Stage 1: Preliminary Diagnosis of Relational Pattern

Object relations theory suggests that the patient enters therapy in a state of developmental delay with strong dependency needs, rigid defenses and a weak observing ego. Consequently, it makes sense that psychotherapy is a process of correcting these limitations. The developmental delay and dependency issues experienced by the patient will express themselves in the patient’s relationships with others, which is why psychotherapy should begin with the taking of a relational history. In reviewing the patient’s current and past relationships a dysfunctional pattern of relating will emerge. This pattern will also emerge in the therapeutic relationship if the therapist is non-judgmental, empathic, and understanding.

This relational assessment is most effective if it begins with the client's current relationships including family, friends, co-workers, and supervisors or supervisees at the workplace. The client's overall connectedness within the community can also be revealing. Questions about marital relations, parenting style, and relations with neighbors help reveal the patient’s relational pattern, in terms of both strengths and problem areas.

Once current relationships have been assessed, the therapist needs to inquire about past relationships. This history should begin with the most recent and regress into childhood. Proceeding in this fashion facilitates the client's recall of earlier memories. The therapist's goal is to assess any pattern of interaction across the patient's life span that provides insight into the client's personality structure. The client also might gain some insight during this task, but the therapist needs to be careful not to interpret either the therapists or the patient's insights at this time, for interpretations would run counter to the goals of the following stage.



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