Terapi Sürecinde Karşı Aktarım ve Terapötik İttifakın İlişkisi Üzerine Sistematik Bir Gözden Geçirme

Abstract

Bu çalışmada, karşı aktarımın psikoterapi süreci içerisindeki rolünü ortaya koymak amacıyla, terapötik ittifak ve karşı aktarım arasındaki ilişkiyi değerlendiren çalışmaların gözden geçirilmesi amaçlanmıştır. Bu amaçla, önceden belirlenen anahtar kelimeler ile Google Scholar, PubMed, ScienceDirect, PsycNET, MEDLINE, TR Dizin ve Ulakbim veri tabanlarında yayınlanmış Türkçe ve İngilizce makaleler 1999 (Ocak)-2024 (Aralık) yılları kısıtında taranmıştır. Tarama sonucunda dahil etme ölçütlerini karşılayan 15 çalışma gözden geçirilmiştir. İncelenen araştırmalarda karşı aktarım, farklı biçimlerde tanımlanarak terapist ya da dış gözlemciler tarafından değerlendirilmiştir. Terapötik ittifak ise genellikle Bordin’in kuramına dayalı geliştirilmiş ölçeklerle incelenmiş ve bu değerlendirmelerde terapist, danışan ve süpervizör gibi farklı kaynaklardan veri toplanmıştır. Araştırmaların bulguları bir arada değerlendirildiğinde ise karşı aktarım ile terapötik ittifakla ilişkisine dair farklılaşan sonuçlar elde edilmiştir. Kesitsel araştırma bulguları, olumsuz karşı aktarımın terapötik ittifakı zayıflattığını; olumlu karşı aktarımın ise terapötik ittifakı destekleyebildiğini ortaya koymuştur. Bunun haricinde boylamsal araştırmalar, olumlu karşı aktarımın yardımcı etkisinin yalnızca tedavinin başlangıç aşamasında gözlemlendiğini, tedavinin ilerleyen aşamalarında ise terapötik ittifakın gücünü zayıflattığını göstermiştir. Karşı aktarımın terapötik ilerlemeye olan en önemli katkısı ise etkili bir şekilde yönetildiğinde terapötik ittifakı desteklemesi olarak bulunmuştur. Sonuç olarak, olumlu karşı aktarım ile terapötik ittifak arasındaki sonuçlar daha karmaşıkken, olumsuz karşı aktarımın terapötik ittifak için zedeleyici olduğu konusunda bir uzlaşı söz konusudur. Bununla birlikte, karşı aktarımın olumsuz etkilerinin uygun şekilde telafi edilmesi ile olumlu terapötik kazanımların elde edilebileceğine dair bulgular, terapi süreci açısından umut vericidir. Bu derlemenin bulguları, terapötik ilişkinin inşa edilmesi ve etkin bir biçimde sürdürülmesi için klinisyenlerin karşı aktarım dinamiklerini fark etme ve yönetmeye yönelik terapötik becerilerini geliştirmelerinin önemini ortaya koymaktadır.

Keywords

• karşı aktarım
• terapötik ittifak
• terapötik ilişki
• psikoterapi süreci

A Systematic Review on the Relationship Between Countertransference and Therapeutic Alliance in the Therapy Process

Abstract

This study aimed to explore the role of countertransference within psychotherapy by reviewing research on the relationship between countertransference and the therapeutic alliance. Articles published in Turkish and English between January 1999 and December 2024 were searched using specific keywords across Google Scholar, PubMed, ScienceDirect, PsycNET, MEDLINE, TR Dizin, and Ulakbim. Fifteen studies that met the inclusion criteria were analyzed. Countertransference was defined in various ways and assessed either by therapists or external observers. At the same time, the therapeutic alliance was generally evaluated using Bordin’s theoretical framework with data collected from therapists, clients, and supervisors. Overall, the findings presented mixed results regarding their relationship. Cross-sectional studies indicated that negative countertransference tends to weaken the therapeutic alliance, whereas positive countertransference may enhance it. In contrast, longitudinal studies suggested that the beneficial effects of positive countertransference are mostly evident during early treatment stages but may diminish or even impair the alliance in later phases. The most significant contribution of countertransference to therapy appears to be its capacity to support the therapeutic alliance when effectively managed. In conclusion, despite the complex findings regarding positive countertransference, there is a broad consensus that negative countertransference harms the therapeutic alliance. Importantly, some studies show that these adverse effects can be addressed and transformed into positive therapeutic outcomes, which is encouraging for the therapy process. These results underscore the importance for clinicians to develop skills in recognizing and managing countertransference dynamics to foster and maintain a strong therapeutic relationship.

Keywords

• countertransference
• therapeutic alliance
• therapeutic relationship
• psychotherapy process

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