Tag Archives: therapeutic relationship

Evidence-Based Relationship Factors in Counseling and Psychotherapy

The medical model of psychotherapy . . . has led us to accept a view of clients as inert and passive objects on whom we operate and whom we medicate. Gene V. Glass, in The Great Psychotherapy Debate, 2001, p. ix

John and Max Seattle

In a 1957 publication in the Journal of Consulting Psychology, Carl Rogers boldly declared:

  1. No psychotherapy techniques or methods are needed to achieve psychotherapeutic change.
  2. Diagnostic knowledge is “for the most part, a colossal waste of time” (1957, p. 102).

Let’s pause for a moment and reflect on what Rogers was saying.


If diagnosis is a waste of time and therapy techniques are unnecessary, then what can counselors or therapists do to produce positive outcomes? Here’s what Rogers said:

All that is necessary and sufficient for change to occur in psychotherapy is a certain type of relationship between psychotherapist and client.

Rogers’s revolutionary statements refocused counseling and psychotherapy. Until Rogers, therapy was primarily about theoretically based methods, techniques, and interventions. After Rogers, writers and practitioners began debating whether the relationship between client and therapist—not the methods and techniques employed—might be producing positive therapy outcomes.

This debate continues today. Wampold (2001) has called it “the great psychotherapy debate.” This debate has been boiled down to a dichotomy captured by the question: “Do treatments cure disorders or do relationships heal people?” (Norcross & Lambert, p. 3).

Keep in mind that like lots of things on planet Earth, the techniques vs. relationship debate promotes a false dichotomy. IMHO, most “rational” professionals understand that therapy relationships and techniques are BOTH important to positive outcomes. Seriously, how could it be otherwise?

But there is a positive outcome from this debate. Various researchers around the world started focusing on how to define specific relationship factors that contribute to counseling outcomes. Previously, these relationship factors were lumped into a category called “common factors.” Common factors were viewed as the main reason why all therapy approaches tend to produce approximately equal positive outcomes.

Flowing from research on common factors, one of the most fascinating and important movements in counseling and psychotherapy is now called, “Evidence-based relationships” (Norcross, 2011). As it turns out, there’s a large body of existing and accumulating research to help us clearly identify what’s relationally therapeutic.

In the attached link, you’ll find the powerpoint slides that Kim Parrow and I developed for a supervisor training yesterday, at the University of Montana. Our goal was to describe, demonstrate, and discuss 10 specific and observable relationship factors that contribute to positive counseling outcomes. We call them Evidence-Based Relationship Factors (EBRFs). They include:

  1. Congruence
  2. Unconditional positive regard
  3. Empathic understanding
  4. WA1: Emotional bond
  5. WA2: Goal consensus – Focus on strengths
  6. WA3: Task collaboration
  7. Rupture and repair
  8. Countertransference (management)
  9. Progress monitoring (feedback)
  10. Culture and Cultural Humility

The link at the bottom of this post will take you to our powerpoint slides. Also, for more information, you can always check out various theories textbooks, including Counseling and Psychotherapy Theories in Context and Practice (from which this blog was adapted). https://www.amazon.com/Counseling-Psychotherapy-Theories-Practice-Resource/dp/1119084202/ref=sr_1_1?ie=UTF8&qid=1504292029&sr=8-1&keywords=counseling+and+psychotherapy+theories+in+context+and+practice

EBRFs for Supervisors 2017 FIN

Building a Therapeutic Relationship with Parents: Part III – Collaboration

Collaboration, as an attitude, requires that at least to some extent, parenting professionals come from a position of “not knowing” (Anderson, 1993; Anderson & Goolishian, 1992). As Anderson (1993) stated: “The not knowing position is empathic and is most often characterized by questions that come from an honest continuous therapeutic posture of not understanding too quickly” (p. 331).

[This excerpt is from How to Listen so Parents will Talk . . . http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_5?ie=UTF8&qid=1368845509&sr=1-5%5D

Not knowing requires professionals to resist the ubiquitous impulse to be all-knowing experts. Resisting the impulse to demonstrate one’s expertise is especially important when initially meeting with and working with parents.

It can be very difficult for parenting professionals to  establish and maintain a collaborative attitude. This is partly because human services providers who work with parents also need to be experts and must demonstrate their expertise. Similar to radical acceptance, collaboration between professionals and parents is a dialectic where the professional embraces both the parents’ expertness and his or her own expertise.

Some writers have emphasized that true collaboration between professionals and parents requires a form of leaderlessness (Brown, Pryzwansky, & Schulte, 2006; Kampwirth, 2006). In contrast, our position is that professionals who work with parents can and should bring the following knowledge, skills, and expertise to the consulting office:

  • How to lead or direct a counseling or consultation meeting
  • How to quickly form collaborative relationships and a working alliance with parents
  • Knowledge of what contemporary research says about child development and child psychopathology
  • A wide range of theoretically diverse and research-informed strategies and interventions to use with parents
  • A wide range of theoretically diverse and research-informed strategies and techniques for parents to implement with their children

At the same time, parents are also experts who bring the following knowledge and expertise into your office:

  • Their own personal memories and experiences of being parented
  • Knowledge and experience of their children’s unique temperament and behavior patterns
  • Awareness of their personal parenting style and efforts to parent more competently
  • Knowledge of their existing parenting strategies as well as the history of many other parenting ideas they have tried and found to be more or less helpful
  • An understanding of their limits and abilities to use new or different parenting strategies and techniques

In a very practical sense, it would be inappropriate (and probably ineffective) to ignore the fact that parents come to human services professionals expecting advice and guidance about how to be and become better parents. This is the frame from which virtually all parenting interventions flow. Consequently, if the consultant or therapist behaves too much like an equal and doesn’t act at all like an expert who offers concrete and straightforward advice, the meeting will likely fail because the basic assumption that the therapist is a helpful expert will be violated.

On the other hand, for many reasons, parents are in a vulnerable state and consequently, if they feel their parenting consultant  is acting like a judgmental or condescending expert, they will usually become defensive and antagonistic. To counter this possibility, the professional  needs to hold a collaborative attitude that honors the parents’ knowledge and experience. This collaborative attitude will help parents see themselves as respected and relatively equal partners in the therapeutic and/or educational consultation process.

Overall, the model we describe in this book (How to Listen so Parents will Talk and Talk so Parents will Listen) emphasizes that, from a position of respect, interest, and curiosity, parenting consultants, counselors, and therapists work to quickly establish a partnership with parents. When therapeutic or educational work with parents is most successful, parents will likely perceive you as an empathic, accepting, and collaborative expert willing to offer a wide range of theoretically divergent, practical, meaningful, and simple suggestions for how to parent more effectively.