The Working Alliance in Psychotherapy: Risk, Criticism and Perspectives in the Italian Context

Abstract

This paper investigates which factors inherent to the various forms of psychotherapy are conducive to success and which are not. Particular emphasis is placed on the role of communication between the therapist and the patient, with specific regard to the outcome of treatment. The habitual practices and main problems facing healthcare professionals with regard to information and consent to psychotherapy are analysed in the context of the results of some recent studies of outcomes and processes which support the notion that the factors most frequently associated with successful psychotherapy are cooperation, proper information and a shared commitment to achieving the objectives of treatment.

Key words:

• confidentiality
• consent
• ethics
• malpractice risks
• psychotherapist responsibilities
• psychotherapy
• working alliance

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

1. Cf. Andamento e Costo del Contenzioso a Livello Nazionale, Medmal Claims Analysis, (4th edition) in: http://www.sanita.ilsole24ore.com/pdf2010/Sanita2/_Oggetti_Correlati/Documenti/Regioni-e-Aziende/MEDMAL%20CLAIMS%20ANALYSIS%20DATI%20OK.pdf

2. See, for example, Penal Supreme Court Sect. VI, Decision, (hearing 23-03-2011) 11-04-2011, n. 14408, which recognizes psychoanalysis as a veritable psychotherapeutic activity that, as such, requires regular enrolment on the Register of Psychotherapists. This decision has been criticized both on the grounds that it does not distinguish between psychoanalysis (as a theory) and analytical psychotherapy and because of its somewhat debatable assertion that the conversational method is a ‘veritable form of therapy and a typical act of the medical profession’; indeed, this would make the professional practice of such an activity problematic even for the psychotherapist-psychologist. Cf. also Penal Supreme Court Sect. VI, 15 May 2013, n. 23843.

3. For a discussion of this issue, see Giacomo Pestelli, Diritto penale e manipolazione mentale: tra vecchi problemi e prospettive de jure condendo, in Riv. it. dir. e proc. pen.2009, 03, 1274; Cassazione penale, sez. II, 7 gennaio 2011, n. 4183.

4. On this issue, see Cass. Pen., sez. IV, 12 February 2013, n. 16975; V. sez. 4, sentenza n. 48292 del 27.11.2008, Rv. 242390. Cf. also: Giandomenico Dodaro, La posizione di garanzia degli operatori psichiatrici. Giurisprudenza e clinica a confronto, Franco Angeli, 2011.

5. In Italy, this issue (regulated both by the Deontological Code of Psychologists and by that of Physicians) pertains to public law, in that the Penal Code (art. 622) classifies as unlawful the violation of professional confidentiality, thereby reaffirming the social relevance of the citizen's right to confidentiality in all that concerns the intimate sphere of the person. However, its citation of ‘just cause’ of revelation also leaves room for interpretation.