What Makes The Therapy Relationship Work?

For those of you who are familiar with therapy, either as clients or therapists, or both, have you ever thought about the reasons why sometimes therapy clicks and a bond is formed – and sometimes the relationship falls flat?

Looking at research about elements that make a strong therapy bond, we find some factors that studies have been able to measure.

Clients report very common sense reasons for feeling a bond: good eye contact, smiling, warm greetings and farewells, correctly identifying the client’s feelings, and remembering previous conversations.  These strike me as factors that would help any relationship, whether it was therapy, friendship, or talking to your car mechanic.  It doesn’t seem special to therapy.  Somewhat more interesting, although also predictable, was that personal characteristics of the therapist have an impact on a strong alliance (attire, age, gender, body type, ethnic background) and so does the therapy environment: office size, lighting, decorations, colors and books. It makes sense for general comfort but I doubt that even the best books on the shelf can forge a relationship.

I imagine that all of the reasons listed so far are helpful in creating some safety and the beginning of a bond, but my 30 years as a therapist tells me that this next category is where the strong alliances are formed.  This idea is the one that I would have emphasized if asked – clinical interventions.   Clinical interventions are all the things that we say and do as therapists. Some books talk about clinical interventions as if they can be separated from the clinician, client or the relationship, but I just don’t believe that.  As clinicians, what we say and how we say it cannot be divorced from who we are and the relationship that we want to create.  When we (both client and therapist) reach an understanding of some aspect of our client’s life, it is the deepening of a real bond.

It is all about understanding. Before change can happen, we have to understand. Think about it – this is also true outside the office walls.  Understanding is quite a gift, maybe because it is so rare. 

To read more about some of these factors, see Robinder Bedi, Michael D. Davis, and Meris Williams’ article “Critical Incidents In The Formation Of The Therapeutic Alliance From The Client’s Perspective” in Psychotherapy: Theory, Research, Practice, Training, 2005, volume 42, #3, pp. 311-323.

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