The therapeutic relationship, also known as the working alliance, comprises two parts: the client’s positive emotional attachment to the therapist and the client and the therapist’s shared understanding of the tasks and goals of treatment (Bordin, 1979).
The establishment of a therapeutic connection has emerged as a particularly important process correlated with a positive outcome in various studies in the adult literature (Horowitz, Marmar, Weiss, DeWitt, & Rosenbaum, 1984; Luborsky, Crits-Christoph, Mintz, & Auerbach, 1988).
Due to the “involuntary client” status of many children at the start of therapy, the nonverbal nature of many forms of client-centred and play therapy for children, and the social deficits hypothesized to be central in the development and maintenance of many serious child problems, Shirk and Saiz (1992) argue that this process variable may be an even more significant contributor to the outcome for children (e.g., aggression).
Therapeutic Relationship Definition
A therapeutic relationship’s goal is to help the person in treatment alter his or her life for the better. This type of relationship is critical because it is frequently the first place where the person undergoing treatment discloses intimate thoughts, beliefs, and emotions about the issue(s) at hand. As a result, the therapist must create a safe, open, and non-judgmental environment in which the affected person can feel at peace.
Trust, respect, and congruence are major components of a good therapeutic relationship. Therapists are encouraged to be real and empathic. Like any other social connection, the therapeutic relationship has limits that help define what is acceptable and what is not.
Phases of Therapeutic Relationship
The client’s sense of the therapist’s support and empathy is crucial in the early stages of treatment.
A collaborative partnership emerges later in treatment to overcome or address the client’s concerns. During the second phase, everyone shares responsibility for achieving goals.
The therapeutic relationship is into four stages, according to Rivera (1992).
1. Commitment
Initially, the patient and the therapist agree to devote time and energy to achieving particular objectives.
At this stage, the therapist’s perception, the strength of the client’s motivation, and the compatibility of personalities/experiences are all key considerations.
2. Process
This is the most difficult stage because it encompasses the treatment and the relationship. This is when the therapist looks for patterns and collects and organises data.
The therapist will search for triggers, cycles, and repetitive interactions in the client. This is also when the therapist gathers more information and attempts to make changes.
3. Change
This level denotes the treatment plan’s completion and success. The client can accept his or her current mental or emotional state and develop behaviours that will improve their overall well-being.
4. Termination
The client “graduates” at this point. Both the therapist and the client can acknowledge each other as self-sufficient individuals.
Positive transference and regressive kinds of reliance have been handled at this point. Permission and rights to develop one’s life independently have been given to the client.
Examples of Therapeutic Relationships
It’s critical to identify particular examples of therapy’s components and phases. The client’s first impression of the therapist is crucial to deepening the relationship and progressing to the following commitment stage.
Here are some helpful methods that therapists can use to improve the therapeutic process and ones to avoid.
Empathic reaction
Empathetic responses are critical in the early phases of therapy to form a solid therapeutic connection. Empathetic replies consider both the content and emotion of what the client is saying. Here’s an example of a discussion like this.
Therapist: So, what exactly are you going through?
Client: I’m very nervous about going to school.
Therapist: Could you elaborate?
Client: My parents are constantly berating me about my grades, which are never good enough.
Therapist: I understand your parents’ nagging about your grades never being good enough makes you apprehensive about school.
Client: That’s right. It’s pretty tricky.
Transference
Transference and counter-transference become crucial parts of the therapeutic partnership during the process stage of therapy.
It also occurs in therapy when the client projects feelings they have (or are experiencing for another person in their life) onto the therapist. In this case, the client is channelling their animosity toward their parents onto the therapist.
Therapist: You indicated that your father hurt you when you were a child.
Client: No, I didn’t say that! You never pay attention to me or hear me correctly. You’re like my parents in that you misunderstand everything I say.
Counter-transference
Counter-transference occurs when the therapist projects their feelings onto the client. This can be harmful to the therapy relationship and the client’s progress.
Counter-transference awareness is essential to the therapist’s approach and professional development.
In the following example, the therapist gives advice rather than listening to the client, providing space, and creating an environment where they can find solutions or process their feelings.
Client: My spouse wants me to work full-time and do all the housekeeping simultaneously. I simply cannot accomplish everything; it seems impossible, and he is demanding.
Therapist: Why don’t you hire a maid instead of doing the chores yourself? You’re both well-off enough to be able to afford it.
Counter-transference can sometimes be the therapist’s attraction to the client or overly or underly involvement in the scenario.
Characteristics of Therapeutic Relationship
The client-therapist connection has numerous components that vary depending on the particular relationship. However, there are specific similar themes and qualities that I have included below.
Genuineness
The therapist must be a real human being, able to freely and deeply be themselves rather than an all-knowing professional. They must be a genuine person who can connect with others.
Empathy
This refers to a therapist’s ability to detect, identify, and comprehend the circumstance that their client is in, as well as their feelings, thoughts, and motives.
This is the core and foundation of a therapeutic relationship because it develops a personal connection between the therapist and the client, allowing the client to realize that their therapist is listening to them, values their needs, and understands them.
Possessing a trusting and nonjudgmental mindset
Clients must believe their therapist is trustworthy for a connection to form, grow, and flourish.
For clients who find it challenging to open up or explore their feelings because they worry that it is not safe for them to do so, it matters greatly that they can feel confident that their therapist will not judge them.
Warmth and care
There can be a sensation of anxiety, uncertainty, and nervousness when entering a consulting room for the first time or even meeting a new therapist after a break from therapy.
As a result, a therapist must provide a welcoming, compassionate, and secure environment where clients can express their feelings, ideas, and thoughts.
Observation and experience
A therapist’s knowledge and expertise allow them to understand better what has been said, to attract attention to the language used, or to a specific way that a client is presenting in that given session.
It’s also worth noting that a client’s experience and insight are pretty valuable.
Types of Therapeutic Relationship
It is no secret that relationships affect personal healing. The therapeutic alliance is a one-of-a-kind connection in which the interactions, bonds, and purpose all contribute to a client’s healing, treatment progress, and outcome success.
Transference
Transference was first described as repeating a previous connection by Sigmund Freud in 1905.
It occurs when feelings from an old significant object or event create feelings and impulses that transfer to the therapist.
Transference is founded on the unconscious and regressive distortions, not on the genuine relationship.
A new definition of transference is “interactive communication,” and the fundamental engine of treatment and transformation is the symmetry between the client and the therapist (Lingiardi, Holmquist, & Safran, 2016).
Transference, simply put, is the ‘transfer’ of feelings from previous relationships to the therapist. This can provide time for reflection, healing, and learning new ways to interact with others.
Working alliance
The therapeutic relationship includes a component called the working alliance. It’s the coming together of a client’s rational side and the therapist’s analyzing side.
Bordin (1979) is famous for conceptualizing the working alliance in tasks, goals, and the bond.
- Tasks are the procedures, methods, and techniques that must be used to achieve the client’s objectives.
- Goals are what the client wants to get out of therapy and are dependent on the problem at hand.
- The therapist-client relationship is built on trust and confidence that the tasks chosen will help the client achieve their objectives.
Real relationship
The actual relationship comprises the interpersonal attraction and compatibility between the client and therapist.
Genuineness and realism are two aspects of the actual relationship in therapy, according to Gelso (2011).
Genuineness is defined as the desire to avoid dishonesty, especially self-deception. The therapist must be aware of oneself to portray an accurate picture of themselves in the connection.
Realistically, realism is all about experiencing the client in a way that helps them. Within the connection, this concept of reality incorporates both empathy and comprehension.
Importance of Therapeutic Relationship
Establishing a therapeutic relationship is an important element in the healing process, and trust is essential for the partnership to be fruitful.
A person seeking a therapist must have faith that the therapist has the necessary expertise, skill set, and willingness to provide effective treatment.
Because the therapist wields significant power in the therapeutic relationship, a patient must believe that personal information will be kept private and that the therapist will not harm or exploit the patient.
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An individual in therapy may be more willing to open up emotionally and share more specifics about his or her difficulties once a therapeutic relationship has been established.
As a result, the therapist can understand the affected person’s point of view, feelings, and motivations.
With a better grasp of the circumstance, the therapist can provide the most appropriate treatment and utilize the most successful tactics to address the problem.
What Makes a Therapeutic Relationship?
The therapeutic relationship, also known as the working alliance, comprises two parts: the client’s positive emotional attachment to the therapist and the client and the therapist’s shared understanding of the tasks and goals of treatment (Bordin, 1979).
What Is a Therapeutic Relationship in Healthcare?
A therapeutic connection with the patient, which involves effective communication and information sharing, will help the nurse understand the patient’s preferences for their environment, allowing them to feel safe and confident in their care.
Conclusion
Clients and practitioners repeatedly observe that education, skill sets, certificates, degrees, techniques, and therapeutic approaches are meaningless without a solid therapeutic relationship.
A therapeutic relationship, on the other hand, cannot be taught directly. Therapists can master the therapeutic alliance and stages of the therapeutic process through knowledge, experience, practice, and self-reflection.
It is worthwhile to devote time and effort to developing these crucial interpersonal skills to improve one’s personal and professional life.
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