What Works in Therapy  |  Douglas Behan, DSW, LCSW

The Therapeutic Relationship

Effective Therapy Starts and Ends with the Relationship

Humans are social creatures and our relationships can have great power. This is never truer than in the relationship that forms between a therapist and client. Any discussion about the common factors of effective psychotherapy starts with the therapeutic relationship. There is overwhelming research support showing the relationship is a highly potent factor of change regardless of the model being used. If the therapeutic relationship is not strong, therapy outcomes are usually impacted.

What the Research Says...

In their review of the research literature, Norcross and Lambert (2018) report that, “the psychotherapy relationship makes substantial and consistent contributions to patient outcome independent of the specific type of psychological treatment. The therapy relationship accounts for client improvement (or lack of improvement) as much as, and probably more than, the particular treatment method” (p. 308).

"Clients do not emphasize the effectiveness of a particular technique or methods.
 
Instead, they primarily attribute the effectiveness of their treatment to the relationship with their therapists."
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(Norcross, 2010, p. 115)

Dr. Mark Cameron, a social work professor from Southern Connecticut University, discusses the role of the therapeutic relationship in treatment.

What it Means for Therapists

Building a strong therapeutic relationship is more than just setting the stage for the work to come; it is a major part of the curative work. The relationship is integral to deploying treatment methods and techniques effectively.

Evidence-based and evidence-supported treatments have been growing in use to guide treatment. Their effectiveness is contingent upon delivery within a strong therapeutic relationship, which is not typically prescribed by the treatment guide. Even when the relationship is mentioned, specific evidence-based steps to achieve it are usually not included – making the treatment guide potentially misleading on clinical and empirical grounds (Norcross & Lambert, 2018). Therapists should establish and maintain a strong therapeutic relationship with clients and be willing to adapt to the unique characteristics presented by each client.