“Relationship” most important factor in therapy…. Really?

One of the most annoying things I hear therapists and professionals talk about regarding therapy and what helps is the “relationship.” Here is the problem, take a step back if you are a professional reading this or a normal person. What do they mean? I have many relationships. I have relationships with co workers, friends, parents, siblings, teachers. Now compare those to a gf/bf, of which is intimate and sexual. We would all say that each of these are of different kinds of “relationships.” My position is that therapists and even academicians throw the concept out there to try and try hard to say many different forms of therapy are of equal value. This means from freud’s psychoanalysis, to Roger’s rogerian therapy, to Cognitive Behavioral therapy, and behavior modification! The problem is that simply is not true that all forms of therapy work equally well, but that is for another entry.

So, in grad school I kept hearing the therapeutic relationship blah blah blah, is the most important factor for successful therapy. Actually, sometimes the profs would not even use therapeutic, but just the relationship… Well, words are important, the English language has quite a few, that delineate ideas at a fine level of analysis. Hangry was recently added to the dictionary, love the word. Because in one word if I say John is hangry, it communicates to you that he’s in a pissy mood because he is hungry. So one word vs literally saying the sentence, “John is in an irritable/angry mood because he is hungry,” efficient!

I then looked up the research on where my profs were getting this information on relationship and passing it onto us. It turns out, it is technically the “therapeutic alliance,” of which is measured by the “therapeutic alliance scale.” Now we are getting somewhere I thought. Now, this scale is broken down into 3 component parts (get to those in a few). I’ll give an analogy here to help you understand. When you think of someone as extraverted. You may think of 3 component parts of the concept, extraversion. First, lets just say verbal, they talk a lot, and to many people. Fair, simple. Second, time spent. They love to spend time around a lot of people, not being alone, prefer parties, clubs, bars, anything with people. Then the third component, activity. They tend to be very active individuals, out and about a lot, and again around a lot of people.

So, three component parts for extraversion, Verbal, Time Spent, Activity. The point is you can say these are three distinct aspects that can describe extraverts. Now, when I looked up the component parts of the “therapeutic alliance.” Again, this concept being sold to grad school students as the “therapeutic relationship” or just “relationship” we find something interesting. That scale breaks down the alliance into three parts Goal, Task, and Bond. So, to simplify… you walk into my office we start talking and identify the goal, lets say to lessen your anxiety, we both agree. Goal aspect of the scale is accomplished, you will give it high score on the scale. Now, we say how will we lessen your anxiety, and both agree on talk therapy, cognitive therapy, yippee two out of the three down. You will now score that as high on the scale regarding questions related to the task. Finally, then there are the questions related to how you feel towards me as in bonding. Liking me in general, my demeanor, attitude, patience etc.

The point I am making here is you can have an inflated score because we both have agreed therapist and client, on two aspects Goal, and Task that technically are very impersonal. You can hate me and think I’m a terrible person, yet we both agree that you want to lessen your anxiety (Goal)! The same goes for how it will be done (Task), talk therapy, both agree. Then yes, your idea of how well you mesh, get along with, like in general (Bond). Bond is only a component part of the scale that taps our lay conceptualization of the general concept of relationship.

When I taught this to the undergrad counseling psychology course I pointed out this scale could be used in the classroom… I said, you came in the first day, got the syllabus. We both agreed the GOAL was to learn counseling psychology principles.. The way we would accomplish this TASK was through lecture, with power-point presentations accompanying me throughout the course, with students asking questions. Then finally, the BOND was simply if they liked me as an instructor, my demeanor, sarcasm, amazing wit, and so forth! Well, I guess I just invented a “teacher student alliance rating scale.” Just kidding a 30 second google search shows something to that effect exists. Hey, I’m not an educational psychologist!

What I am saying is that profs are bastardizing the concept of the therapeutic alliance down to merely…. relationship…. in this context and is way oversimplifying it.

I think it is done for political motivations. In particular, I think many professors point to the relationship to attempt to get away, with doing poor forms of therapy. Stay tuned for entries on how many crappy therapies there are out there! freud is dead. His therapy is terrible and should be completely removed from curriculum except for its historical importance, and using it as an example of non-science….more to come.

One thought on ““Relationship” most important factor in therapy…. Really?

  1. Interesting observations. I do agree that simply describing the therapeutic process as a relationship minimizes the process. As practitioners, we know that there is much more involved. By as a society at large, the issue of the term relationship or therapeutic relationship is more palatable. Therapeutic alliance may be off putting. We are trying to reach a target audience and in order to do that, we have to express our points in terms that they can grasp. The terms have to be relatable. The individual has to buy in to the concepts. Especially those individuals who are resistant to therapy. Relationship is a word that is personal so it will resonate. Maybe not in the way that professional prefer but the audience is looking at it from a personal perspective.

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