Therapeutic relationship
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The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client. In
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
the therapeutic relationship has been theorized to consist of three parts: the working alliance,
transference Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
/
countertransference Countertransference is defined as redirection of a psychotherapist's feelings toward a client – or, more generally, as a therapist's emotional entanglement with a client. Early formulations The phenomenon of countertransference (german: G ...
, and the real relationship. Evidence on each component's unique contribution to the outcome has been gathered, as well as evidence on the interaction between components. In contrast to a
social relationship A social relation or also described as a social interaction or social experience is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more individuals ...
, the focus of the therapeutic relationship is on the client's needs and goals.


Therapeutic Alliance / Working Alliance

The
therapeutic alliance A therapeutic alliance, or working alliance, is a partnership between a patient and his or her therapist that allows them to achieve goals through agreed-upon tasks. The concept of therapeutic alliance dates back to Sigmund Freud. Over the cour ...
, or the working alliance may be defined as the joining of a client's reasonable side with a therapist's working or analyzing side. Bordin conceptualized the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client's goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals. Research on the working alliance suggests that it is a strong predictor of psychotherapy or counseling client outcome. Also, the way in which the working alliance unfolds has been found to be related to client outcomes. Generally, an alliance that experiences a rupture that is repaired is related to better outcomes than an alliance with no ruptures, or an alliance with a rupture that is not repaired. Also, in successful cases of brief therapy, the working alliance has been found to follow a high-low-high pattern over the course of the therapy. Therapeutic alliance has been found to be effective in treating adolescents with PTSD, with the strongest alliances were associated with the greatest improvement in PTSD symptoms. Regardless of other treatment procedures, studies have shown that the degree to which traumatized adolescents feel a connection with their therapist greatly affects how well they do during treatment.


Necessary and sufficient conditions

In the Humanistic approach,
Carl Rogers Carl Ransom Rogers (January 8, 1902 – February 4, 1987) was an American psychologist and among the founders of the humanistic approach (and client-centered approach) in psychology. Rogers is widely considered one of the founding fathers of ps ...
identified a number of
necessary and sufficient conditions In logic and mathematics, necessity and sufficiency are terms used to describe a conditional or implicational relationship between two statements. For example, in the conditional statement: "If then ", is necessary for , because the truth of ...
that are required for therapeutic change to take place. Rogers stated that there are six necessary and sufficient conditions required for therapeutic change: # Therapist–client psychological contact: A relationship between client and therapist must exist, and it must be a relationship in which each person's perception of the other is important. # Client incongruence: That incongruence exists between the client's experience and awareness. # Therapist congruence, or genuineness: The therapist is congruent within the therapeutic relationship. The therapist is deeply involved, they are not 'acting' and they can draw on their own experiences (self-disclosure) to facilitate the relationship. # Therapist unconditional positive regard: The therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied. # Therapist empathic understanding: The therapist experiences an empathic understanding of the client's internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapist's unconditional regard for them. # Client perception: That the client perceives, to at least a minimal degree, the therapist's unconditional positive regard and empathic understanding.


Transference and Counter-Transference

The concept of therapeutic relationship was described by Freud (1912) as "friendly affectionate feeling" in the form of a positive
transference Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
. However, transferences, or more correctly here, the therapist's 'counter-transferences' can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.


Operationalization and Measurement

Several scales have been developed to assess the patient-professional relationship in
therapy A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis. As a rule, each therapy has indications and contraindications. There are many different ...
, including the Working Alliance Inventory (WAI), the Barrett-Lennard Relationship Inventory, and the California Psychotherapy Alliance Scales (CALPAS). The Scale To Assess Relationships (STAR) was specifically developed to measure the therapeutic relationship in
community psychiatry Center for Mental Health Services''(CMHS), also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead o ...
, or within care in the community settings.*''McGuire-Snieckus'', R., McCabe, R, Catty, J., Hansson, L., and Priebe, S. (2007). A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37, 85-95.


See also

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Acting in "Acting in" is a psychological term which has been given various meanings over the years, but which is most generally used in opposition to acting out to cover conflicts which are brought to life inside therapy, as opposed to outside. One commentat ...
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Acting out In the psychology of defense mechanisms and self-control, acting out is the performance of an action considered bad or anti-social. In general usage, the action performed is destructive to self or to others. The term is used in this way in sexua ...
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Body-centred countertransference Body-centred countertransference involves a psychotherapist's experiencing the physical state of the patient in a clinical context. Also known as somatic countertransference, it can incorporate the therapist's gut feelings, as well as changes to ...
* Clinical Psychology *
Counselling Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes. This is a list of co ...
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Counseling Psychology Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health. ...
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Countertransference Countertransference is defined as redirection of a psychotherapist's feelings toward a client – or, more generally, as a therapist's emotional entanglement with a client. Early formulations The phenomenon of countertransference (german: G ...
* Existential counselling *
Existential Therapy Existential psychotherapy is a form of psychotherapy based on the model of human nature and experience developed by the existential tradition of European philosophy. It focuses on concepts that are universally applicable to human existence inclu ...
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Gestalt Therapy Gestalt therapy is a form of psychotherapy that emphasizes personal responsibility and focuses on the individual's experience in the present moment, the therapist–client relationship, the environmental and social contexts of a person's life ...
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Humanistic Psychology Humanistic psychology is a psychological perspective that arose in the mid-20th century in answer to two theories: Sigmund Freud's psychoanalytic theory and B. F. Skinner's behaviorism. Thus, Abraham Maslow established the need for a "third force ...
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Intersubjectivity In philosophy, psychology, sociology, and anthropology, intersubjectivity is the relation or intersection between people's cognitive perspectives. Definition is a term coined by social scientists to refer to a variety of types of human interac ...
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Interpersonal psychoanalysis Interpersonal psychoanalysis is based on the theories of American psychiatrist Harry Stack Sullivan (1892–1949). Sullivan believed that the details of a patient's interpersonal interactions with others can provide insight into the causes and cure ...
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Intersubjective psychoanalysis The term " intersubjectivity" was introduced to psychoanalysis by George Atwood and Robert Stolorow (1984), who consider it a "meta-theory" of psychoanalysis. Intersubjective psychoanalysis suggests that all interactions must be considered contex ...
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Negative therapeutic reaction The negative therapeutic reaction in psychoanalysis is the paradoxical phenomenon whereby a plausible interpretation produces, rather than improvement, a worsening of the analysand's condition. Freud's formulations Freud first named the negative th ...
* Object relations theory *
Parallel process Parallel process is a phenomenon noted in clinical supervision by therapist and supervisor, whereby the therapist recreates, or parallels, the client's problems by way of relating to the supervisor. The client's transference and the therapist's cou ...
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Person-centered therapy Person-centered therapy, also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers beginning in the 1940s and ex ...
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Psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
* Psychoanalytic Theory *
Psychodynamics Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
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Psychodynamic psychotherapy Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of psychological therapy. Its primary focus is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict wi ...
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Psychology Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between ...
* Psychotherapy *
Relational psychoanalysis Relational psychoanalysis is a school of psychoanalysis in the United States that emphasizes the role of real and imagined relationships with others in mental disorder and psychotherapy. 'Relational psychoanalysis is a relatively new and evolving ...
* Relational psychodynamics *
Systemic therapy In psychotherapy, systemic therapy seeks to address people not only on the individual level, as had been the focus of earlier forms of therapy, but also as people in relationships, dealing with the interactions of groups and their interactional p ...
*
Systems psychology Systems psychology is a branch of both theoretical psychology and applied psychology that studies human behaviour and experience as complex systems. It is inspired by systems theory and systems thinking, and based on the theoretical work of Roger ...
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Therapeutic alliance A therapeutic alliance, or working alliance, is a partnership between a patient and his or her therapist that allows them to achieve goals through agreed-upon tasks. The concept of therapeutic alliance dates back to Sigmund Freud. Over the cour ...
*
Transference Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
*
Transpersonal Psychology Transpersonal psychology, or spiritual psychology, is a sub-field or school of psychology that integrates the spiritual and transcendent aspects of the human experience with the framework of modern psychology. The '' transpersonal'' is defined ...


References

{{Authority control Psychoanalytic theory