Facets of the psychotherapy relationship: a metaphorical approach

Although many separate aspects of the psychotherapy relationship have been studied, including empathy, working alliance, and self-disclosure, a metaphorical approach has the potential to generate a more holistic perspective of this phenomenon. Hence, the goal of this study was to explore the nature of the psychotherapy relationship from the psychotherapists’ perspective using a metaphorical approach. In an online survey, a sample of N=373 Czech psychotherapists and counselors rated a set of relational metaphors in terms of how accurately they depicted their roles in their relationships with their clients. The single most endorsed metaphor for the practitioner’s role was a guide. Furthermore, the principal component analysis identified three relational components, namely, Mentor, Resource Supplier, and Remedy Distributor. The associations among these components and multiple practitioners’ variables, including demographic and practice-related variables and theoretical orientation, were explored. These three components represent general dimensions of the psychotherapy relationship that cut across various theoretical orientations and, thus, define psychotherapy relationships in a general sense.

First Encounters in Psychotherapy: Relationship-Building and the Pursuit of Institutional Goals

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time.

Gaslighting: How Pathological Labels Can Harm Psychotherapy Clients

Gaslighting is a conscious or unconscious form of psychological abuse that occurs when a perpetrator distorts information to confuse a victim, triggering the victim to doubt their memory and sanity. Gaslighting can contaminate a psychotherapy relationship when clinicians rely on pathological labels to direct the therapeutic process. When psychotherapists use pathological labels, the treatment focus is often directed toward problems that lie within the client, which can be counterproductive, particularly when the client is recovering from interpersonal abuse. This article summarizes how the application of pathological labels in combination with the principles of social constructivism influenced a group of mental health professionals to gaslight the author. Illustrative narrative that depicts the author’s experience of having been gaslit by her psychology professor and then by her psychotherapist is included. The author describes how these harmful relationships caused the author to endure double-binds and betrayal during her healing process. Last, a brief discussion about posttraumatic growth and recommendations related to potential alternatives to the current diagnostic process are offered. This article was written to raise awareness of how the use of pathological labels can result in harm to psychotherapy clients.

What Works in the Psychotherapy Relationship: Results, Conclusions, and Practices

This chapter concludes the first volume of the third edition of Psychotherapy Relationships That Work. The authors present the formal conclusions and the 28 recommendations of the Third Interdivisional Task Force. Summaries of the meta-analytic associations between the relationship elements and psychotherapy outcomes are provided. Those statements, approved by the 10 members of the Steering Committee, refer to the work in both this volume on therapy relationships and the second volume on treatment adaptations or relational responsiveness. These statements reaffirm and, in several instances, extend those of the earlier task forces. The chapter concludes with final thoughts on what works, and what does not, in the therapy relationship.

Evidence-Based Psychotherapy Relationship: The Third Task Force

This chapter introduces and frames the third edition of Psychotherapy Relationships That Work, which features dozens of original meta-analyses on what works in the relationship. The authors frame the work within the Third Intradivisional Task Force on Evidence-Based Relationships and Responsiveness. To accommodate new research, the book has grown to two volumes: one on relationship elements (what works in general) and one on treatment adaptations/responsiveness (what works in particular). The centrality of the therapy relationship, its interdependence with treatment methods, and potential limitations of the task force work are all highlighted. Frequently asked questions are also addressed. The authors hope that the book serves to repair some of the damage incurred by the culture wars in psychotherapy and to promote rapprochement between the research and practice communities.

Psychotherapy Relationships that Work

Psychotherapy Relationships That Work is the definitive, evidence-based book on the psychotherapy relationship: what works in general (Volume 1) and what works for particular patients (Volume 2). Each chapter presents definitions, clinical examples, landmark studies, comprehensive meta-analyses, diversity considerations, and training implications and ends with bulleted clinical practices. The third edition of the classic Psychotherapy Relationships That Work features expanded coverage and updated reviews with an enhanced practice focus. The result is a compelling synthesis of best available research, clinical expertise, and patient values that underscores the power of the therapist-client connection.