Processing the Therapeutic Relationship

The authors propose that if therapists and clients process their therapeutic relationship (i.e., directly address in the here and now feelings about each other and about the inevitable problems that emerge in the therapy relationship), feelings will be expressed and accepted, problems will be resolved, the relationship will be enhanced, and clients will transfer their learning to other relationships outside of therapy. The authors review theories supporting the idea of processing the therapeutic relationship, discuss the relevant empirical literature in this area, and provide their conceptualization of the construct of processing the therapeutic relationship based on the theory and empirical findings. Finally, they discuss methodological concerns and suggest implications for clinical practice, training, and further research

Culture and the therapeutic relationship: Perspectives from Chinese clients

Chinese people in the United Kingdom and United States underuse mental health services and, when they do seek help, may find that therapy does not meet their needs. In response to calls in the literature for naturalistic studies of therapy with people of Chinese background, this study used a qualitative, multiple-case approach to examine clients' individual experiences in depth and detail. Semistructured interviews were conducted with eight Chinese clients. The aim was to investigate how culture might play a role in the therapeutic relationship. Qualitative analysis yielded four key themes concerning clients' and therapists' awareness of culture and how this impacted their working relationship: "Cultural encapsulation", "cultural formulation", "cultural liberation", and "culture is not important." Although participants' perceptions of therapy showed similarities to those reported by clients of European American descent, culture entered into the therapeutic relationship in complex and diverse ways. The findings have implications for delivering culturally sensitive therapies

If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient-provider relationship.

Purpose:The patient-provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient-provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. Patients and methods:We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient-provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. Results:The majority of participants emphasized how a strong patient-provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient-provider relationship impeded engagement. Conclusion:We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient-provider relationship and contend that a strong patient-provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care

The Therapeutic Bond Scales: Psychometric Characteristics and Relationship to Treatment Effectiveness

The Therapeutic Bond Scales assess the quality of the therapeutic relationship from the patient\u27s perspective. The therapeutic bond is composed of 3 aspects: working alliance, empathic resonance, and mutual affirmation. Scales were developed to measure these aspects and the therapeutic bond as a whole. The correlations between these scales and 2 measures of outcome (session quality assessed by the patient and termination outcome evaluated by nonparticipant raters) were examined. All scales were significantly correlated with session quality. Therapeutic bond was significantly correlated with termination outcome in both a linear and a curvilinear fashion, suggesting that, at least in the initial phase of therapy, the therapeutic bond can be too high as well as too low

Measuring quality in the therapeutic relationship-Part 2: subjective approaches

Publisher version: http://qualitysafety.bmj.com/content/19/6/479.ful

A state of readiness : an exploration of the client's role in meeting at relational depth

It is widely acknowledged that the therapeutic relationship is important to therapeutic outcome. In recent years, there has been additional evidence to suggest that specific, identifiable moments of relational depth between client and therapist can also have a major positive impact on the progress and outcome of therapy; however, the question of how such moments occur remains largely unexplored. Are they solely initiated by the therapist, or does the client have a role too? This article explores clients' perceptions of the factors facilitating an experience of relational depth. Findings suggest that immediately prior to such an experience the clients themselves have reached a state of readiness, and as making a positive decision to bring their vulnerability to the fore in the therapeutic relationship, thereby facilitating a potential moment of change. Findings are discussed in relation to contemporary theory with implications for practice given

What impact - if any - does working outdoors have on the therapeutic relationship?

This research investigated therapist's experiences of how working outdoors in nature impacts on the therapeutic relationship. Although outdoor therapy has emerged as a significant practice (McLeod, 2013; Mind, 2013), very little research had been done on what impact it might have on the therapeutic relationship. Given the importance of the therapeutic relationship (Norcross, 2011), this was identified as an area worth investigating

Examining the Relationship Between the Therapeutic Bond and the Phases of Treatment Outcome

Examined the association between the therapeutic bond—an element of the therapeutic alliance—and treatment effectiveness. 114 psychotherapy clients completed self-report questionnaires at intake and throughout open-ended, psychodynamically oriented psychotherapy. Three bond scales, role investment (RI), empathic resonance (ER), and mutual affirmation (MA), were contrasted to session quality and the three phases of outcome (remoralization, remediation, and rehabilitation). Results indicated that different aspects of the bond predicted session quality and treatment outcome. Clients who felt motivated and invested in therapy (relatively high RI) and who reported that the therapeutic environment was friendly and affirmative (relatively high MA) were likely to rate the session as being helpful and productive. Clients who had a relatively high sense of understanding and of being understood (ER) experienced greater remoralization and remediation (but not rehabilitation). The results are placed within the context of recent research into the therapeutic alliance

"They're Really PD Today": An Exploration of Mental Health Nursing Students' Perceptions of Developing a Therapeutic Relationship With Patients With a Diagnosis of Antisocial Personality Disorder

The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses’ perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them

Clients\u27 Internal Representations of Their Therapists

Thirteen adults in long-term individual psychotherapy were interviewed regarding their internal representations (defined as bringing to awareness the internalized image ) of their therapists. Results indicated that in the context of a good therapeutic relationship, clients\u27 internal representations combined auditory, visual, and kinesthetic (i.e., felt presence) modalities; were triggered when clients thought about past or future sessions, or when distressed; occurred in diverse locations; and varied in frequency, duration, and intensity. Clients felt positively about their representations and used them to introspect or influence therapy within sessions, beyond sessions, or both. The frequency of, comfort with, and use of clients\u27 internal representations increased over the course of therapy, and the representations benefited the therapy and therapeutic relationship. Therapists tended not to take a deliberate role in creating clients\u27 internal representations, and few clients discussed their internal representations with their therapists