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The Therapeutic Alliance in A Social Learning Setting: The Importance of Relationship

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Length: 20 minutes

Hannah Starobin, LMSW and Cynthia Manson, MSW

The importance of the therapeutic alliance was first recognized by Freud.  Adam Phillips paraphrases Freud beautifully when he writes (1995); “people are only as mad (unintelligible) as other people are deaf (unable, or unwilling to listen)” (p.34).*  The path to recovery begins with the understanding of meanings and with human connection.  The Second Chance Program at New York Presbyterian Hospital / Payne Whitney Westchester is a social learning unit focused on treating individuals diagnosed with chronic treatment refractory schizophrenia.  Second Chance utilizes cutting edge psychopharmacology, group and individual skills training and a token economy in a therapeutic milieu environment.  It is through the simplicity of a genuine human connection and the therapeutic alliance that these often marginalized and isolated individuals once again connect to themselves and to others.  With the use of two case presentations we illustrate how the therapeutic alliance and a social learning environment work in concert to help the patient find a sense of himself, his strengths and a place in the world.  In one case we discuss the creation of a secure “holding environment” and the lending of ego strength.  In a second case we explore the use of transference and countertransference in a patient with psychogenic polydipsia.
* Phillips, A. (1995). Terrors and Experts. Cambridge, MA: Harvard University Press.


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