The Importance of the Relationship in Therapy

How a strong therapeutic alliance can lead to real change

Posted Dec 22, 2016

As a therapist, my role in a person’s life is a unique one. I meet strangers who come to me for help, support, and to take on what I believe is the most important venture anyone can, to truly know and understand themselves. The trust I am awarded each time a person tells me his or her story is something that has never ceased to humble and inspire me in my 30-plus years of clinical practice. When I see someone start to break free from some of the limitations imposed on them by their own past or the pain of their early relationships and experiences, to find their way, uncover their goals, and start to reveal who they really are, it is genuinely the most rewarding part of therapy. I consider each of the people I’ve spoken to brave and am grateful to play any role in their journey toward becoming the only thing any of us can hope to be… our real selves. For those reasons and more, I care deeply about the relationship I establish with the people who come to see me in therapy.

Over the years, research has confirmed what so many therapists have known intuitively, that the therapeutic relationship itself is essential to the success a patient experiences. Some studies have even called it the most important common factor to successful outcomes. When a task force put together by APA’s Society of Clinical Psychology set out to identify empirically supported treatments, they found that the “therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment,” and that “the therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.”

Dr. John Norcross, who headed up the task force, defined the therapeutic alliance as referring to “the quality and strength of the collaborative relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment tasks, and a relationship bond.” Along with empathy and genuineness, this alliance represents an integral part of the therapeutic relationship. Research shows, time and time again, that this alliance plays an extremely important role in the change process.

In his new book, Overcoming the Destructive Inner Voice: True Stories of Therapy and Transformation, my father, Dr. Robert Firestone, invites an audience into the therapy process, where they can witness how the formation of this relationship can deeply impact the evolution of an individual. One of the things I most admire about my father’s approach to therapy is his ability to see the possibility of a person without their defenses. With an almost x-ray like vision, he can almost immediately appreciate the unique essence of a person, separate from the influence of a painful past or the ongoing abuse of a cruel inner critic. The short stories he tells in his book eloquently and colorfully illustrate exactly how the relationship between patient and therapist can help people change. In his foreword to the book, my father wrote of psychotherapy that “nowhere in life is a person listened to, felt, empathized with, and experienced with such concentrated sharing and emphasis on every aspect of personal communication.”

A good therapist has a deep interest in their client as an individual and will see and relate to them in ways that are sensitively tailored to the person’s specific needs. There is no one proven method of therapy – no one-size-fits-all approach to treatment, because no one person is like the other. In order to be available to a patient and establish a solid relationship built on trust and understanding, the therapist has to be equally attuned to the patient and their own state of being. As my father put it, “Above all the therapist must remain an authentic human being with genuine feelings.”

When you consider how many of our problems come from early issues in our relationships, it makes sense that much of our healing would occur within a relationship. An attuned therapist can offer a person, not just a new way of looking at themselves but at relationships in general. Attachment research tells us that the biggest predictor of our attachment patterns in our relationships is the one we experienced growing up. The attachment strategy we form in our earliest years can shape the reactions we have and the reactions we create in others throughout our lives. The best way to form healthier, more secure attachments is to make sense and feel the full pain of our story – to create what Dr. Daniel Siegel often refers to as a “coherent narrative.” This process of self-understanding is one of the great gifts of the therapeutic process. The genuine curiosity a therapist has in their patient creates a safe space for the client to explore their own story and start to make sense of it.

When the therapist reacts to someone in a different manner than they’re used to or would expect, with attunement and reflection, the person can form a new model for attachment. The formation of a secure attachment to the therapist has been shown to be significantly associated with greater reductions in client distress. By experiencing a secure attachment with the therapist, the person can feel safe to start to resolve some of their old traumas and evolve their model of relating. This is why the establishment of trust in the relationship is so crucial to the success of the outcome of therapy.

It is on this groundwork of trust that a person feels safest to reveal their real selves. As they peel back the layers of their defenses, they can start to recognize their unique wants and needs, what they wish to change or who they hope to become.  As my father put it, “There is a need to be sensitive to clients’ real feelings, qualities, and priorities, and to distinguish them from the negative overlay on their personalities that prevents them from reaching their full potential for living.” This is the principle I aim to live by both in my practice and in myself, because I know that only by knowing ourselves can we be fully available and of service to others.