Psychotherapy: Theory, Research, Practice, Training

2005, Vol. 42, No. 4, 421 430

Copyright 2005 by the Educational Publishing Foundation

0033-3204/05/$12.00
DOI: 10.1037/0033-3204.42.4.421

THE ROLE OF RELATIONSHIP AND TECHNIQUE IN

THERAPEUTIC CHANGE
MARVIN R. GOLDFRIED AND JOANNE DAVILA

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State University of New York at Stony Brook

This article discusses varying perspectives on the role of technique and the
relationship in therapeutic change. The
theoretical assumptions underlying the
debate are briefly described, as are the
positions of humanistic, behavioral,
psychodynamic, and experiential orientations. Theory and research that consider the integration of relationship and
technique are presented. It is then proposed that there are general principles
of therapeutic change that are facilitated by both the relationship and technique. It is suggested that these principles of change should be seen as the
active ingredients of therapy, thereby
moving the field away from a debate
about whether technique or the relationship is more important. Instead, an
emphasis on studying general principles
of change and the processes by which
technique and relationship facilitate
these principles is encouraged.
Keywords: therapeutic change, therapeutic relationship, alliance, technique
One of the most important questions that can
be asked about psychotherapy is what makes it
work; what are the key ingredients that lead to
therapeutic change? This question has long been
Marvin R. Goldfried and Joanne Davila, Department of
Psychology, State University of New York at Stony Brook.
We thank Catherine Eubanks-Carter for her comments on a
draft of this article.
Correspondence concerning this article should be addressed to Marvin R. Goldfried Department of Psychology,
State University of New York, Stony Brook, New York,
11794-2500. E-mail: marvin.goldfried@sunysb.edu

debated in the literature, and much of the focus

has centered on two primary components that are
thought to lead to change: therapeutic techniques
and the therapeutic relationship. All too often,
however, these components have been seen as
separate and typically pitted against one another,
fostering the idea that it is either techniques or
the relationship that is most responsible for
change.
In 1995, The Society of Clinical Psychology
Division 12 of the American Psychological Association (APA)published the findings of a
task force that sought to arrive at a consensus
about which therapy techniques had received empirical support (Task Force on Promotion and
Dissemination of Psychological Procedures,
1995). Despite the attempt to translate research
findings into recommendations for clinical practice, the report was quite controversial with regard to a number of issues (e.g., do interventions
used in research studies parallel what happens in
real clinical practice), not the least of which was
the premise of the task force, namely that it was
only the therapy technique that contributed to
change (Norcross, 2002). To address the concern
that providing a list of empirically supported
treatments implied that the therapist-client relationship was not therapeutic in itself, the Division
of PsychotherapyDivision 29 of the APA
established its own task force to review the research findings on the role of the therapy relationship in producing change (Norcross, 2002).
The goal of this task force was not to refute the
conclusions of the task force on treatment techniques, but rather to highlight the fact that data
existed on the importance of the therapy relationship. Nonetheless, the debate surrounding technique versus the relationship continues to exist.
In this article, we briefly review the underlying
theoretical assumptions associated with the debate, and focus our attention more on attempting to provide an integrated perspective on the
relationship and technique. Moreover, we elaborate how the roles of the relationship and
technique can best be understood in the context

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Goldfried and Davila

of facilitating broader and higher-order principles of change.

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Theoretical Assumptions Underlying the

Therapeutic Change Process
Whether we realize it or not, what we think
about the relative importance of the therapy relationship versus the technique, and perhaps even
how we interpret the existing findings for one or
the other, can have its roots in our implicit assumptions about human behavior. This section
will attempt to make some of these assumptions
more explicit, and to indicate how they, at least in
a general sense, influence cognitive behavioral,
psychodynamic, and experiential therapists. It
also will be emphasized that even though these
schools of therapy differ in their assumptions,
points of agreement can still be found.
Perhaps one of the strongest advocates of the
importance of the therapeutic relationship in the
change process was Carl Rogers. In an early
statement, Rogers (1951) argued for the importance of the relationship over technique. Citing
the Fiedler (1950) study that indicated that experienced therapists working within different orientations were more similar than were inexperienced therapists, Rogers maintained that it was
the therapists affirmation of the client that produced therapeutic change, suggesting that the
client moves from the experiencing of himself as
an unworthy, unacceptable, and unlovable person
to the realization that he is accepted, respected,
and loved, in this limited relationship with the
therapist. . . as the client experiences the attitude
of the acceptance which the therapist holds toward him, he is able to take and experience this
same attitude toward himself (pp. 159 160).
Rogers position on changing human behavior
may be most dramatically contrasted with that of
Skinner, as seen in their 1956 debate at the meeting of the American Psychological Association
(Rogers & Skinner, 1956). In presenting his view
on the control of human behavior, Rogers acknowledged that he agreed with Skinner on the
point that it is possible to set up external conditions to bring about change especially change
that involved being creatively adaptive and in
better control of ones life. Beyond this, Rogers
went on to say, the similarity ends. Rogers thesis
is that people possess a self-actualizing potential,
and all we need to do is to set up the appropriate
conditions for this potential to be actualized. In

422

contrast to an external authority that attempts to

influence and control the individual, Rogers
maintained that, the only authority necessary is
the authority to establish certain qualities of interpersonal relationship (p. 1065). Rogers position on the nature of the interpersonal relationship required for therapeutic change was
described in greater detail in his later article in
which he outlined the necessary and sufficient
conditions for therapeutic change (Rogers, 1957).
These conditions involve providing the client
with unconditional positive regard and empathy,
which are genuinely felt by the therapist.
For his part, Skinner similarly acknowledged
that his assumptions about human behavior and
the change process are radically different from
Rogers. In his concluding comment in this debate, Skinner reaffirmed that human behavior is
always under the control of external forces, and
that the reluctance to acknowledge this may be
due to ones fear of exercising control over another person. Laying down the gauntlet, he suggested that in conquering this fear, we shall
become more mature and better organized, and
shall, thus, more fully actualize ourselves as human beings (p.1065).
Consistent with Skinners position, behavior
therapy began by placing the primary emphasis
on the development of techniques, whereby the
therapist would actively and deliberately create
conditions by which the client could learn new
ways of functioning. Within this context, the relationship was viewed as being less important as
a primary vehicle of change, and indeed it was
construed that the therapists primary function
was that of a social reinforcement machine
(Krasner, 1962). An even more dramatic illustration of the relative importance of technique over
the therapeutic relationship may be seen by Lang,
Melamed, and Harts (1970) experimental use of
the device for automatic desensitization (affectionately known as DAD), which involved no
contact with a therapist whatsoever. Instead, participants were presented with tape-recorded depictions of anxiety-producing situations for them
to imagine, with a second tape providing them
with instructions for relaxation.
In contemporary applications of behavior therapy or cognitive behavior therapy, the primary
emphasis is on having clients learn more effective skills for coping with life problems. It is this
focus on technique within behavior therapy that
has historically relegated the therapeutic relation-

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Special Issue: Relationship and Technique

ship to the category of nonspecifics within the
therapeutic intervention. The relationship has
been considered to be nonspecific in two senses.
First, it is not viewed theoretically as being intrinsic to the learning process implemented by the
technique. Second, it is viewed as something not
readily defined or easily measured.
Despite our depiction above, it would be incorrect to characterize behavior therapy as viewing the relationship as totally unimportant. Indeed, just as Rogers was influenced by the
findings of Fiedler (1950) on the importance of
the therapists personal characteristics, Kanfer
and Phillips (1970) indicate in their book on
learning foundations of behavior therapy that
the therapist may enhance or detract from the
effectiveness of his behavioral techniques
through the impact of his own personal and interactional characteristics (p. 465). In a similar
vein, Goldfried and Davison (1976) devoted a
separate chapter on the therapeutic relationship in
their book on behavior therapy, which maintained
that Any behavior therapist who maintains that
principles of learning and social influence are all
one needs to know in order to bring about behavior change is out of contact with clinical reality
(p. 55). Cognitive therapy for depression (Beck,
Rush, Shaw, & Emery, 1979) has similarly emphasized the importance of the therapy relationship as the context within which techniques may
be effectively employed.
In some respects, early psychoanalytic therapy,
like behavior therapy, emphasized technique over
the relationship with its emphasis on therapist
neutrality. Although the therapeutic change process played itself out in the interaction between
patient and therapist, this was believed to occur
through the development of transferential reactions that the patient had to the silent analyst and
the analysts subsequent accurate interpretations.
As psychoanalytic thinking has broadened to include more relational perspectives, the importance of the relationship has dramatically increased. In their review of contemporary
relational approaches, Messer and Warren (1995)
describe these approaches as placing the clienttherapist relationship at the center of the therapeutic change process, and further suggest that
object-relations theories provide a way to understand how the therapeutic relationship itself can
lead to change, independent of its role as a vehicle for interpretation. In line with this, Luborsky
(1984) identifies two curative factors in psycho-

analytic psychotherapy: achieving understanding

and achieving a helpful relationship. However, he
notes that the pursuit of understanding cannot be
useful unless it occurs in an adequately supportive relationship, and, moreover, that the power
of the relationship may be the more potent of the
two (p. 28). Strupp and Binder (1984) consider
the defining characteristic of therapy to be the
human relationship and suggest that the essence
of therapeutic change is in the human experience
in which the client feels understood, and from
this develops a new understanding of the self and
behavior. This is similar to what Alexander and
French (1946) have suggested in their notion of
the corrective emotional experience, in which
experiences in the client-therapist relationship
lead to new learning. Indeed, McWilliams (2004)
suggests that one of the core assumptions of
psychoanalytic therapy is . . . the raw emotional
power of the here-and-now therapeutic relationship (p. 41). So, although more traditional psychoanalytic approaches may have been more
technique oriented, contemporary approaches are
strongly relationship based (Messer & Warren,
1995).
Gestalt therapy has experienced similar transitions, moving from an emphasis on technique to
a more integrated perspective (Elliott, Watson,
Goldman, & Greenberg, 2004). The early work of
Perls (1969) clearly placed its primary emphasis
on technique, whereby clients sitting in the hot
seat provided the context in which experiential
exploration would occur. An emphasis was
placed on a form of dream interpretation in which
clients enacted various elements of the dream
(e.g., make believe you are the train) and the
resolution of internal conflicts was approached
through the use of the empty-chair technique.
Little regard was given to the importance of the
therapy relationship. Indeed, Perls was known to
be quite blunt in providing clients with confrontational interpersonal feedback (e.g., telling a client who was showing little affect, You bore
me!). In more recent years, Gestalt therapists
have acknowledged the importance of a good
therapeutic relationship and have incorporated it
into their technique-oriented approach. An example of this is the process-experiential approach to
therapy by Greenberg and his associates (e.g.,
Elliott et al., 2004; Greenberg & Paivio, 1997),
which involves an integration of person-centered
and gestalt therapies.
In summary, we have suggested that assump-

423

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Goldfried and Davila

tions about the change process that are based on
a learning model had originally underscored the
importance of the technique, whereas those approaches aligned with a person-centered orientation have emphasized the central role of the therapy relationship. However, there have been
exceptions to this original influence, and changes
in emphasis can be seen as occurring over the
years, particularly in contemporary analytic approaches, which have become relational in nature, and even in some cognitive and behavioral
approaches. Of course, we have not provided an
exhaustive review of the relative importance of
relationship and technique within different theoretical orientations. Nonetheless, it serves to illustrate how different theoretical assumptions
have influenced various orientations in their
stance on what contributes to change.
The Interplay of Relationship and Technique
Phrasing the question of whether change occurs as a function of the therapeutic relationship
or technique limits a consideration of the possibility that both are important and both work together. As Gelso and Hayes (1998) have observed, the therapeutic relationship and technique
constantly interact with and influence one another. There is a profound synergism between the
two. The techniques used by the therapist, for
exampleand certainly the manner in which
they are usedinfluence the kind of relationship
that unfolds. Likewise, how the therapist feels
toward the client will have a profound effect on
the techniques he or she uses and the manner in
which they are used with each client (Gelso &
Hayes, 1998, p.8). Indeed evidence exists to support this view.
Both the Relationship and Technique
Contribute to Change
Research has shown that within the context of
the same study, both therapeutic relationship and
technique contribute to the change process. This
can be illustrated by two studies carried out
within a naturalistic setting in the cognitive treatment of depression. In one (Persons & Burns,
1985), the intervention technique consisted of
challenging maladaptive automatic thoughts believed to be associated with depressed mood.
Although the results indicated that this intervention resulted in improved mood, mood changes

424

were also found to be associated with the quality

of the therapeutic relationship. A second study on
cognitive therapy for depression (Burns & NolenHoeksema, 1992) not only found that clients
perception of therapist empathy was associated
with outcome, but homework compliance was as
well.
Although both technique and relationship were
found to contribute to change in the two studies
noted above, it is certainly possible that they did
so by affecting one another. Cognitive behavior
therapists often maintain that certain techniques
(e.g., successful use of relaxation) can enhance
the therapy relationship. Similarly, Elliott et
al.,(2004) maintain that experiential techniques
can be viewed as building on and deepening an
alliance (p.142). In a review of research addressing the question of how therapeutic techniques
may affect the alliance, Ackerman and Hilsenroth
(2003) conclude that technique can indeed have
an impact on the alliance. For example, it has
been found that exploratory strategies can enhance the bond between therapist and patient
(Bachelor, 1991), as can accurate interpretation
(Crits-Christoph, Barber, & Kurcias, 1993) and
reflection, listening, and advising (Sexton, Hembre, & Kvarme, 1996).
The Relationship Influences the Effectiveness of
the Technique
Even with interventions that advocate the importance of specific therapeutic techniques, the
relationship has been found to enhance or detract
from success. At the very least, the relationship
can serve to prevent clients from terminating
prematurely (Horvath, 2000). Even when the client remains in therapy, however, the relationship
can influence the effectiveness of technique. For
example, an early study by Morris and Suckerman (1974) found that systematic desensitization
carried out by a warm therapist (e.g., demonstrating concern) was more efficacious than a comparable intervention carried out by a cold therapist (aloof and impersonal). In a more recent
study of therapist effects in a multicenter study
on the use of cognitive behavioral therapy in
treating panic disorder, some therapists were
found to have been more successful than others.
It is interesting to note that the more successful
therapists did not differ with regard to how
closely they adhered to, or how competent they
were in, administering the cognitive behavioral

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Special Issue: Relationship and Technique

techniques (Huppert, Bufka, Barlow, Gorman,
Shear, & Woods, 2001). Although no measure
was obtained on the nature of the therapy relationship, it was found that the more successful
outcomes were obtained by more experienced
clinicians. Given the comparability of the therapists skill in implementing technique, it is possible that the greater experience was associated
with a better therapeutic relationship.
The role of the relationship in the effectiveness
of technique is clearly illustrated in a processoutcome study by Castonguay, Goldfried, Wiser,
Raue, and Hayes (1996), which examined cognitive therapy for depression. Surprisingly, it was
found that the commonly used technique of linking two aspects of a clients functioning (e.g.,
thoughts and feelings) was negatively related to
outcome. However, upon further examination, it
was determined that the ineffective use of this
cognitive technique occurred only in those instances where there was a strained therapeutic
alliance.
Even among those who advocate the importance of technique, it is acknowledged that certain types of clients and certain types of clinical
problems require a balancing of relationship and
technique. For example, Beutler, Clarkin, and
Bongar (2000) have found that there are instances
where behavioral procedures as used by directive
therapists are less effective for clients for whom
there is high internal locus of control. Thus, for
individuals who have a sense that their personal
freedom is threatened when they are told what to
do by another individual, a directive intervention
can backfire by creating a sense of psychological reactance (Brehm, 1966). In such instances,
the technique must therefore be presented within
the context of a therapeutic relationship in which
therapists guide the clients to engage in certain
procedures without making them feel that they
are being told what to do.
Another example of where the efficacy of a
technique is dependent on the nature of the therapeutic relationship can be seen in the work of
Linehan (1993) on dialectical behavior therapy
for the treatment of borderline personality disorder. Although she advocates the use of various
behavioral techniques in order to provide clients
with skills for more effective coping with life
demands, clinical experience with this population
indicates that their history of invalidating experiences does not make them receptive to the directiveness associated with learning coping skills.

In essence, the message that there are things that

they need to change, or things that they could do
better, is interpreted by borderline patients as
criticism. To deal with this dilemma, Linehan
recommends that the therapist strike a delicate
balance between acceptance and change. Once
clients feel that they are accepted for who they
are, they become more receptive to active change
techniques.
An example of a clinical problem in which
techniques are used, but only in the context of a
strong therapeutic relationship, is that of complicated or delayed grief (Exline, Dorrity, & Wortman, 1996). Therapists from different orientations have acknowledged that the emotional
distress experienced in the context of grief work
requires a strong therapeutic bond in which clients can feel safe and supported. The use of
exposure in the treatment of posttraumatic stress
disorder (PTSD), which involves reexperiencing
and tolerating the emotions associated with the
trauma, similarly requires a strong interpersonal
bond. In a study of cognitive behavior therapy
for PTSD, which involved imaginal exposure to
traumatic memories, it was found that the establishment of a positive therapeutic alliance early in
treatment predicted symptom reduction (Cloitre,
Stovall-McClough, & Chemtob, 2004). The study
also revealed that this relationship was associated
with clients ability to regulate their emotional
states during the imaginal exposure.
The Therapy Relationship as Technique
In addition to the existence of a close interplay
between technique and relationship, one at times
may even construe the therapy relationship itself
as a technique. Extending Krasners (1962)
somewhat provocative conceptualization of the
therapist as a reinforcement machine, Merbaum and Southwell (1965) demonstrated that
differential empathic responding in a study of
verbal conditioning served to reinforce clients
verbal behavior. In a process analysis of one of
Rogers therapy tapes, Truax (1966) found that
the focus of the session and the direction in which
the client went was a function of what Rogers
reflected on.
Still a further illustration of the relationship as
technique can be seen in Kohlenberg and Tsais
(1991) functional analytic model of therapy,
which uses radical behavioral principles to guide
the therapeutic interaction. In order to provide

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Goldfried and Davila

clients with feedback on the interpersonal impact
that their in-session behavior makes on the therapist, the therapist makes use of the therapy
relationship and discloses his or her personal
reactions in order to differentially reinforce interpersonal behaviors. This is illustrated in the following interaction between a therapist and her
female client:

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T: What are you feeling right now?

C: Nothing. [with a sneering look on her face]
T: It feels like a slap in the face, you know. (Kohlenberg &
Tsai, p. 187)
After a few minutes, the therapist provides further feedback
on her reaction to the client:
C: I just shut down, got really scared. The biggest thing this
year is how Ive let you into my life. Ive never felt so
supported in such a deep and consistent level by anyone
before. Its really scary to tell you.
T: It makes me feel closer to you when you tell me things that
are scary. (Kohlenberg & Tsai, p. 187).

These examples illustrate the difficulty in distinguishing technique and relationship within a behavioral context, and the same point can be made
about experiential therapy. In their description of
emotion-focused therapy, Elliott et al., (2004)
describe the alliance formation as a therapeutic
task in much the same way that other experiential
techniques are therapeutic tasks (e.g., two-chair
dialogue). This view is consistent with the notion
that certain skills can be learned that can enhance
an optimal therapeutic relationship, such as accurate empathy, reflection, and self-disclosure
(Egan, 1990; Goldfried, Burckell, & EubanksCarter, 2003; Hill & OBrien, 1999).
General Principles of Changes
It would be helpful to comment on the process
of change itself as way of gaining a better appreciation of the role that the relationship and technique play in the change process itself. Although
different theoretical approaches may construe the
relationship in different ways and make use of
different techniques, and different types of clinical
problems may require different interventions, it
nonetheless is possible to delineate some general
principles that account for therapeutic change.
Elsewhere, one of us (Goldfried, 1980) has
maintained that principles of therapeutic change
can be found at a level of abstraction between the
specific interventions that are used (e.g., transfer-

426

ence interpretation, relaxation training, emptychair technique) and the more general theory that
is used to explain why these specific interventions might work (e.g., psychodynamic, behavioral, gestalt). At this middle level of abstraction,
it is possible to delineate principles of change that
are common across orientations, such as: (a) the
facilitation of expectations that therapy will help;
(b) the establishment of an optimal therapeutic
alliance; (c) offering feedback that can help clients increase their awareness about what is contributing to their life problems; (d) the encouragement of corrective experiences; and (e) an
emphasis on continued reality testing. These general principles may be implemented by a variety
of different clinical procedures, which can vary
as a function of the case at hand and the therapists particular theoretical orientation.
In reviewing the process of change as it occurs
in various settings (e.g., therapy, religious healing), Frank (1961) has maintained that positive
expectations and the offering of hope that change
is possible is essential to the change process. As
we know from clinical experience as well as
research findings (Prochaska & DiClemente,
2005), even the most efficacious of interventions
can prove to be ineffective in instances where the
precontemplative client neither expects nor
wants to change. In such instances, the role of the
therapist is to instill at least a minimal level of
optimism and motivation to engage in the therapeutic process.
The facilitation of an optimal therapeutic alliance, like the presence of positive expectations
and motivation to change, is essential to the
change process. Although behavioral approaches
have historically thought of this as the nonspecifics of therapy, the work of Bordin (1979) has
specified the components of the alliance, each of
which can be measured and hopefully altered to
facilitate the change process. According to Bordin, the therapeutic alliance is composed of three
factors: (a) The presence of a personal bond between therapist and client, where the client views
the therapist as caring, understanding, and knowledgeable; (b) an agreement between client and
therapist regarding the goals of treatment (e.g.,
reduction of symptoms, improvement of relationship with significant other); and (c) an agreement
as to the means by which these goals may be
achieved (e.g., relaxation, empty-chair work).
Thus the therapeutic alliance serves as the con-

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Special Issue: Relationship and Technique

text in which specific interventions can take
place, whatever they might be.
Assuming clients may have reasonable expectations and motivation to change, and have a
good alliance with their therapist, they nonetheless are typically unaware of the factors contributing to their life problems. Thus they need to
increase their awareness of the connections between their thoughts, feelings, needs, and actions;
the impact that others make on them; and the
impact they have on others. Metaphorically
speaking, they are in the dark about these
determinants/dynamics, and the role of the therapist is to use various clinical interventions to
focus a light on these factors (e.g., reflection of
feeling, highlighting how thoughts influence feelings, helping them become aware of how they are
misperceiving the motives of others).
In many respects, expectations and motivation for change, a facilitating alliance, and an
increased awareness all set the stage for what
may be considered the core of the change process, namely corrective experiences. Based on
the original contribution of Alexander and
French (1946), the corrective experience involves the change principle whereby clients
engage in behavior that they may have been
avoiding or otherwise not encountering and,
despite their original negative expectations, experience something positive. This novel experience can then serve to help them change their
thinking, feeling, desires, and behavior. Within
the context of psychodynamic therapy, the corrective experience is viewed as occurring
through the interactions with the therapist
(Strupp & Binder, 1984)providing a sort of
reparenting. In behavior therapy, the corrective experience is typically seen as taking place
between sessions, such as when a fearful client
is exposed to a heretofore frightening situation
without any harm occurring.
Although a corrective experience can have a
powerful impact on a client, it is the rare situation
where a single experience can bring about the
needed therapeutic change. More often, a number
of such experiences are needed, with each further
enhancing an increasing awareness that the difficulties experienced in the past need not continue
in the present. In this respect, this continued
reality testing involves an ongoing process in
which increased awareness leads to corrective
experiences, which then provides evidence for
further awareness. Whereas a psychodynamic

orientation calls this working through, a behavioral approach has referred to it as repeated
exposure.
How the Relationship and Technique
Implement Change Principles
As we hope is evident from reviewing these
change principles, they do not lend themselves to
an easy categorization as either technique-driven
or relationship-driven. Indeed, that is the point.
An understanding of therapeutic change cannot
be reduced to simple comparisons of technique
and relationship, but rather may be best understood in terms of the ways in which technique
and relationship facilitate these more general
principles. Thus the question is not if the relationship and technique produce therapeutic
change, but rather how they do.
In addressing the question of how the therapy
relationship and intervention techniques can contribute to change, it is useful to consider their
function in implementing the different principles
of change that we have outlined in the previous
section. Thus the facilitation of expectations that
therapy will help can occur within the context of
the therapy relationship by virtue of the concern
and confidence that is communicated by the therapist. It may also be facilitated by means of
things such as psychoeducational methods and
self-help books; by the successful experience associated with, for example, a relaxation induction; by helpful exploration and accurate interpretations; or by motivational interviewing
techniques (Miller & Rollnick, 2002).
The establishment of an optimal therapeutic
alliance is most certainly based on the quality of
the therapy relationship, which particularly contributes to the formation of the bond between
client and therapist. However, the bond and
client-therapist agreement on both goals and
methods are also dependent on the skillful use of
techniques such as reflection, accurate empathy,
appropriate self-disclosure, the empty-chair
method, and desensitization procedures. Moreover, the work of Safran and Muran (2000) suggests that when there is a strain in the therapeutic
alliancethe presence of which is essential for
the implementation of therapy techniquesthere
are specific techniques that must be implemented
in order to repair the alliance.
Offering clients feedback to help them increase
their awareness about what is contributing to

427

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Goldfried and Davila

their life problems can similarly occur through
the nature of the relationship as well as by techniques that are employed. There are many techniques that are designed to facilitate increases in
client awareness, as in the use of case formulation
presentations, reflections and clarifications, interpretations, therapist self-disclosure of the impact
made by the client, between-session selfmonitoring methods, and empty-chair interventions. However, the nature of the therapeutic relationship can affect the success of these
techniques. Strong, positive, trusting relationships can provide therapists with the power that is
necessary to allow clients to tolerate such feedback and to have feedback make an impact on
them.
From the perspective of diverse orientations,
the relationship and technique are always involved in providing the client with corrective
experiences. As noted earlier, according to more
psychodynamic and interpersonal approaches, the
therapy may be thought of as involving a form of
reparenting, whereby the client has the opportunity to interact with a significant other in novel
and more gratifying ways. As emphasized by
Alexander and French (1946), who first identified
this as a key aspect of the therapy change process,
these corrective experiences can be an outgrowth
of the relationship between client and therapist.
Of course, there are techniques that are used
within this context. For example, to the extent
that the therapist makes use of self-disclosure,
corrective experiences (e.g., the reduction of fearful behavior and the development of more effective functioning) may be facilitated through modeling. Behavioral approaches have traditionally
emphasized the therapy relationship as having a
social influence function, which is corrective in
that it serves to encourage and reinforce clients
for risk-taking like engaging in more effective
between-session behavior. These novel experiences may further be implemented by exposure
techniques in the case of anxiety problems, and
behavior rehearsal methods in instances where
the goal is to encourage more effective interpersonal interactions.
The principle of ongoing reality testing, which
entails the reiteration of increased awareness and
corrective experiences, makes use of the therapy
relationship and techniques in ways we have already described for these two principles of change.
It is through clients continued novel risk taking, as
well as the processing of these experiences, that

428

lasting therapeutic change can be possible, and the

ongoing engagement in these activities is often facilitated through an internalization of what has been
learned from the therapeutic relationship.
Concluding Comments
In this article, we have presented a way to
think about the roles of technique and the relationship in the therapeutic change process from a
different perspective than is typically considered.
Specifically, we have suggested that technique
and the relationship serve to facilitate general
principles that are the keys to the change process,
including the facilitation of expectations that
therapy will help, the establishment of an optimal
therapeutic alliance, offering feedback that can
help increase awareness, the encouragement of
corrective experiences, and an emphasis on continued reality testing. As noted earlier, these ideas
have been presented before (Goldfried, 1980),
and have even been extended. For example, Beutler, Consoli, and Lane (2005) have attempted to
specify client variables that need to be considered
in any intervention, such as whether or not a
client will be receptive to a directive or nondirective approach to intervention. Further research
is needed to help us better understand the parameters associated with the role of technique and
relationship in fostering the general change principles. For example, questions need to be addressed about how different components of the
therapeutic alliance (e.g., client-therapist bond,
agreement on goals, and agreement about methods) are related to change, and how this may vary
as a function of such variables as nature of the
clinical problem, client characteristics, and type
of technique. However, these ideas have not yet
become part of mainstream thinking, and with
this article, we hope to move the research agenda
further in that direction.
Fortunately, there are others who share our
goals. In a critique of the current randomized
clinical trial approach to therapy research,
Westen, Morrison, and Thompson-Brenner
(2004) argued, among other things, that it is not
possible to delineate exactly what needs to be
done therapeutically when working with certain
clinical problems (e.g., depression). To follow a
manual that clearly specifies exactly what the
therapist needs to do provides constraints on clinical judgment often to the detriment of therapeutic success (Castonguay et al., 1996; Henry,

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Special Issue: Relationship and Technique

Strupp, Butler, Schacht, & Binder, 1993; Roth &
Fonagy, 1996). At the other extreme, to provide
no clinical guidelines leaves us where psychotherapy research was a half century ago, when
still in its infancy. Rather than studying competing theory-based treatment interventions whose
specifications leave no room for clinical judgment, Westen and his colleagues recommend that
we shift our research approach and study conceptions and principles of change. Moreover, shifting
the research focus in this way would also impact on
training, and would open the door to more collaboration and integration between relationship-based
and technique-based orientations.
In contrast to past task forces that have either
sought to provide the field with a consensus on
empirically supported treatment procedures
(Task Force on Promotion and Dissemination of
Psychological Procedures, 1995) or empirically
supported therapy relationships (Norcross, 2002),
Castonguay and Beutler (2006) assembled a task
force to delineate empirically based principles of
change. In much the same way that we have
argued that the question to be asked is not
whether technique or therapy relationship contributes to change, but rather how each does, the
Castonguay and Beutler task force has focused on
how therapy relationships, treatment procedures,
and participants contribute to the change process
for different types of clinical problems. Thirtyeight years ago, Paul raised a question that is
fundamental to the field of psychotherapy: What
treatment, by whom, is most effective for this
individual with that specific problem, and under
which set of circumstances? (Paul, 1967). In
specifying the mediating and moderating mechanisms of change, as we and others suggest, these
efforts have the potential to bring us closer to
answering Pauls as yet unanswered question.
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