DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Understanding what constitutes a positive therapeutic relationship is invaluable in
effective therapy, but training in a manualised way may be problematic. Therapists need
time to grow and need to be encouraged to become self aware in a way that allows them
to be intuitive and creative, flexible and context aware (Ducket, Pilgrim, Ross, Adams,
Donne, 2005). There is reflection-in -action and on-action, whereby new cases are looked
at as unique so theories and techniques are elaborated and refined to fit the particular
client. Ducket et al also asserted that reflective practice needs another person as a
professional supervisor to ensure that it is constructive. Reflective practise involves selfawareness,
honesty and insight into our own values. This will be shaped by our
professional stance as clinical psychologists including training, theoretical models and
technical skills as well as our personal styles, issues and our demographics.
These will influence how we filter information and effect how we understand/use the
skills implicit in a positive therapeutic relationship. Clinicians need to be aware of their
own feelings towards the individuals they see.
From the conceptualisations discussed above it appears that the attachment of the
therapist and client and their collaboration, whether that be on goals and tasks or the
being in a positive therapeutic relationship in itself, is vital for good a outcome, (e.g.
Henry et al 1994). If an alliance is established between the patient and therapist, then the
patient will experience the therapy as therapeutic. Research suggests that different
patients will feel that different aspects of the relationship are important to them
(Bachelor, 1995) and how the individual sees their therapist will be vital. Furthermore,
the expectations the individual comes with and the personal meaning they attach to any
intervention will also be important.
A consistent finding is that individuals who rated the therapy relationship better at an
earlier stage had a better outcome (e.g. Meier, 2005). Klein, (2003) showed that early
therapy alliance significantly predicted improvement in depressive symptoms. Martins’
(2000) meta-analysis also concluded that because the clients tend to view the alliance
consistently through treatment they are therefore more likely to view the relationship
positive at the end if they did so at the start.
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