The Therapeutic Relationship

The decision to come to therapy is often not an easy one. It can be rife with stress about if it will be helpful, how we will be perceived, what emotions and issues will come up, what kind of commitment it may require, and how our lives may change through therapy. It is certainly a courageous act to trust a new person with the most vulnerable parts of our lives and selves in the search for relief. This process of establishing trust is central to one of the most important ingredients in therapy: the therapeutic relationship.

In the research world, the therapeutic relationship is known as a “common factor.” A common factor is something that occurs in all types of therapy and can make a big difference in the outcome (i.e., whether or not things improve). How do we know if a therapy relationship is a good fit? Are there variables we should be looking for that might indicate a good therapy relationship? What does the research say?

Something termed as the “real relationship” has been shown to significantly affect the success of therapy. What’s meant by this is “the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic.”1 In other words, does an authentic, honest relationship exist outside the roles of therapist and client? Data suggests this is a big factor in success outcomes in therapy.

Another factor heavily studied and known to affect the success of therapy is therapist empathy.2 This refers to understanding what a person is experiencing and then being able to communicate that understanding effectively. It was long hypothesized that empathy mattered as an ingredient in good therapy and research has overwhelmingly supported this.

Collaboration and consensus between therapist and client on the goals of therapy has been shown to have a medium to strong effect on therapy outcome.3 You may enjoy talking to your therapist, but are you both actively working together to achieve the goals you developed? Is there a clear direction to your therapy that makes sense to you?

In 1951, a psychologist named Carl Rogers proposed that positive regard and affirmation were important factors in therapy. This may seem obvious now, but in 1951 this was a revolutionary idea. Having a feeling of being cared for and affirmed has shown to positively affect therapy success.4

These ideas are the fundamentals of a therapy relationship proven to matter in successful treatment. If you’re looking to start therapy for the first time or trying to find a new therapist, then these factors can be a guide to help you find what works.

References

1. Gelso, C.J., Kivlighan, D. M., & Markin, R. D. (2018). The real relationship and its role in psychotherapy outcome: A meta-analysis. Psychotherapy, 55(4), 434-444. doi: 10.1037/pst0000183

2. Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399-410. doi: 10.1037/pst0000175

3. Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to therapy outcome. Psychotherapy, 55(4), 372-383. doi: 10.1037/pst0000170

4. Farber, B. A., & Doolin, E. M.(2011) Positive regard and affirmation. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (pp. 168-186). New York, NY: Oxford University Press. doi: 10.1093/acprof:oso/9780199737208.003.0008