Members of the third interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness reviewed the evidence on 16 relationship factors thought to enhance psychotherapy outcomes. Experts conducted meta-analyses on each one. A panel then rated the effectiveness of those relationship elements using the following criteria: the number of studies in a given area; the consistency of empirical results; the independence of the supportive studies; the size or strength of the association; the external validity of the research; and evidence for a causal link between the relationship behavior and good outcomes.
Based on those findings, the panel categorized elements of the therapy relationship into the following three groups.
Demonstrably effective
- The alliance (in individual adult psychotherapy, in youth psychotherapy, and in couple and family therapy). Building an effective working relationship with your patient or patients; defined by the quality and strength of the relationship.
- Collaboration. Working together with your patient on the treatment process so that you are “on the same page.”
- Goal consensus. Fostering agreement on the goals and expectations of therapy.
- Cohesion in group therapy. Promoting a positive bond between all members of a psychotherapy group by facilitating a climate of openness, warmth and egalitarianism.
- Empathy. Sensitive understanding of the patient’s feelings and struggles; seeing them from the patient’s point of view.
- Collecting and delivering client feedback. Using feedback systems to gauge how a patient is doing and using the information to tailor treatment accordingly. This relationship factor has been shown in controlled trials to cause positive outcomes.
- Positive regard/affirmation. Prizing and supporting your patients, regardless of their behavior, attitudes or emotions.
Probably effective
- Congruence/genuineness. Relating authentically to your patients without hiding behind a professional or personal facade.
- The real relationship. Nurturing a therapy relationship marked by genuineness and seeing each other in realistic terms.
- Emotional expression. Sharing genuine emotions with your patient in ways that are appropriate to the framework of therapy.
- Cultivating positive expectations. Supporting patients’ expectations that their mental health will improve as a result of psychotherapy.
- Promoting treatment credibility. Promoting patients’ belief that psychotherapy makes sense, is suited to their needs and is effective.
- Managing countertransference. Attending to and controlling your own emotions as they are stirred up in relation to your patient.
- Repairing alliance ruptures. Using therapy tools such as empathy, collaboration and mutual discussion to address breakdowns in the therapy relationship.
Promising but not yet sufficiently researched
- Self-disclosure and immediacy. Using the immediate situation to invite your patient to examine what is happening in the therapy relationship. It may involve disclosing aspects of your emotions or personal life in ways that can feel risky and unfamiliar.
