''Negative process'': A recurrently discovered and underestimated facet of therapeutic process and outcome in the individual psychotherapy of adults

A good therapeutic alliance has proven to be an important contributor to positive outcome in the individual psychotherapies of adults. Treatment models that have been studied include psychodynamic, cognitive, cognitive-behavioral, interpersonal, experiential, and some eclectic approaches. However, the ability of therapists to establish and maintain a good alliance has been greatly overestimated. The reason for this is the enormous difficulty that human beings have in dealing with interpersonal conflict in which they are participants. Evidence for the ways in which therapists struggle with negative therapeutic process-hostile interchanges between patients and therapists-is traced throughout the psychotherapy research literature. It appears that negative process is a major obstacle to successful treatment, and that its pervasiveness has been underestimated. A therapeutic technical strategy that uses metacommunication is recommended for effectively managing negative process. Training therapists to use this technical strategy is discussed, as are recommendations for future research on the topic of negative process.