Why the Clinician-Client Relationship is Critical to the Outcome of Therapy

Putting aside the discussion on the effectiveness of one psychotherapeutic approach over another, it is clear that the differences in approaches appears to be minimal or small at the very least (Wampold,2001,2007,2010). And so we are left with the question: if the differences in effectiveness of approaches is minimal what are the other factors that influence the outcome of psychotherapy? On reviewing the evidence, Lambert & Bergin, (1994) firmly state that common factors account for positive outcomes in therapy and may be credited with “the gains that result from psychological interventions” (McFadzean, 2005).

Goldfried, M. R., & Davila, J. (2005). The role of relationship and technique in therapeutic change. Psychotherapy: Theory, Research, Practice, Training, 42(4), 421-430. doi:10.1037/0033-3204.42.4.421

(Horvath and Greenberg, 1994) As Binder and Strupp (1997) have suggested, the outcome of the therapeutic alliance is highly connected with the therapist’s capability to recognize whether the treatment they have applied is helpful and if it isn’t how it could be changed in order to turn into a positive treatment. (Binder and Strupp, 1997) Furthermore, both statements suggest that there must be a close connection between the therapist and the family/person, which is being treated at the considered moment. Those texts could suggest that it is important to have a personal, yet professional connection with the “client” in order to achieve a positive outcome. However, this would mean that one must take their work life into their everyday life and engage with the patient even outside work hours and that would be crossing the professional boundaries. To give an example for a positive treatment which evolves into a negative, I would like to draw your attention to the Netflix Original Series - Atypical.

Gelso & Carter (1985) suggested therapeutic relationship as “the feelings and attitudes that the counselling participants have toward one another and the manner in which these are expressed”. The establishment of a therapeutic relationship between the therapist and the client that is open, non-judgmental and empathic serve as the basis of new internalisations. It allows the client to develop trust towards the therapist and bring about

One of the main instruments to success in client treatment is when professional is engaging and recall the client and family in treatment (Thompson, Bender, Lantry, & Flynn, 2007). Thompson, Bender, Lantry, & Flynn, (2007), states that engagement is a vital yet challenging element in active treatment. According to Thompson, Bender, Lantry, & Flynn (2007), “clients that engaged are likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction.” The engagement process involves the client and the professional to create and develop a connection or association (Thompson, Bender, Lantry, & Flynn, 2007). Engagement is successful with treatment replicates the value of the

Overall, the therapy session was successful for both the client and clinician. The clinician maintained the clients attention throughout the session, while effectively targeting the therapy

A therapeutic relationship requires the development of rapport, empowerment and collaboration which again are achieved through effectively using all aspects of verbal and non-verbal communication. While rapport develops as trust develops, empowerment is achieved when the OT uses their skills, knowledge and self to support the client in overcoming the challenges they face (O’Toole, 2013). Collaboration which encourages clients to be ‘agents of change in their own circumstances’ (O’Toole, 2012, p17) is the final component in the establishment of a therapeutic relationship. Establishing an effective therapeutic relationship and achieving mutual understanding facilitates client-centered practice and is considered the difference between successful and unsuccessful therapy (O’Brien & Hussey, 2013).

Those patients are usually more difficult to build an alliance with because they are guarded. These patients are struggling with a chronic mental illness; one reason could be that they frequently misunderstood, alienated and oppressed as well as it could be a symptom of their illness. Strategies to help in the engagement of these patients involves, effectively convey empathy, using the Carl Rogers “Client Centered Counseling” where the patient is the nucleus of the treatment (Shea, 1998). The clinician then strengths prospective interviewing techniques as well as, empathic listening, framing/reframing, and encouragement to help the involuntary patient feel safe and confident to freely share and engage with the clinician. Other techniques clinician can employ includes; motivational interviewing and interviewing for strength and family support. On the other hand, other factor that can affect the relationship between patient and clinicians is the obvious position of power of the clinician, which may intimidate the patient . To illustrate this point Gemain and Gitterman highlighted in their life modeled practice from an ecological perception that “ with power differences between the patients reduced to the greatest degree possible....the client-worker relationship is transactional-client and worker roles shift from those of subordinate recipient and superior expert...to a role relationship characterized by mutuality and reciprocity” (cited in

Engagement with the client is a vital yet challenging aspect in effective therapy. According to Thompson, Bender, Lantry and Flynn (2007), when the clients are engaged they are more likely to create a connection with their counselors or therapist, participate to a greater degree, endorse the treatment goals, remain longer in the treatment, as well as reporting higher levels of satisfaction. Once in the therapy room, multiple factors can assist in building accord and empathy and equally undermine it. It is, therefore, important for the therapist to utilize non-verbal techniques to validate the client and detect obstacles that may impede change (Gurton, 2015).

There are basic critical elements that form this collaborative client-clinician relationship. These elements constitute the key factors that strengthen the therapeutic alliance. The elements include; the emotional bond and partnership, goals, tasks and the relationship history of the participants (Meissner, 1996). Goals as an element refers to the end result of the therapy. It involves what the client hopes to acquire from the therapy (Berzins, 2008). Therefore when the working alliance is being established, goals to be achieved must be considered. The client establishes this strong and trustworthy relationship knowing that something must be achieved at the end of the treatment session. The clinician must also know the goals and objectives

A client’s improvement was related to the high level of the engagement of the therapeutic relationship; and

Instead of focusing solely on the process of therapy, we have benefitted from tailor-fitting our approach to the unique factors most often reported by clients as to why they have changed. Hubble, Duncan, and Miller (1999) report in their book The Heart and Soul of Change: What Works in Therapy that client factors such as strengths and resources (40%) and the therapeutic relationship (30%) have more of an impact on client change than factors such as treatment models and therapeutic processes.

Establishing and maintaining a positive therapeutic relationship between health care professionals and their clients or patients is of utmost importance. A therapeutic relationship usually refers to the relationship constructed between a health care professional and his or her client. The attributes in establishing a strong therapeutic relationship involves delivering empathy and compassion, acknowledging individualism, offering encouragement and support, being there for the patients or clients, displaying genuiness, showing respect, encouraging equality, maintaining boundaries, and having self conscious or awareness. (Browne, Cashin, & Graham, 2012) Effective communication plays an important role in maintaining a positive therapeutic relationship. Effective communication is not only just spoken or written words but the ability to convey the message clearly so that the receiver is able to comprehend the intention or the emotion behind the message. Effective communication is mainly based on two main classifications; verbal and non-verbal communication. (Mateosian, 2011) This essay is going to discuss how both verbal and non-verbal communication play important roles in establishing and maintaining a therapeutic relationship between clients or patients and the health care professionals.

In the first step, one way that could be useful for bonding with a client is genuineness, which is the ability to meet person-to-person by listening and communicating with clients, without contradicting their messages and being clear and concrete in communications with your client. Being genuine in a therapeutic situation shows the ability to use therapeutic communication tools in an appropriate manner, rather than in a rude fashion. Varcarolis, E. (2009). Developing Therapeutic relationships. http://evolve.elsevier.com/Varcarolis. According to Miley K, O’Melia M, DuBois B, (2012), states that when workers are genuine, they cause authentic relationship with their

Rogers proposed that if these were met, it was inevitable that psychological change would occur within the client irrespective of techniques, methods or expertise of the counselor (4). It was a guaranteed outcome if the relationship met the following criteria: two persons are in psychological contact, the client is experiencing incongruence, the therapist is congruent or integrated in the relationship, the therapist experiences unconditional positive regard or real caring for the client, the therapist experiences empathy for the client’s internal frame of reference and endeavors to communicate this to the client, the communication to the client is achieved. These six conditions are considered to have two basic components, those associated with the actions and experiences of the therapist, and those linked with the client and their experiences and capacity to engage in a therapeutic relationship.