Relational psychoanalysis

Domain I · Psychodynamic & depth psychology · Mitchell, Aron, Benjamin · 1988

What it is

Relational psychoanalysis is a two-person psychoanalytic therapy. It holds that mind is built from relationships, both actual and internalised (Mitchell's "relational matrix"), and that the analyst is always a participant in the treatment, never a neutral observer.

Format

• Format. Open-ended, individual, usually 1–4 sessions a week, often for years. Face-to-face and couch are both used. Many relational clinicians work face-to-face at once- or twice-weekly frequency. No standard session count exists. Frame elements such as fees, missed sessions, contact between…
• Move on when the patient can stay with their experience in the room and repetitive interpersonal patterns are becoming visible, inside and outside sessions.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Pushing optimism, which can deepen dread.
• Ongoing passivity. Maroda regards therapists as often "excessively passive".
• Abreaction without integration, and the patient leaving dysregulated. See 5.3.
• Surprise that turns into shock, or "safety" that turns into collusion with avoidance.
• Intellectualised decoding. It is working if the affect from the dream arrives in the session.

Problems the guide addresses

• Stuck treatment / impasse
• Resistance
• Overwhelm and dysregulation
• "Non-adherence": missed sessions, lateness, payment problems, frame breaches
• Ruptures
• Patient rejects the focus on "us"
• Erotic transference and countertransference; boundary risk
• Self-disclosure backfires
• Analyst over-acknowledgment, guilt or shame
• Compliance and "relational" false self

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.