Chapter 5 – Evidence-Based Chapter 5 – Evidence-Based RelationshipsRelationships

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This chapter focuses on relationship variables or factors that appear to have a positive influence on counseling or psychotherapy outcomes.

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The Great Psychotherapy Debate

Empirically Supported Techniques or Treatments vs. Evidence-Based Relationships

Where do you find yourself in this debate?

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Carl Rogers’s Identified three Core Conditions to Therapeutic Change

Congruence Unconditional Positive Regard Accurate Empathy

Chapter 5Chapter 5 Congruence refers to having your

thoughts, feelings, and behaviors match. Rogers believed that therapists should be

honest, somewhat spontaneous, and real. Congruence doesn’t mean interviewers

should say whatever they want to say. Some censoring is still needed.

It’s very important to examine your motives when it comes to self-disclosure and touch.

On average, congruence appears to account for about 6% of positive outcomes variance.

Chapter 5Chapter 5 Unconditional Positive Regard (UPR)

involves a warm regard for the other person as a separate individual worthy of respect. What are some of the ways therapists

can communicate congruence? UPR is conveyed not so much by what

you say, but by how you say it. On average, UPR accounts for a little less

than 9% of positive outcomes variance.

Chapter 5Chapter 5 Accurate Empathy is central to effective

interviewing. It is a complex concept characterized by an

effort to see the world from the client’s perspective.

Research suggests that empathy includes: (a) emotional stimulation, (b) perspective-taking, and (c) emotional regulation.

Empathy has a robust effect on treatment outcomes, accounting for nearly 10% of treatment variance.

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Psychoanalytic and Interpersonal Relationship Concepts Transference Countertransference Working alliance

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Transference is when your client views you in ways similar to how he or she viewed his or her parents or early caregivers. Transference feels inappropriate. It’s like putting an old map on a new terrain. It’s a way to glimpse a client’s early

relationship dynamics. There’s indirect empirical support for

focusing on transference in therapy.

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Countertransference (CT) is similar to transference, but involves therapists projecting their issues onto clients. CT is broadly defined as any reaction you may have

to your client. Client transference can trigger interviewer CT. Freud thought CT was always bad, but contemporary

therapists see it as potentially informative. There’s evidence that not addressing CT can

adversely affect treatment outcomes, and addressing it can increase positive outcomes.

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5-Minute Reflection

Get with a partner or small group and discuss the concepts of transference and CT. Especially discuss the sort of people who are most likely to trigger your CT reactions.

Report any insights you have back to the class.

Chapter 5Chapter 5 The Working Alliance (aka: therapeutic

relationship) has three main components: Goal consensus Collaboration on tasks Emotional bonding

Evidence strongly supports the positive influence of a positive working alliance on treatment outcomes.

Feedback is also used to enhance the relationship.

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Role Modeling (aka: Identification and Internalization) Clients may identify with and internalize

traits of their parents, caregivers, and therapists.

Conceptually, these concepts can be viewed from both psychoanalytic and behavioral perspectives.

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Behavioral and Social Psychologists have emphasized that clients respond best to interviewers who display high levels of: Expertness (Credibility) Attractiveness Trustworthiness

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Feminist Relationship Concepts include Mutuality: This refers to sharing power

and working collaboratively. Client as Expert (aka: Empowerment):

This concept includes an emphasis on holding the clients’ perspectives as the greatest source of authority re: information.

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Summary and Conclusions