People Who Perceive a Trusting Relationship Have Better Therapy Outcomes

The real relationship is a component of the therapeutic relationship. The therapeutic relationship consists of three elements: the therapeutic alliance or working alliance, a dynamic process of transference-countertransference, and a personal or real relationship. Although there has been a wide range of attention given to the therapeutic alliance and transference aspects at the core of the therapeutic process, less has been devoted to understanding the real/personal relationship. According to Charles J. Gelso of the Department of Psychology at the University of Maryland, “The working alliance may be seen as reflecting the work collaboration between therapist and client, whereas the real relationship is the personal, non-work element of all relationships.” The distinction between the two relationships prompted Geslo to explore how the real relationship affected treatment outcome in a sample of 42 clients undergoing brief therapy.

Geslo evaluated the real relationships between the clients and their therapists at the beginning of treatment, one session into treatment, and at the conclusion of the four sessions of therapy and found that the subjectivity of the relationship was directly related to treatment outcome. Specifically, Geslo found that clients who perceived their real relationships with their therapists as trusting, respectful, and strong from the beginning of treatment had better outcomes than those who perceived it as weak. Additionally, the average of the perceptions taken at three different times seemed to predict treatment outcome. However, Geslo also discovered that the therapists’ perceptions of the relationship did not impact outcome.

This finding was interesting because even though the client and therapist perceptions had independent effects on treatment outcome, for the participants with positive outcomes, both perceptions tended to converge toward treatment completion. Geslo realizes that his findings should be considered in light of the fact that the therapists were from university counseling centers only and that the outcomes in this study were based only on brief psychotherapy. Future work should look at how the real relationship affects treatment outcome in longer courses and with a more diverse participant sample in hopes of gaining insight into ways to strengthen the real relationship when it is weak.

Gelso, C. J., Kivlighan, D. M., Jr., Busa-Knepp, J., Spiegel, E. B., Ain, S., Hummel, A. M., et al. (2012). The unfolding of the real relationship and the outcome of brief psychotherapy. Journal of Counseling Psychology. Advance online publication. doi: 10.1037/a0029838

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  • Kevin


    September 13th, 2012 at 1:15 PM

    This really offers very little new insight into this issue.
    Of course, any time that there is trust within any relationship then it is bound to be a more positve relationship with more beneficial outcomes than one filled with more distrust and dishonesty.

  • Angie


    September 13th, 2012 at 2:33 PM

    I’ve been to three therapists in the past and the only reason i had to go to a second and then a third was because I just didn’t feel right and comfortable with the relationship I had with my former therapists.

    When you enjoy a good therapist relationship it can really help you in coming out with everything you want to share and just the feeling of trust you have due to that relationship has a big role to play in the success of the therapy.

  • Purple Dreamer

    Purple Dreamer

    September 13th, 2012 at 5:15 PM

    In complete agreement with both previous responses – this really is nothing new, and yes, that relationship really is helpful in sharing. I have been to several different therapists in my life, and finally found “the one” who I truly trust, respect, and connect with. It has, not surprisingly, made all the difference in the world, and the progress I’ve made in the last year is more than I made with all previous therapists combined.

  • Leon


    September 13th, 2012 at 11:01 PM

    I’m sure the client’s perception has a big impact on the treatment outcome. It is very similar to what is seen in physical health conditions isn’t it? You believe you can heal and it helps the healing!

    But I am surprised to see the therapist’s perception did not have a big role in this. Because I thought their perception and enthusiasm could also impact the outcome and effectiveness of the treatment!

  • Justin c

    Justin c

    September 14th, 2012 at 4:07 AM

    The one thing that any therapist wants to immediately establish with any patient will be a level of trust. Most of them realize that without developing this trust then their hopes for helping this patient improve will tend to go down. Instinctively we all respond much better to those people whom we deem trustworthy and whom we feel are looking out for us. I would want the same from my therapist. You need to find someone who you feel has your best interests at heart and who will help you to evolve into a stronger person.

  • georgiaa


    September 14th, 2012 at 12:39 PM

    they say you got to have a good relationship with your therapist.but the reason why I would seek a therapist in the first place is coz I do not want to talk about my problems with people I feel a sense of relationship with!I want to talk to a stranger,someone who knows nothing about me and someone I do not know too much this not conflicting?

  • Michael tucker

    Michael tucker

    September 15th, 2012 at 3:39 AM

    um yeah, if there’s anyone I want to develop a bond of trust with, it would definitely be my therapist!

  • lacie


    September 15th, 2012 at 3:08 PM

    surprised to see the therapist’s perception has no effect on therapy outcome..after all its the therapist that administers help and treatment,I would have definitely thought his perception would be more important than even the client!

  • Mikey


    September 17th, 2012 at 4:19 AM

    It would also be helpful if the therapists work hard to establish that trusting relationship as well. Please don’t leave all of this on the client, who already has alot of responsibility for doing the hard work in therapy. Much of this is up to the counselor to establish a trusting rapprt with a patient, and help them ease through this transition time.

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