The therapeutic relationship: A mechanism for change

What happens in psychotherapy when patients experience their therapist responding to them in a way that is strikingly different from what they have come to expect in relationships?

Corrective relational experiences (CREs) are meaningful moments within the therapeutic relationship that challenge patients’ existing expectations about themselves and others (Alexander & French, 1946). Although such experiences have long been considered potentially important in psychotherapy, relatively little is known about their forms and how they may contribute to therapeutic change.

In our study published in Psychotherapy (2026), we explored CREs among 57 patients diagnosed with major depressive disorder who received short-term psychodynamic psychotherapy. The patients participated in semi-structured interviews after completing treatment, reflecting on their experiences in therapy. Importantly, these interviews took place, on average, approximately 3 years after treatment ended, allowing us to examine which therapeutic experiences remained meaningful over time. From the interviews, we identified 21 corrective relational experiences and organized them into four types using ideal type analysis:

• Experiencing empathic engagement involved patients being surprised by the therapist’s genuine care, attentiveness, and emotional presence. Feeling truly seen and heard helped patients develop trust; strengthened their sense of self-worth; and, in some cases, allowed them to reconsider what they could expect from relationships outside therapy.
• Experiencing nonjudgmental acceptance occurred when therapists responded with acceptance and flexibility in situations in which patients expected criticism or judgment. These experiences appeared to have consequences beyond the therapy room: All patients in this group also described improvements in their interpersonal functioning.
• Experiencing new understanding or insight involved therapeutic interactions that enabled patients to understand themselves in new ways. Interpretations, questions, boundaries, and other therapist interventions became corrective when they were experienced not simply as intellectual insights but also as meaningful relational experiences.
• Experiencing encouragement and empowerment involved therapists helping patients discover their own ability to cope with difficulties rather than providing solutions for them. Patients described becoming more confident in their capacity to face challenges and act independently.

Across all four types, patients who described a CRE also reported improvements in how they related to themselves. Most also described an improved relationship with their therapist. Notably, these patients showed a faster reduction in depressive symptoms during treatment than those who did not report such experiences.

Our findings suggest that therapeutic change may sometimes occur through distinct relational moments in which something unexpected happens: A patient anticipating criticism encounters acceptance, a patient expecting emotional distance encounters genuine care, or a patient expecting someone else to provide the answer discovers their own capacity to act.

Understanding these experiences may help therapists become more attentive to moments in which the therapeutic relationship itself offers patients an opportunity to revise deeply held expectations about themselves and others. Rather than viewing this relationship merely as the context in which interventions occur, our findings highlight its potential to become an active mechanism of change.

This article is in the Clinical Psychology topic area.

Alexander, F., & French, T. M. (1946). The corrective emotional experience. Psychoanalytic therapy: Principles and application (pp. 25–70). Ronald Press.

Leibovich, L., Sadek, A., Ben David-Sela, T., Khoury, Y., Malka, M., Midgley, N., & Zilcha-Mano, S. (2026). “I too deserve good”: A qualitative exploration of corrective relational experiences in psychodynamic therapy for depression. Psychotherapy, 63(1), 24–32. https://doi.org/10.1037/pst0000607

Liat Leibovich, PhD, is a clinical psychologist and supervisor in private practice and at “Ahava,” an out-of-home residential care facility for children at risk. She also is a researcher at the University of Haifa in Israel, where her research focuses on mechanisms of change in psychodynamic psychotherapy. Contact Liat Leibovich.

Abigail Sadek is a clinical psychology intern at Meuhedet Health Services in Israel. She also maintains a private psychotherapy practice in Tel Aviv for adolescents and adults.

Tal Ben David Sela, PhD, is a lecturer in the Department of Psychology at The College of Management Academic Studies in Israel. Her research focuses on psychotherapy for postpartum depression.

Yara Khoury is a doctoral student in clinical psychology. She studies patients’ experiences of psychotherapy and how measuring and considering these experiences can broaden the understanding of therapeutic processes and outcomes, including outcomes beyond symptom reduction.

Nick Midgley, PhD, is a professor of psychological therapies with children and young people at Anna Freud and University College London in the United Kingdom.

Michal Malka is a doctoral student and lab manager at the Psychotherapy Research Lab at the University of Haifa. Her doctoral research focuses on understanding the impact of the therapeutic alliance within psychotherapy.

Sigal Zilcha-Mano, PhD, is a professor of clinical psychology and head of the Psychotherapy Research Lab at the University of Haifa. Her research focuses on individual-specific mechanisms of therapeutic change.