By Peggy Natiello, Ph.D. (1998)

"It's the relationship that heals, the relationship that heals, the relationship that heals - my professional rosary", says Irv Yalom, M.D. in Love's Executioner (1989, p.91).

More than 30 years of clinical outcome research is documenting the finding that the positive results of effective psychotherapy are in direct proportion to the quality of the relationship.  Theories and techniques of psychotherapy, it seems, must take a back seat to the authentic connectedness that develops between client and therapist.  Lambert (1986) states that: "...at least from the patient's point of view, effective treatment is due to factors associated with relationship variables and the personal qualities of the therapist" (p.189).

The personal qualities that clients identify as facilitative in these research studies are strikingly similar no matter what therapeutic system is under scrutiny.  Consistently, the core conditions of client-centered therapy identified by Carl Rogers, Ph.D. surface in the research. 

For example, in an overview of clinical outcome research Miller, et al (1995) conclude that clients' "...participation is, of course, largely a result of the bond or alliance that clients form with the helping professional...A positive bond or alliance results, at least in part, when the therapist is empathic, genuine and respectful - when he or she exhibits the relationship factors that humanistic psychotherapist Carl Rogers considered the 'core conditions' of effective psychotherapy" (p.56).  Patterson (1989), looking for common factors in eclectic psychotherapy, proposes that:  "Three of these common elements are empathic understanding, respect or warmth, and therapeutic genuineness.  They are the core or essence of client-centered therapy..." (p.427). 

In addition to these therapist-offered conditions, the research further demonstrates that attributes of the clients themselves - their capacity for participating in a relationship, their readiness for change, their life circumstances - play the most significant part in determining the outcome of psychotherapy.  It can be humbling indeed for therapists to realize that it is our clients' work that brings about change, rather than our own interventions.  We practice in a competitive field where expertness, authority and responsibility for (rather than responsibility to) the client are marked under the names of different models of psychotherapy each with its own variety of techniques.  The outcome research, however, reminds us that models and techniques are far less crucial to positive outcome than the development of a connected relationship that will facilitate client effectiveness - a relationship characterized by genuineness, empathy and respect.

Building such a relationship is more easily said than done.  In examining our own helping relationships against the criteria of the outcome research, we can ask ourselves:

• Am I trusting my clients or trying to take responsibility for them?

• Do I view myself or the client as the expert in the relationship?

• Do I rely on techniques or intellectual interventions to "help" my clients to reach their goals?

• Am I listening closely to my clients or am I trying to change the way they see things?

• Am I able to validate my clients' insights, strengths, and self-discovered decisions about change?

• Does my professional self-esteem depend on knowing that I changed my clients' lives?

No matter what model of therapy we follow, the answers to these questions may indicate to what degree we are able to form authentic dialogue and connected, healing relationships with our clients.

In more than twenty years of training psychologists, social workers, counselors organizational development consultants, and medical personnel, the staff at the Center for Interpersonal Growth has placed the ability to develop healing relationships at the core of the curriculum.  Learners in our intensive training communities participate actively in the group process and receive consistent feedback from one another on their facilitative and relational attitudes.

In addition to the participatory component described above, our training model also includes in-depth theory and practice of the complex facilitative skills and attitudes researched by Carl Rogers, Ph.D. - the same attitudes that are currently being cited in clinical outcome research.

 Rogers himself said that this staff "...is developing a new and exciting mode of professional training.  To a surprising degree, they have been able to provide a situation in which professional skills and personal growth are both enhanced within the same group.  In my judgment, it is an excellent laboratory for producing growing professional persons."

Needless to say, we are pleased to see the therapeutic relationship, as Rogers described it more than fifty years ago, and as we attempt to foster it in our training programs, coming back into its own.

References

• Lambert, et al, 1986.  The effectiveness of psychotherapy.  In Garfield & Bergin (Eds.), Handbook of Psychotherapy and Behavior Change (3rd. Ed.), pp.157-211.  New York:  John Wiley.

• Miller, et al., 1995.  In Family Therapy Networker, March/April, pp. 53-63.

• Patterson, 1989.  Foundations for a systemic eclectic psychotherapy, Vo.26, No.4, pp. 427-435.