case_images: PMC9036100_01
case_images: The therapeutic course as an idealized exploration-exploitation-dilemma (red). Goal-directed therapeutic interaction starts at pole (1): Overly exploitation/non-adaptive behavioral outcome: At the beginning of therapy, the client is stuck and repeatedly maintains his dysfunctional pattern; free energy is very high. (2) Elaborating/validating the current model, work with emotions, starting guided reality checks in a safe environment, define experiments. More clarity, first success experiences, less free energy. (3) Balance/more adaptive behavioral outcome: both sufficient safety and sufficient experimentation, ratio may vary, directed exploration, thorough self-directed reality checks. Lowest possible value of free energy (4) Is there evidence that too much exploration, aimless experimenting leads to avoidance of key issues? Problems in therapeutic relationship? Increasing free energy. (5) Overly exploration/non-adaptive behavioral outcome: many new behavioral projects are started but not finished, impulsivity, too much new information, inefficient use of behavioral experiments, no robust learning experience and change, risk of falling back into the grip of the dysfunctional internal model. Free energy is very high again.
case_images: fpsyg-13-842488-g001.jpg
case_images: PMC9036100_01_fpsyg-13-842488-g001.jpg
case_images: F1
case_images: In the longer term, this gradually leads to more and more free energy, i.e., PEs, and ultimately to chronic uncertainty or chronic stress (Figure 1, left). In this respect, regarding the balance aspect in Figure 1, the following applies: preserve the good and dare the new. The client may drop out of the goal-achievement alliance, become involved only in a very non-committal way, and instead of directed exploration, just experiment aimlessly (Figure 1, 4). Stress and free energy rise again, and she may find herself trapped in old patterns again (Figure 1, 5). With this impulsive action, she left the path of directed exploration (Figure 1, 3) and landed at the point of undirected exploration (Figure 1, 5). She fell right back into the other extreme of overly exploitation (Figure 1, 1). Security in therapeutic relationship is of utmost importance in order to update the client's priors, reduce her uncertainty (Figure 1, 1 and 5) and to help her more and more to achieve a balance (Figure 1, 3). If the therapist remains faithful to her survival strategy due to her own high stress (Figure 1, 1), she would simply continue to meet the client's needs in a kind of anticipatory obedience.
case_images: Model of safety regulation modified according to. The dashed line indicates the optimal level. Here, the person experiences no stress and is in emotional equilibrium.
case_images: fpsyg-13-842488-g002.jpg
case_images: PMC9036100_01_fpsyg-13-842488-g002.jpg
case_images: F2
case_images: In Figure 2, the safety reservoir is ideally always well-filled. The precise content of these aspects is again guided by the model of safety regulation specific to the client (Figure 2).
case_images: Interacting survival strategies between Julia and her therapist.
case_images: fpsyg-13-842488-g003.jpg
case_images: PMC9036100_01_fpsyg-13-842488-g003.jpg
case_images: F3
case_images: With this impulsive action, she left the path of directed exploration (Figure 1, 3) and landed at the point of undirected exploration (Figure 1, 5). Security in therapeutic relationship is of utmost importance in order to update the client's priors, reduce her uncertainty (Figure 1, 1 and 5) and to help her more and more to achieve a balance (Figure 1, 3).  In this (Figure 3) it becomes visible at a glance at which point it becomes difficult for Julia's therapist to keep her own free energy low: Namely, when she realizes that the therapeutic process now expects her to actively frustrate her client.