Conceptualizing the therapeutic relationship: Mediator or moderator of change?

Abstract

Although the therapy relationship has long been recognized as an essential factor in the change process, there has been disagreement concerning whether the relationship is itself curative or rather supports the bene fi ts of speci fi c therapeutic techniques. To advance and clarify this conversation, this article conceptualizes the therapy relationship as both a mediator and/or moderator of change that can be used strategically in accord with case formulation for treatment goals. We begin with a brief overview of the relevant literature on the therapy relationship versus technique and the role of the therapy relationship as mediator or moderator across theoretical orientations. We then suggest an integrative framework by which clinicians and psychotherapy researchers may conceptualize the therapeutic relationship based on case conceptualization, where the requirements in each case and not theoretical orientation should determine the therapist ’ s use of the therapy relationship. Finally, we discuss implications for psychotherapy research and practice. Public Health Significance Statement This article discusses the role of the therapist – client relationship in promoting positive treatment outcomes. We review debates about the importance of the therapy relationship versus speci fi c therapeutic techniques and describe how different types of psychotherapy frame the relationship. We argue that it is essential for psychotherapy practitioners and researchers to develop a fl exible view of how to use the therapeutic relationship with regard to speci fi c clinical problems and relevant evidence-based techniques.