In fact, scientists have studied this question extensively, and although there are no definitive answers, they have determined that there is one factor that seems to be present in all forms of psychotherapy, no matter what modality (individual or couple) or orientation (Freudian, Jungian, behavioral, etc.). That single factor is called a "therapeutic alliance."

The therapeutic alliance is formed between he therapist and their client and occurs at a point in the therapeutic relationship when the client elevates the therapist to a position of authority, and believes that this power and authority is shared between them. There is a deep sense of collaboration and participation in the process and in this way a positive attachment develops between the client and the therapist.

In the beginning of therapy, the therapeutic alliance is based on the client experiencing the therapist as supportive and helpful. In the later sessions, the alliance is experienced as a joint struggle against what is impeding the client, a shared responsibility for working out treatment goals, and a sense of wellness.

From an attachment theory perspective, psychotherapy also includes other important elements that influence the therapeutic alliance. John Bowlby, the psychiatrist who first wrote about attachment theory, viewed the therapist as a surrogate parent-figure who encouraged the client to explore their inner world from a secure base that the therapist creates. In the context of therapeutic work with individuals, Bowlby defined five tasks:

1. Create a safe place, or Secure Base, for client to explore thoughts, feelings and experiences regarding self and attachment figures;
2. Explore current relationships with attachment figures;
3. Explore relationship with psychotherapist as an attachment figure;
4. Explore the relationship between early childhood attachment experiences and current relationships; and
5. Find new ways of regulating attachment anxiety (i.e., emotional regulation)

Additionally, when people have experienced unhealthy parenting as children, neuroscience has shown that some people do not develop certain capacities because their parents may not have had these abilities themselves. The part of the brain just behind the eyes is called the prefrontal orbital cortext, an area of the brain that regulates functions that have to do with interpersonal relationships. When we are born, this part of the brain is not completely developed and therefore environmental experiences determine how it evolves. Therefore, psychotherapy may include working on any one or a number of these skills, including:

• Autonoetic consciousness: Knowing oneself over time.
• Social cognition: Empathy and the ability to look into the minds of others.
• Self reflection: Ability to look into your own mind.
• Emotion regulation: Ability to soothe oneself and be soothed by others
• Response flexibility: Weigh options before acting.

References
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