Therapeutic Relationship

Description of the Strategy

Psychodynamic and client-centered psychotherapies have a long history of recognizing the importance of the therapeutic relationship. However, this is not the case for behavior therapy. Behaviorism emerged in the 1950s from dissatisfaction with traditional approaches to psychotherapy. Behavior therapists sought to apply techniques derived directly from learning theory and from learning laboratories. It was widely accepted by behaviorists that the application of the established principles of learning was all that was necessary to facilitate change. A number of factors are likely responsible for this omission: (1) In the laboratory, the [Page 587]relationship between scientist and experimental subject was not relevant, so the translation from lab to clinic did not focus on relationship; (2) specifying the therapeutic relationship objectively is quite difficult; and (3) early behavior therapists may have wished to disassociate from less scientific psychotherapeutic approaches and their foci. For these and other reasons, early proponents of behavior therapy de-emphasized the therapeutic relationship.

Emergence of attention to the therapeutic relationship in behavior therapy can be seen in the writings of individual pioneers of the behavior therapy movement. Joseph Wolpe, for example, gave virtually no attention to the therapeutic relationship in his writings from the early 1950s. By the late 1960s, he was suggesting that a nonjudgmental attitude facilitates information gathering and should continue throughout treatment. By the 1980s, Wolpe contended that a therapeutic relationship characterized by warmth and positive regard is a customary component of behavior therapy.

Cognitive-behavioral approaches also tended to expend far more energy describing the intervention strategies than the relationship that would be the context for those interventions. Albert Ellis, founder of rational-emotive behavior therapy, purported that a warm therapeutic relationship was preferable but not necessary for treatment. Aaron T. Beck asserted that cognitive therapists ought to approach treatment as a collaborative effort, in which we treat the client like a colleague. In his description of cognitive therapy, Beck stated that the initial sessions of treatment should focus on initiating a relationship, gathering information, and providing some relief from symptoms. However, he provided few details regarding how to develop the relationship, what interpersonal factors are important, and what is the mechanism by which the relationship facilitates change.

Wide recognition of the importance of the therapeutic relationship in behavior therapy began in the latter part of the 1970s. It was at this time that the possible influence of the therapeutic relationship became more accepted and many behavior therapists came to regard both technical skills and interpersonal sensitivity as important in therapy. Some summary papers and psychotherapy texts published in the late 1970s and early 1980s included detailed descriptions of interviewing methods that would facilitate or enhance the therapeutic alliance. At this time, the client-therapist relationship was commonly described as a “nonspecific” factor. That is, the relationship was seen as a factor that could reasonably impact the outcome of therapy, although it was not supported as an essential component of treatment.

Current psychotherapy books and treatment manuals include sections on the therapeutic relationship in behavior therapy and address interpersonal considerations more frequently than was common in the past. Furthermore, some contemporary behavior therapies give special attention to the therapeutic relationship, incorporating it as a major component of treatment (e.g., acceptance and commitment therapy, dialectical behavior therapy, functional analytic psychotherapy, integrative behavioral couples therapy).

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