Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Synchrony

The purpose of this article published today in Frontiers in Psychology with Zoe McParlin, Francesco Cerritelli and Professor Karl Friston is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient.

We propose a framework in this article to explain the critical role of touch in developing therapeutic alliances and synchrony in general (see figure below). Touch appears to be critical in initiating, developing, and enhancing the salience of synchronous relationships. This framework is based on active inference and encompasses an integrative hierarchical framework that promotes synchrony and the therapeutic alliance to engender allostasis. While it has long been recognized that touch and skin contact have therapeutic benefits for patients and individuals, much less research has been conducted on the bidirectional role of touch. This generic model explains how touch can be used to infer and predict others’ states of mind, which are crucial for developing dyadic and triadic relationships in general and in a clinical setting. However, it is important to note that there is a particular emphasis on perinatal and pediatric care, due to its focus on the role of touch and developing synchrony. Additionally, by inferring individuals more precisely, we can help create more adaptive feedback loops that minimize surprise, increase understanding, and reduce physical and psychological stress, all of which are crucial for daily survival. The ensuing model considers how touch can strengthen and tighten neurobiological and social bonds to achieve a synchronous relationship and a more effective therapeutic alliance.

Therapeutic alliance as active inference. (A) Opportunity to build a synchronous relationship and understanding of the injury. (B) Opportunity to show empathy to reduce anxiety and fears. (C) Working together to create a therapeutic alliance for recovery. (D) Regulating disrupted allostasis. (E) Joint attention to regulate allostasis and support recovery. (F) Injury and pain—“what have I done?” (G) Fears of what the injury will become. (H) Anxiety over the injury. (I) The hope of collaborative communication to understand and create a treatment and management plan. (J) Previous priors surrounding the injury including injury beliefs, social expectations, family and injury history.