| "Maybe if I have this client blink his eyes at an | | | | that Rogers recommends (1961) asking yourself as a |
| increased speed, while exposing him to his past, and | | | | clinician concerning the development of a helping |
| add some cognitive behavioral therapy while sitting | | | | relationship. These questions should be explored |
| next to a waterfall, he may be able to function more | | | | often and reflected upon as a normal routine in your |
| effectively in his life!" Yes this is rather exaggerated, | | | | clinical practice. They will help the clinician grow and |
| however it demonstrates the idea that as | | | | continue to work at developing the expertise needed |
| professionals in the field of therapy, we often seek | | | | to create a strong therapeutic relationship and in turn |
| complex theories, techniques, and strategies to more | | | | the successful practice of therapy. |
| effectively treat our consumers. A large amount of | | | | 1. Can I be in some way which will be perceived by |
| our precious time is spent seeking new theories and | | | | the client as trustworthy, dependable, or consistent in |
| techniques to treat clients; evidence for this | | | | some deep sense? |
| statement is shown by the thousands of theories | | | | 2. Can I be real? This involves being aware of |
| and techniques that have been created to treat | | | | thoughts and feelings and being honest with yourself |
| clients seeking therapy. | | | | concerning these thoughts and feelings. Can I be who |
| The fact that theories are being created and the field | | | | I am? Clinicians must accept themselves before they |
| is growing is absolutely magnificent; however we | | | | can be real and accepted by clients. |
| may be searching for something that has always | | | | 3. Can I let myself experience positive attitudes |
| been right under our nose. Clinicians often enjoy | | | | toward my client - for example warmth, caring, |
| analyzing and making things more intricate that they | | | | respect) without fearing these? Often times clinicians |
| actually are; when in reality what works is rather | | | | distance themselves and write it off as a |
| simple. This basic and uncomplicated ingredient for | | | | "professional" attitude; however this creates an |
| successful therapy is what will be explored in this | | | | impersonal relationship. Can I remember that I am |
| article. This ingredient is termed the therapeutic | | | | treating a human being, just like myself? |
| relationship. Some readers may agree and some may | | | | 4. Can I give the client the freedom to be who they |
| disagree, however the challenge is to be open | | | | are? |
| minded and remember the consequences of | | | | 5. Can I be separate from the client and not foster a |
| "contempt prior to investigation". | | | | dependent relationship? |
| Any successful therapy is grounded in a continuous | | | | 6. Can I step into the client's private world so deeply |
| strong, genuine therapeutic relationship or more | | | | that I lose all desire to evaluate or judge it? |
| simply put by Rogers, the "Helping Relationship". | | | | 7. Can I receive this client as he is? Can I accept him |
| Without being skilled in this relationship, no techniques | | | | or her completely and communicate this acceptance? |
| are likely to be effective. You are free to learn, | | | | 8. Can I possess a non-judgmental attitude when |
| study, research and labor over CBT, DBT, EMDR, | | | | dealing with this client? |
| RET, and ECT as well as attending infinite trainings on | | | | 9. Can I meet this individual as a person who is |
| these and many other techniques, although without | | | | becoming, or will I be bound by his past or my past? |
| mastering the art and science of building a | | | | Empirical Literature |
| therapeutic relationship with your client, therapy will | | | | There are obviously too many empirical studies in this |
| not be effective. You can even choose to spend | | | | area to discuss in this or any brief article, however |
| thousands of dollars on a PhD, PsyD, Ed.D, and other | | | | this author would like to present a summary of the |
| advanced degrees, which are not being put down, | | | | studies throughout the years and what has been |
| however if you deny the vital importance of the | | | | concluded. |
| helping relationship you will again be unsuccessful. | | | | Horvath and Symonds (1991) conducted a Meta |
| Rogers brilliantly articulated this point when he said, | | | | analysis of 24 studies which maintained high design |
| "Intellectual training and the acquiring of information | | | | standards, experienced therapists, and clinically valid |
| has, I believe many valuable results--but, becoming a | | | | settings. They found an effect size of .26 and |
| therapist is not one of those results (1957)." | | | | concluded that the working alliance was a relatively |
| This author will attempt to articulate what the | | | | robust variable linking therapy process to outcomes. |
| therapeutic relationship involves; questions clinicians | | | | The relationship and outcomes did not appear to be |
| can ask themselves concerning the therapeutic | | | | a function of type of therapy practiced or length of |
| relationship, as well as some empirical literature that | | | | treatment. |
| supports the importance of the therapeutic | | | | Another review conducted by Lambert and Barley |
| relationship. Please note that therapeutic relationship, | | | | (2001), from Brigham Young University summarized |
| therapeutic alliance, and helping relationship will be | | | | over one hundred studies concerning the therapeutic |
| used interchangeably throughout this article. | | | | relationship and psychotherapy outcome. They |
| Characteristic of the Therapeutic Relationship | | | | focused on four areas that influenced client outcome; |
| The therapeutic relationship has several | | | | these were extra therapeutic factors, expectancy |
| characteristics; however the most vital will be | | | | effects, specific therapy techniques, and common |
| presented in this article. The characteristics may | | | | factors/therapeutic relationship factors. Within these |
| appear to be simple and basic knowledge, although | | | | 100 studies they averaged the size of contribution |
| the constant practice and integration of these | | | | that each predictor made to outcome. They found |
| characteristic need to be the focus of every client | | | | that 40% of the variance was due to outside |
| that enters therapy. The therapeutic relationship | | | | factors, 15% to expectancy effects, 15% to specific |
| forms the foundation for treatment as well as large | | | | therapy techniques, and 30% of variance was |
| part of successful outcome. Without the helping | | | | predicted by the therapeutic relationship/common |
| relationship being the number one priority in the | | | | factors. Lambert and Barley (2001) concluded that, |
| treatment process, clinicians are doing a great | | | | "Improvement in psychotherapy may best be |
| disservice to clients as well as to the field of therapy | | | | accomplished by learning to improve ones ability to |
| as a whole. | | | | relate to clients and tailoring that relationship to |
| The following discussion will be based on the | | | | individual clients." |
| incredible work of Carl Rogers concerning the helping | | | | One more important addition to these studies is a |
| relationship. There is no other psychologist to turn to | | | | review of over 2000 process-outcomes studies |
| when discussing this subject, than Dr. Rogers himself. | | | | conducted by Orlinsky, Grave, and Parks (1994), |
| His extensive work gave us a foundation for | | | | which identified several therapist variables and |
| successful therapy, no matter what theory or | | | | behaviors that consistently demonstrated to have a |
| theories a clinician practices. Without Dr. Rogers | | | | positive impact on treatment outcome. These |
| outstanding work, successful therapy would not be | | | | variables included therapist credibility, skill, empathic |
| possible. | | | | understanding, affirmation of the client, as well as the |
| Rogers defines a helping relationship as , " a | | | | ability to engage the client and focus on the client's |
| relationship in which one of the participants intends | | | | issues and emotions. |
| that there should come about , in one or both | | | | Finally, this author would like to mention an interesting |
| parties, more appreciation of, more expression of, | | | | statement made by Schore (1996). Schore suggests |
| more functional use of the latent inner resources of | | | | "that experiences in the therapeutic relationship are |
| the individual ( 1961)." There are three characteristics | | | | encoded as implicit memory, often effecting change |
| that will be presented that Rogers states are | | | | with the synaptic connections of that memory |
| essential and sufficient for therapeutic change as well | | | | system with regard to bonding and attachment. |
| as being vital aspects of the therapeutic relationship | | | | Attention to this relationship with some clients will |
| (1957). In addition to these three characteristics, this | | | | help transform negative implicit memories of |
| author has added two final characteristic that appear | | | | relationships by creating a new encoding of a positive |
| to be effective in a helping relationship. | | | | experience of attachment." This suggestion is a topic |
| 1. Therapist's genuineness within the helping | | | | for a whole other article, however what this |
| relationship. Rogers discussed the vital importance of | | | | suggests is that the therapeutic relationship may |
| the clinician to "freely and deeply" be himself. The | | | | create or recreate the ability for clients to bond or |
| clinician needs to be a "real" human being. Not an all | | | | develop attachments in future relationships. To this |
| knowing, all powerful, rigid, and controlling figure. A | | | | author, this is profound and thought provoking. Much |
| real human being with real thoughts, real feelings, and | | | | more discussion and research is needed in this area, |
| real problems (1957). All facades should be left out of | | | | however briefly mentioning it sheds some light on |
| the therapeutic environment. The clinician must be | | | | another important reason that the therapeutic |
| aware and have insight into him or herself. It is | | | | relationship is vital to therapy. |
| important to seek out help from colleagues and | | | | Throughout this article the therapeutic relationship has |
| appropriate supervision to develop this awareness | | | | been discussed in detail, questions to explore as a |
| and insight. This specific characteristic fosters trust in | | | | clinician have been articulated, and empirical support |
| the helping relationship. One of the easiest ways to | | | | for the importance of the therapeutic relationship |
| develop conflict in the relationship is to have a | | | | have been summarized. You may question the validity |
| "better than" attitude when working with a particular | | | | of this article or research, however please take an |
| client. | | | | honest look at this area of the therapy process and |
| 2. Unconditional positive regard. This aspect of the | | | | begin to practice and develop strong therapeutic |
| relationship involves experiencing a warm acceptance | | | | relationships. You will see the difference in the |
| of each aspect of the clients experience as being a | | | | therapy process as well as client outcome. This |
| part of the client. There are no conditions put on | | | | author experiences the gift of the therapeutic |
| accepting the client as who they are. The clinician | | | | relationship each and every day I work with clients. |
| needs to care for the client as who they are as a | | | | In fact, a client recently told me that I was "the first |
| unique individual. One thing often seen in therapy is | | | | therapist he has seen since 9-11 that he trusted and |
| the treatment of the diagnosis or a specific problem. | | | | acted like a real person. He continued on to say, |
| Clinicians need to treat the individual not a diagnostic | | | | "that's why I have the hope that I can get better |
| label. It is imperative to accept the client for who | | | | and actually trust another human being." That's quite |
| they are and where they are at in their life. | | | | a reward of the therapeutic relationship and process. |
| Remember diagnoses are not real entities, however | | | | What a gift! |
| individual human beings are. | | | | Ask yourself, how you would like to be treated if |
| 3. Empathy. This is a basic therapeutic aspect that | | | | you were a client? Always remember we are all part |
| has been taught to clinicians over and over again, | | | | of the human race and each human being is unique |
| however it is vital to be able to practice and | | | | and important, thus they should be treated that way |
| understand this concept. An accurate empathetic | | | | in therapy. Our purpose as clinicians is to help other |
| understanding of the client's awareness of his own | | | | human beings enjoy this journey of life and if this |
| experience is crucial to the helping relationship. It is | | | | field isn't the most important field on earth I don't |
| essential to have the ability to enter the clients | | | | know what is. We help determine and create the |
| "private world" and understand their thoughts and | | | | future of human beings. To conclude, Constaquay, |
| feelings without judging these (Rogers, 1957). | | | | Goldfried, Wiser, Raue, and Hayes (1996) stated, " It |
| 4. Shared agreement on goals in therapy. Galileo once | | | | is imperative that clinicians remember that decades of |
| stated, "You cannot teach a man anything, you can | | | | research consistently demonstrates that relationship |
| just help him to find it within himself." In therapy | | | | factors correlate more highly with client outcome |
| clinicians must develop goals that the client would like | | | | than do specialized treatment techniques." |
| to work on rather than dictate or impose goals on | | | | References |
| the client. When clinicians have their own agenda and | | | | Constaquay, L. G., Goldfried, M. R., Wiser, S., Raue, |
| do not cooperate with the client, this can cause | | | | P.J., Hayes, A.M. (1996). Predicting the effect of |
| resistance and a separation in the helping relationship | | | | Cognitive therapy for depression: A study of unique |
| (Roes, 2002). The fact is that a client that is forced | | | | and common factors. Journal of Consulting and Clinical |
| or mandated to work on something he has no | | | | Psychology, 65, 497-504. |
| interest in changing, may be compliant for the | | | | Horvath, A.O. & Symonds, B., D. (1991). Relation |
| present time; however these changes will not be | | | | between a working alliance and outcome in |
| internalized. Just think of yourself in your personal life. | | | | psychotherapy: A Meta Analysis. Journal of Counseling |
| If you are forced or coerced to work on something | | | | Psychology, 38, 2, 139-149. |
| you have no interest in, how much passion or energy | | | | Lambert, M., J. & Barley, D., E. (2001). Research |
| will you put into it and how much respect will you | | | | Summary on the therapeutic relationship and |
| have for the person doing the coercing. You may | | | | psychotherapy outcome. Psychotherapy, 38, 4, |
| complete the goal; however you will not remember | | | | 357-361. |
| or internalize much involved in the process. | | | | Orlinski, D. E., Grave, K., & Parks, B. K. (1994). |
| 5. Integrate humor in the relationship. In this authors | | | | Process and outcome in psychotherapy. In A. E. |
| own clinical experience throughout the years, one | | | | Bergin & S. L. Garfield (Eds.), Handbook of |
| thing that has helped to establish a strong therapeutic | | | | psychotherapy(pp. 257-310). New York: Wiley. |
| relationship with clients is the integration of humor in | | | | Roes, N. A. (2002). Solutions for the treatment |
| the therapy process. It appears to teach clients to | | | | resistant addicted client, Haworth Press. |
| laugh at themselves without taking life and | | | | Rogers, C. R. (1957). The Necessary and Sufficient |
| themselves too serious. It also allows them to see | | | | Conditions of Therapeutic Personality Change. Journal |
| the therapist as a down to earth human being with a | | | | of Consulting Psychology, 21, 95-103. |
| sense of humor. Humor is an excellent coping skill and | | | | Rogers, C. R. (1961). On Becoming a Person, |
| is extremely healthy to the mind, body, and spirit. | | | | Houghton Mifflin company, New York. |
| Try laughing with your clients. It will have a profound | | | | Schore, A. (1996). The experience dependent |
| effect on the relationship as well as in your own | | | | maturation of a regulatory system in the orbital |
| personal life. | | | | prefrontal cortex and the origin of developmental |
| Before delving into the empirical literature concerning | | | | psychopathology. Development and Psychopathology, |
| this topic, it is important to present some questions | | | | 8, 59-87. |