Academic journal article Journal of Mental Health Counseling

Master Therapists' Construction of the Therapy Relationship

Academic journal article Journal of Mental Health Counseling

Master Therapists' Construction of the Therapy Relationship

Article excerpt

Qualitative research methods were used to elicit master therapists' statements regarding their use and understanding of the therapy relationship. The master therapists were identified and recruited in a previous study (Jennings & Skovholt, 1999) through a procedure used to create a sample of information-rich cases. The result of the analysis is a Model of Relationship Stances. The Safe Relationship Domain is composed of three categories of therapist actions: Responding, Collaborating, and Joining. The Challenging Relationship Domain also is composed of three categories of therapist actions: Using Self, Engaging, and Objectivity. The domains and categories are conceptualized as relationship stances utilized by the master therapists to meet individual client needs.

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The long war among theoretical orientations in counseling and psychotherapy has come to a truce. Numerous studies have found that most approaches can produce positive change, but a consistent superiority of one approach has not been found. Instead, much of what is effective in psychotherapy is due to pantheoretical or common factors, those shared by many schools of psychotherapy (Asay & Lambert, 1999).

Although the most important pantheoretical variable appears to be the client (Tallman & Bohart, 1999), the therapist is another promising variable. There is now strong evidence for the therapist effect on client outcome. Luborsky, McLellan, Woody, O'Brien, and Auerbach (1985) found that significant therapy success was determined most by a helpful relationship with the therapist. In research studies, the contribution by the therapist surpassed all but the contribution by the client (Teyber & McClure, 2000). In an exhaustive review of the research, Wampold (2001) affirmed the neglected but critical therapist effect:

   We have seen that the particular treatment that the therapist
   delivers does not affect outcomes. Moreover, adherence to the
   treatment protocol does not account for the variability in outcomes.
   Nevertheless, therapists within treatment account for a large
   proportion of the variance. Clearly, the person of the therapist is
   a crucial factor in the success of therapy. (pp. 20-21)

A highly effective therapist does seem to make a difference. We know this implicitly as people and consumers when we actively search for a really good practitioner: a doctor, dentist, attorney, or therapist. We know that some are better than others. Yet, this notion of exploring the therapist variable has been less of a focus in contemporary research.

Reviewing the research that pointed out the critical importance of the therapist and the therapeutic relationship, Teyber and McClure (2000) emphasized focusing future research on factors that enhance the therapist-client relationship. The authors stated, "In many studies, what therapists say and do in the therapy hour that promotes a good working alliance has proven to be the most important contributor to change and positive treatment outcome" (p. 70). Therefore, the present research investigated the working alliance as constructed by a sample of those considered the "best of the best" by their professional colleagues, a group of master therapists.

METHODOLOGY

We used a qualitative interview method to investigate therapist contributions to the therapy relationship because in-depth interviews with practicing therapists can provide data for variables that have yet to be identified in the research literature. When the purpose of a study is to describe clinically relevant therapist modes of perceiving and acting, a discovery-oriented approach is deemed most suitable (Marshall & Rossman, 1999). We were interested in what master therapists could tell us about their construction and use of the therapy relationship. In the pursuit of this research question, information-rich informants provided the kind of data this investigation sought. …

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