How collaboration in therapy becomes therapeutic: the therapeutic collaboration coding system

Background. The quality and strength of the therapeutic collaboration, the core of
the alliance, is reliably associated with positive therapy outcomes. The urgent challenge
for clinicians and researchers is constructing a conceptual framework to integrate the
dialectical work that fosters collaboration, with a model of how clients make progress
in therapy.
Aim. We propose a conceptual account of how collaboration in therapy becomes
therapeutic. In addition, we report on the construction of a coding system – the
therapeutic collaboration coding system (TCCS) – designed to analyse and track on a
moment-by-moment basis the interaction between therapist and client. Preliminary
evidence is presented regarding the coding system’s psychometric properties. The TCCS
evaluates each speaking turn and assesses whether and how therapists are working
within the client’s therapeutic zone of proximal development, defined as the space between
the client’s actual therapeutic developmental level and their potential developmental
level that can be reached in collaboration with the therapist.
Method. We applied the TCCS to five cases: a good and a poor outcome case of
narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and
a dropout case of narrative therapy.
Conclusion. The TCCS offers markers that may help researchers better understand
the therapeutic collaboration on a moment-to-moment basis and may help therapists
better regulate the relationship.
This work was supported by the Portuguese Foundation for Science and Technology (FCT); the PhD Grant SFRH/BD/46189/2008.