Academic journal article The European Journal of Counselling Psychology

The Therapeutic Relationship and Cognitive Behavioural Therapy: A Case Study of an Adolescent Girl with Depression

Academic journal article The European Journal of Counselling Psychology

The Therapeutic Relationship and Cognitive Behavioural Therapy: A Case Study of an Adolescent Girl with Depression

Article excerpt

The therapeutic relationship has been argued to be one of the most important factors in psychotherapy. Currently, Cognitive Behavioural Therapy (CBT) and the value of the therapeutic relationship have been receiving more attention in the literature and research. In this paper, I discuss a case study that supports the value of the therapeutic relationship when working from a CBT approach.

The Rationale for This Case Study

There are a number of factors that I found interesting when I worked with Noluthando’si case that made me decide to use this as a case study. When I first started working with Noluthando’s case, what I found initially interesting was working with an adolescent. Entering into the psychology profession, I believed that working with adolescents was an area of specialisation that I may enjoy working within. This belief was confirmed by this case. CBT was the therapeutic approach I adopted. I found, as a therapist in training, that I was battling to apply therapy, namely CBT and its techniques, to the case and I felt that it was creating distance between me and the client, and the therapeutic relationship. This difficulty enabled me to realise the importance of the therapeutic relationshipii and how without it, I found therapy to be impossible. There were many dimensions of interest to this case, but what I was interested in particularly within the therapeutic process with Noluthando, was the value of the relationship between therapist and client when working from a Cognitive Behavioural Therapy approach.

Therapy and the Relationship

Different theorists use the terms “therapeutic relationship” and “alliance” interchangeably. Bordin (1994) differentiates between the therapeutic relationship from the therapeutic alliance by describing the alliance as being a relationship in which both the therapist and the client work together in therapy. Both therapist and client have valuable contributions to bring to therapy, and the relationship is a partnership in which both therapist and client work together to reach the client’s goals. Bordin (1994) dispels the view of the therapist being viewed as a “magician” and advocates for the use of the therapeutic alliance.

Many authors agree with Hobson (1985) who states that the therapeutic relationship is what is crucial in any therapy. Yalom and Leszcz (2005) uphold that the relationship is integral for any therapy to be effective and meaningful for clients. When discussing the therapeutic relationship, Kahn (1997) reflects on the value of one of his teacher’s words of more than 30 years ago, “The relationship is the therapy” (p. 1).

Many more authors place value on the therapeutic relationship. Reisner (2005) points to the therapist as being the important factor in determining the outcome of therapy and that the strong alliance formed between therapist and client is a powerful indicator of positives gained in therapy. Teyber (2006) says that forming a strong therapeutic relationship early is the best predictor of positive treatment outcomes, and that the relationship is the foundation of change for the client.

Garfield (1997) highlights common factors that are important in most therapies, and that one of the common factors is the therapeutic relationship. This is considered as one of the most basic factors but is crucial for continuation in therapy and change. Some psychotherapy approaches follow a view that the therapeutic relationship is sufficient in itself and all that is necessary for therapy. However, Garfield (1997) relates that the relationship between therapist and client is necessary but other variables need to be applied too.

The therapeutic relationship is a factor that accounts for 30% of positive outcomes in therapy, as revealed by Lambert (1992). Duncan (2002) tells how therapists place so much emphasis on tools and technique, whilst the perception of how the client views the therapeutic relationship is what is crucial to positive outcomes in therapy. …

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