The relationship between psychologist and patient is a cardinal element of psychotherapy: the relationship that is created is based on trust, empathy and collaboration, essential elements for building a solid therapeutic alliance (Bordin, 1979).
However, the therapeutic link does not always follow a linear trend, since there is the possibility that dysfunctional dynamics emerge. Among these is the collusionwhich can negatively affect the effectiveness of the treatment and the well -being of the patient.
Collusion means a psychological phenomenon that involves two or more individuals in a sort of “implicit pact”, often unaware, which leads to a reinforcement of dysfunctional behaviors or beliefs. In the context of therapy, this dynamic is able to become a real obstacle to change and to consolidate problematic patterns.
Explore the meaning of collusion And of what is its impact in the therapeutic relationship is essential to prevent its consequences and promote an ethical and effective clinical practice.
The therapist-patient collusion
There collusion in psychology It occurs in various contexts, including personal relationships, social groups and professional dynamics. In general, it refers to one unconscious convergence between two individuals which act in a complementary way in order to maintain a dysfunctional situation.
Some examples of collusion in psychology are:
• Couple collusion: within a report both partners can unknowingly support dysfunctional models, such as mutual control or idealization, thus perpetuating conflicts or emotional dependencies
• Narcissistic collusion: it is a type of collusion that occurs when a partner or group confirms and amplifies the sense of grandeur of the other, helping to strengthen narcissistic traits and avoid introspection or propensity to change
• Madness to two (folie à deux): a clinical example of pathological collusion, in which two people share psychotic delusions or convictions, reinforcing each other in the distortion of reality (DSM-IV-TR; magazine of Psychiatry, 2019).
Collusion often tends to develop through unconscious transference and countertransference mechanisms, making it particularly relevant in the context of therapeutic contexts.
The causes of collusion
In psychotherapy the collusion between therapist and patient It can be found when the first, consciously or unconsciously, participates in dynamics that tend to maintain or strengthen the patient’s problems.
It is a phenomenon that represents a relational complexity strongly capable of undermining the therapeutic process and hindering change; Often it arises from the interaction between the personal characteristics of the therapist and the needs or expectations of the patient.
Collusion can emerge for several reasons, including:
• Unresolved needs of the therapist: The professional can be influenced by personal desires, such as the need to feel accepted, appreciated or useful. For example, the fear of provoking a conflict with the patient could lead the professional to an breeding of critical questions or interventions, ending up satisfying dysfunctional behaviors or attitudes that perpetuate the problem
• Difficulty in management of the countertransference: The countertransference refers to the emotional reactions that the therapist develops in response to the patient’s dynamics. When these reactions are not processed, the therapist can involuntarily cultivate with the patient’s disdainive relational patterns, supporting dynamics that strengthen the problem. For example, the therapist could respond with excessive empathy to manipulative or victim behavior, thus feeding the same schemes that you would intend to modify (Gelso & Hayes, 2007).
Collusion can manifest itself in many different forms, depending on the type of relationship that develops between patient and therapist. Here are some examples of frequent:
- confirmation of a victimist role: a therapist could passively accept the patient’s narrative as a victim, without questioning the proposed perspective. In this way, the professional meets the risk of strengthening the patient’s identification with the role of victim, instead of helping him in the exploration of other possibilities or in the assumption of greater responsibility for his actions
- complicity in emotional dependence: a therapist could be hired when he avoids encouraging the patient’s autonomy, thus maintaining a relationship that strengthens emotional dependence. For example, responding to the patient’s reassurance requests continuously without proposing alternative strategies can limit the development of emotional independence
- avoidance of the conflict: for fear of compromising the therapeutic relationship, a psychologist could avoid dealing with difficult topics or problematic aspects, such as dysfunctional behaviors or rigid defenses. This attitude, although initially it seems to preserve the link, hinders the process and prevents the central nodes of the problem, consequently hindering therapeutic progress.
Manage collusion
To deal with and manage collusion in therapy it is necessary that the professional develops a deep awareness of relational dynamicsas well as a ability to constantly monitor one’s emotional and behavioral reactions. Reflection on itself is an extremely important tool for the recognition of collusion signals, such as the desire to avoid conflicts or the tendency to please the patient.
Such self-observation process It offers the therapist the opportunity to identify any problematic aspects in their approach and to intervene to correct them.
The ability of communicate transparently With the patient it is a further element for the prevention of collusion dynamics. In fact, tackling difficult themes or uncomfortable situations, without fear of being able to compromise the therapeutic link in this way, is helpful in the construction of a relationship that is based on mutual trust and authenticity.
This transparency does not imply a critical or judgmental attitude, but rather an willingness to explore the problematic areas together with the patient, thus promoting change.
Another central aspect in the management of collusion is it development of anstrong and collaborative therapeutic alliance. According to Bordin (1994) a therapeutic relationship based on shared objectives, mutual respect and commitment to change significantly reduces the risk of collusion. A solid alliance allows you to also deal with complex topics without compromising the relationship and offers the patient an authentic and constructive relational model.
There are several tools that can be supported by the therapist in the recognition and management of the phenomenon of collusion. Clinical supervision is a fundamental means of analyzing cases with the support of expert colleagues. In fact, the discussion of the dynamics of the therapeutic relationship with an external observer allows the possible identification of collusive patterns that can escape the professional.
In the same way, the comparison with other professionals Through interviewing meetings it is able to offer new perspectives and ideas on how to deal with complex situations.
No less important is the continuous training. The deepening of one’s theoretical and practical knowledge, participation in refresher courses and the study of innovative approaches helps the therapist to develop greater competence in the management of difficult situations, including collusion.
This learning process allows you to face the challenges that can be encountered within the therapeutic relationship with greater safety and thus adapt its approach to the specific needs of each patient.
The consequences of collusion with the patient
If it is not correctly recognized and managed, collusion can have profoundly negative effects on the therapeutic relationship and the effectiveness of the treatment. Among the most relevant consequences we find:
- The maintenance of the status quowhich prevents the patient from the exploration of new perspectives, as well as to start a process of significant change
- impairment of mutual trust due to relationships without authenticity
- failure to achieve tangible progresswho can emerge in the perception of both personal and professional failure by the patient (Safran & Muran, 2019).
For a functional therapeutic relationship
There collusion It is a complex and potentially dangerous dynamic within the relationship between therapist and patient. His recognition and management are a fundamental task for the professional, who must be able to maintain a balance between empathy and professionalism.
Through tools such as supervisiontheinterview And a constant self-reflexion, the therapist can therefore avoid or learn to manage collusion situations, ensuring maximum benefit for the patient.
