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‘The Relationship is the Therapy.’

‘The Relationship is the Therapy.’ By Barry Smyth  

According to Howe (1999:95), the power of other people and the relationships we have with them to influence us for better or worse have long been recognized in literature, film, folk psychology and the social sciences. But what are the personal and interpersonal qualities within the relationship that affect people’s social experience so greatly? If a person turns to a professional psychotherapist for help, it is reasonable to expect that such help be effective but from where does it derive its potency? In this paper, I will examine the therapeutic relationship in order to define it and determine the nature of its effectiveness, while exploring any other opinions to the contrary.

  One definition of psychotherapy is the following: ‘The systematic use of a relationship between therapist and patient – as opposed to pharmacological or social methods – to produce changes in cognition, feelings and behaviour’ (Holmes and Lindley, 1989, c.f. Clarkson, 1995). Bordin defines the working alliance, or what is known as the therapeutic relationship, as the collaboration between the client and the helper based on their agreement on the goals and tasks of counselling (Bordin, 1979, c.f. Egan, 2002:43). But while it is generally recognized today that the relationship between the therapist and client is the key to a positive outcome of the counselling encounter, the form that the relationship takes and how that relationship is encouraged and developed, differs from theory to theory.

  The Person- Centred approach of Carl Rogers maintains that the quality of the relationship is more important than any techniques used by the therapist, and places the concept of trust at the centre of the relationship (O’Farrell, 1999:33). Rogers believed that clients presenting with emotional ‘problems in living’ had been involved in relationships in which their experiencing had been denied, defined or discounted by others (McLeod, 2000:97). He felt that healing could come about from a relationship in which the self was fully accepted and valued. For beneficial personality change to occur, it was necessary that certain conditions exist and continue over a period of time. These conditions could be summarized in the following manner; two people had to be in psychological contact, with the client being in a state of incongruence, anxiety and vulnerability while the therapist would be congruent and integrated into the relationship. He would also experience unconditional positive regard for the client as well as a empathic understanding of the client’s internal frame of reference, all of which he would try to communicate to the client and to a minimal extent would achieve (Rogers, 1957:95, c.f. McLeod, 2000:97).

  Rogers felt strongly that these conditions alone, if present over a period of time, were sufficient for constructive personality change to follow. They became known as his core conditions of empathy, genuineness and unconditional positive regard. Empathy concerns the therapist’s continual attempts to understand the client’s experience from the client’s point of view, not merely on a cognitive level, but also on an emotional and experiential plane. For a therapist to be genuine, the second core condition, he needs access to his own internal process. Only by understanding the flow of his own thoughts, feelings, attitudes and moods can he help the client to become aware of theirs. The third core condition of unconditional positive regard suggests a therapist who can keep in focus at all times that the client is a worthwhile human being struggling to find his way back to his birthright of growth and self-development (Kahn, 1997:46).

  For Rogers, the relationship very much was the therapy but he accepted that the three attributes necessary to a successful clinical relationship were difficult to achieve in their absolute form. He preferred to consider them as three continua along which the therapist was constantly striving to move further. The more advanced along each continuum the therapist was, the more chance that a favourable interpersonal environment might exist to facilitate actualisation and growth.

  Rogers approach to the therapeutic relationship was very much a reaction to the psychoanalytic and psychiatric models of his day which he felt had created a power gulf between therapist and client and that such an imbalance in the relationship was not beneficial to the therapeutic process. However, the approach of Rogers placed no importance on encouraging the client to attend to and discuss the relationship with the therapist, nor had he given any weight to consideration of the unconscious (Kahn, 1997:15). It was two therapists from the psychoanalytic tradition, Merton Gill and Heinz Kohut, who were to build their therapies around the concept of the unconscious while still holding fast to the psychoanalytic notion that working with the relationship between therapist and client was of central importance.

  Freud, himself, was fully aware of the crucial nature of the therapist-client relationship, and how intense, mysterious and complex it was, no matter how it appeared on the surface. He made the remarkable observation that patients transfer to the therapist their attitudes, feelings, fears, and wishes from long ago. He came to believe that it was essential for the therapist to recognize this transference and to know how to respond to it, since he felt it could progress or hinder the therapy depending on how it was dealt with. Eventually he saw the transference as the ‘therapist’s central opportunity and the fulcrum of therapeutic leverage’ (Kahn, 1997:6).

  What Gill and Kohut brought to the debate of the therapeutic relationship was a balancing of the psychoanalytic and humanist traditions. Many psychoanalysts were uncomfortable with the Rogers concept of authenticity since they felt that if one accepted the notion of counter transference, or the unconscious feelings that are stirred in the therapist towards the client, then how much was the therapist to act out his old dramas and to gratify old unsatisfied needs?

  Merton Gill, as a psychoanalyst, felt that for therapy to work, it was not sufficient for the client to simply remember thoughts and feelings long repressed. He felt that it was more important for the client to actually re-experience the unconscious emotions. Since the client’s difficulties were acquired through experience, then they must be transformed through experience and not reasoned away. While he acknowledged the importance of a client understanding the origins of their difficulties, true therapy could only occur when the client re-enacted certain aspects of his past and this could only happen in the therapeutic relationship. The old impulses and feelings had to be experienced in the presence of the person toward whom they were now directed, while also being expressed toward that person and not simply experienced in silence. Furthermore, the therapist, the person to whom the feelings have been expressed, has to then discuss such feelings and impulses with the client (Kahn, 1997: 58). Very importantly at this stage, Gill believed that the therapist had to discuss these feelings in a non-judgemental, nondefensive, interested fashion making the client feel safe to express them further. The relationship is truly the therapy here for through the nondefensive support and encouragement of the therapist to help the client re-experience his old feelings and expectations, he provides the client with a unique experience, whereby he becomes aware of his feelings about the therapist while understanding how those old attitudes determine his interpretation of the events of therapy. Gill believed that it was in the therapeutic relationship that the greatest leverage was to be found; what he meant by this was that working within the transference and continually increasing the client’s awareness of the relationship brought about the most effective therapeutic change. For the client to experience in the therapist a genuine, interested, nondefensive attitude provides him with a situation he has never experienced before and leads to a therapeutic relationship.

  Heinz Kohut was even more responsible for bridging the gap between psychoanalysis and humanism than Gill. He, too, believed in the importance of the relationship between therapist and client and in the centrality of the transference but he went even further with a new understanding and appreciation of the value of empathy communicated to the client.

  Kohut believed that every child, or developing self, had three important needs that had to be met in order for the self to develop fully. These needs were; the need to be ‘mirrored,’ that is for the self to be valued by others, in particular, parent figures; the need to idealize, for the child to believe that at least one parent is powerful, calm, and confident and can be counted on when the world becomes too complex for the child to understand; and the need to be like others, or to not feel too different from the world they have been born into. Kohut felt that one of the benefits of the therapeutic relationship was for the therapist to provide the mirror for the client. This was to be done with empathy and understanding, showing the client that his difficulties and way of being were both understandable and understood. Kohut’s therapist-client relationship can be considered therapeutic due to the humanity expressed by the therapist in the relationship. Such a freely empathizing therapist gives the client a sense of being listened to, being deeply understood, and being accepted while providing an opportunity to learn the ancient roots of their difficulties and building new self structures to compensate for the old deficits (Kahn, 1997:122).

  The above therapists and their theories all point to the premise that it is the relationship that is the most beneficial aspect of the therapy. Awareness of the subtleties and changes in the relationship provides the therapist with perhaps his most therapeutic tool of all. However, there are some who would disagree with the full importance of the working alliance. Practitioners using cognitive and behavioural approaches tend to see the therapeutic alliance as simply a means to an end. They feel that it is wrong to overstress the relationship since it obscures the ultimate goal of helping a client manage a problem better. They do accept that such a goal cannot be achieved if the relationship is poor, but feel that an over-emphasized relationship can be a distraction from the real work to be done (Egan, 2002:42). Albert Ellis proposes that recently there has been a one-sided emphasis on relationship as the crucial element in therapy. He states that while a good therapeutic relationship is usually important to help people feel better, good theory and technique are actually more important to help them get better.

  However, Barbara Berzon listed eight features of helping which reflect the characteristics of helping most valued by those who have been helped. The basic features of effective helping relationships can be summarized as follows; when there is increased awareness and self understanding on the part of the client, in particular, about the ways others see them; when they realize how similar they are to others, contradicting their original reason perhaps for seeking therapy, that is, feeling out of touch with others; the extent to which the client feels understood, accepted and reacted to genuinely by the therapist; being made aware how others perceive them; being encouraged to self-disclose, to be assertive and to be immediate in their reactions; feeling a sense of open communication even when the counsellor is being confrontative; when the client senses the warmth and genuineness of the counsellor being himself and not simply functioning in the role of a helper; when the client feels he can divulge his inner thoughts and feelings in a safe and neutral environment.

  These eight characteristics of a counselling relationship that clients believe have benefited them therapeutically all have their source in the working alliance and stem from the high level of energy and commitment that the therapist brings to the relationship. Furthermore, Kohut’s belief that mirroring, as well as  making the client feel that he is no different from everyone else can be seen in these basic features of an effective helping relationship, adding strength to the premise that the relationship is the therapy.

  Although I have yet to work with clients, I do find I can agree with the above list simply from my own experience as a client in a counselling situation. In particular, the warmth and openness of communication that my counsellor has brought to our relationship has encouraged me in an area of great difficulty – that of self-disclosure and owning my feelings.

  In conclusion, however, we can say that the relationship is the therapy since the therapist provides the client with a secure base from which to explore himself and his relationships. The client needs to see the manner in which he is perceiving and using the therapeutic relationship which helps him understand how he handles himself in relationships with others. Such understandings encourage the client to cognitively link past relationship experiences with current behaviours and emotions while realizing how his current perceptions of interaction with others can influence the conduct of present close relationships. This in turn can help him build new mental models so that he can come to handle himself more competently within relationships. According to Henry and Strupp (1994: 71, c.f. Howe, 1999: 101),

            ‘Therapy is beneficial because the patient experiences a relationship that is qualitatively different from early childhood relationships responsible for the maladaptive interpersonal patterns that ultimately led the patient to seek therapy.’



Clarkson, P., (1995). The Therapeutic Relationship. London: Whurr Publishers Ltd.

Egan, G., (2002). The Skilled Helper. Pacific Grove: Brooks/Cole.

Ellis, A., (1999). ‘The main change agent in effective psychotherapy is specific technique and skill,’ in C. Feltham (ed.), (1999). Controversies in Psychotherapy and Counselling. London: Sage.

Howe, D., (1999). ‘The main change agent in psychotherapy is the relationship between therapist and client,’ in C. Feltham (ed.), (1999). Controversies in Psychotherapy and Counselling. London: Sage.

Kahn, Michael, (2001). Between Therapist and Client. New York: Owl Books.

McLeod, J., (2000). An Introduction to Counselling. Buckingham: Open University                                       Press.

O’Farrell, U., (1999). Courage to Change: The Counselling Process. Dublin: Veritas.

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