Undoubtedly, the relationship established between the therapist and the client is an essential element in psychotherapy. Some authors even go so far as to affirm that "it is the relationship that cures".
It must be understood that therapist and client work together within the framework of a well-understood therapeutic relationship to achieve improvement and / or change in the patient. The therapeutic relationship is not the same as friendship or any other type of interpersonal relationship that the client may have.
An adequate therapeutic relationship has some characteristics that make it unique and distinguish it, which we will describe below..
The therapeutic relationship focuses on the problems and needs of the client based on their demand. For the therapist it is a regulated professional activity.
The term therapeutic framing designates the set of rules that allow psychotherapy to be made viable. These are both external and internal elements (attitudes of the therapist).
|Models||Therapeutic relationship||Therapeutic attitude|
|Psychoanalytic||Main healing element: allows insight into the client through the transference relationship.||Reserved, passive and detached.|
|Behavioral||Framework in which the client's learning processes are developed and behavioral techniques are implemented.||Safe, acts as a model and social enhancer.|
|Cognitive||Cooperative relationship, a mutual collaborative effort to solve the client's problem.||Active and logical.|
|Experiential||Enabling context for personal development||Authentic, empathetic, warm, unconditional customer acceptance.|
|Systemic||The vision of the therapeutic relationship stands out from the other models, since "the system" and its circular causality come into play. The therapist and his team join the family system in order to alter the patterns of interaction, but at the risk of becoming part of its dynamics.||Participant observer.|
Bordin (1979) proposes the concept of therapeutic alliance as an indispensable element in psychotherapy. It has its origin in the psychoanalytic model, but today it has become a common concept to all theoretical models. It refers to three interrelated components: the therapist-client bond, the goals and tasks of therapy.
An example of a low agreement on the objectives can be when the client wants to solve his fear of speaking in public, but the therapist considers that the origin of his anxiety related to childhood intrapsychic conflicts and defense mechanisms should be treated..
Examples of disagreement about tasks may be that the therapist wants to use records as homework, between sessions, and the client thinks that the same dialogue from the therapy session is sufficient. Another example would be the case of a client who believes that the therapist has to give him practical advice strictly related to the problem and the therapist asks questions about the family context in which the patient lives.
Over time, these notions have received empirical support and are widely accepted. As Semerari (2002) says, "the alliance will be perfect when the therapist and the patient share the objectives of the treatment and agree on the need and usefulness of the means adapted to achieve it […]". If we also add a good quality of bond between therapist and client, we are in the best conditions to predict a favorable outcome of psychotherapy.