However, ask them the last time they: (1) read a study on the subject; (2) attended a postgraduate training specifically aimed at improving their skills in this area; or simply to (3) identify and define the factors contributing to an effective relationship, and the answers you’ll get are far more variable.
Why is that? Why doesn’t the therapeutic relationship get more attention in coursework and postgraduate training?
The truth is, while clinicians readily acknowledge the bond they form with clients matters, they deeply believe other factors are more critical to outcome.
How do we know? Research.
As far back as 1996, data began to emerge. In their very interesting study, researchers Sandra Eugster and Bruce Wampold found that therapists’ evaluations of their clinical work were inversely related to the quality of the working relationship. Think about that! The better the relationship, the worse evaluation therapists gave of their clinical work. What mattered most? Technical expertise!
For clients, the picture was quite different. The relationship was the real deal — in particular, their experience of being related to, “in a manner or degree not solely prescribed by the formal role of [the] therapist … subtle clues of authenticity and genuine human relatedness” (p. 1024-5).
While unsettling, such findings should surprise no one. From the outset of training, therapists are not valued for their humanness or personhood, but rather their theoretical knowledge and technical proficiency. In fact, a recent study done in Australia finds between 40 and 47% of graduate programs in psychology make no reference to relationship skills in their course syllabi, program descriptions, or list of training competencies (watch the interview below with one of the lead researchers). These facts, combined with frequent “admonitions against over-involvement, breach of boundaries, …and other such departures from good technique” (Eugster & Wampold, p. 1025), establishes a “vicious cycle” that continues after graduate school — one in which practitioners, and the field, are forever attempting to improve effectiveness by learning new diagnoses, therapy-related terminology, and treatment models.
The latest issue of the journal Psychotherapy goes a long way toward disrupting “business as usual.” Every article is focused on the therapeutic relationship. Here are some of the highlights. If you want to be more effective, bypass learning the latest treatment technique and focus instead on:
- Improving your ability to respond emphatically;
- Putting more of yourself into therapeutic interactions;
- Becoming better at working collaboratively to develop and maintain an explicit agreement on the goals of treatment as well as the respective roles and tasks of various participants (e.g., the therapist and client/s); and
- Routinely and formally assessing the quality of the therapeutic relationship, taking time to address any problems/ruptures in real time.
Here’s one additional resource: my interview with psychologist, Crystal McMullen, the lead researcher of the study mentioned above documenting the dearth of training on the therapeutic relationship. “It takes decades for the psychology industry to let anything go,” she observes, “but, there is a change in the air…”. Hear what is at the core of her optimism, as well as detailed suggestions for the future of the field.
Until next time,
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
Looking for training on the alliance? That is the focus on our upcoming March intensives: