is the opportunity to evaluate process at multiple levels: therapy, supervision and metasupervision (i.e., supervision of supervision). In addition, in collaboration with our colleague Anna Babl, PhD, a former postdoctoral fellow at Adelphi and currently an assistant professor at the University of Leiden in the Netherlands, we will also examine the impact of an online, asynchronous training based on AFT, with the long-term goal of providing the mental health care workforce with accessible and evidence-based training in rupture recognition and repair.

How does this work fit into the goal of the larger "team science" grant project?

The goal of the overall grant project is to develop novel training tools in mental health, investigate the role of relational virtues in training and treatment research in diverse settings, and identify ways virtue-based training can reduce therapist burnout and promote flourishing. Our site's focus on examining AFT's impact on relational virtues for patients, therapists and supervisors, and also assessing a novel online extension of AFT, is perfectly aligned with the overall project's aims.

For those unfamiliar with it, can you explain alliance-focused training?

AFT is a form of supervision that trains therapists to recognize and repair alliance ruptures. It is very experiential; we encourage therapists to draw on their emotional experience as well as their observational skills to recognize when there is a strain in their relationship with their patients.

AFT aims to "destigmatize" ruptures as common phenomena that are inevitable when two human beings with different wishes and needs are interacting, and that provide opportunities for corrective experiences and growth. We seek to help therapists approach ruptures with curiosity, openness, humility and nondefensiveness.

Though it can be conducted as individual supervision, we usually conduct AFT as group supervision, and strive to create a safe, cohesive space in the group where therapists can take the risk of sharing challenging moments in therapy and engaging in experiential awareness-oriented exercises (like role-plays or chairwork) to help them become more aware of their own and their patients' experience.

The therapeutic alliance is a major focus of your research. Can you share what drew you to this area of study and why you believe it to be important?

The field of psychotherapy has a long history of competition between approaches. I have long been interested in ideas and principles that the different approaches agree on-common factors and areas of consensus-as well as the idea of flexibly integrating across approaches in order to be responsive to a particular clinical context.

The alliance is probably the most well-studied and universally agreed upon common factor, and has been referred to as the "quintessential integrative variable." It has a robust relationship with outcome. The alliance is commonly defined (following Edward S. Bordin) as the patient's and therapist's agreement on the goals of therapy, their collaboration on the tasks of therapy, and their bond of mutual trust and respect. Without at least a "good enough" alliance, there is no therapy. So its importance is clear.

Also, for me personally, I am drawn to working in the therapeutic relationship in therapy. I think an alliance-focused approach is a good fit for my personality and my interpersonal style. And the idea of alliance rupture and repair is particularly meaningful-and therapeutic-for me, because I have some perfectionistic tendencies. Reframing ruptures as opportunities helps me bring more patience, compassion (including self-compassion) and courage to the work.

You are the principal investigator for this project-what will your work entail, and who else will be involved with the research?

I am working on this project with co-investigators Chris Muran, PhD, dean of the Gordon F. Derner School of Psychology, and Assistant Professor Emma Freetly Porter, PhD, and our students will be actively involved. We also have a number of clinicians who will serve as supervisors, including several Derner alumni.

The work will entail recruiting 100 therapists who will receive training, and 100 patients for those therapists to work with. We will need to oversee data collection at every therapy session, supervision session and metasupervision session.

What is the goal and expected impact of the research being done at Adelphi through this project?

By examining relational virtues and flourishing in AFT, we will be able to assess whether AFT actually does facilitate these qualities in therapists, and to identify what aspects of AFT (such as specific supervisory tasks or modeling from supervisors) are associated with increases in relational virtues in therapists and patients. By examining processes in supervision and metasupervision, we hope to contribute to the field's knowledge of how supervision contributes to therapist change.

While we expect AFT to have a larger impact on therapists than the online training, we also expect that the comparison will show that the online experiential training is beneficial for therapists. Given how much easier it is to implement and disseminate an online training, this furthers the goal of creating accessible, evidence-based trainings for therapists.

Finally, we may also gain some preliminary data that can help us identify potential moderators of training impact; that is, variables that predict which therapists may benefit more from which form of training. The long-term potential impact on therapists is considerable-the online trainings will be made freely accessible to anyone with internet access, and in the future will include translations into different languages. Findings will also be presented at conferences and submitted to journals for publication.