Conclusions of the Task Force

  • The therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment.
  • The therapy relationship accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.
  • Practice and treatment guidelines should explicitly address therapist behaviors and qualities that promote a facilitative therapy relationship.
  • Efforts to promulgate best practices or evidence-based practices (EBPs) without including the relationship are seriously incomplete and potentially misleading.
  • Adapting or tailoring the therapy relationship to specific patient characteristics (in addition to diagnosis) enhances the effectiveness of treatment.
  • The therapy relationship acts in concert with treatment methods, patient characteristics, and practitioner qualities in determining effectiveness; a comprehensive understanding of effective (and ineffective) psychotherapy will consider all of these determinants and their optimal combinations.
  • The following list summarizes the Task Force conclusions regarding the evidentiary strength of (a) elements of the therapy relationship primarily provided by the psychotherapist and (b) methods of adapting psychotherapy to particular patient characteristics.

Elements of the Relationship

Methods of Adapting

Demonstrably Effective

  • Alliance in Individual Psychotherapy
  • Alliance in Youth Psychotherapy
  • Alliance in Family Therapy
  • Cohesion in Group Therapy
  • Empathy
  • Collecting Client Feedback

 

  • Reactance/Resistance Level
  • Preferences
  • Culture
  • Religion and Spirituality

Probably Effective

  • Goal Consensus
  • Collaboration
  • Positive Regard

 

  • Stages of Change
  • Coping Style

Promising but Insufficient Research to Judge

  • Congruence/Genuineness
  • Repairing Alliance Ruptures
  • Managing Countertransference
  • Expectations
  • Attachment Style
  • The preceding conclusions do not by themselves constitute a set of practice standards, but represent current scientific knowledge to be understood and applied in the context of all the clinical evidence available in each case.

Recommendations of the Task Force

General Recommendations:

  1. We recommend that the results and conclusions of this second Task Force be widely disseminated in order to enhance awareness and use of what “works” in the therapy relationship.
  2. Readers are encouraged to interpret these findings in the context of the acknowledged limitations of the Task Force’s work.
  3. We recommend that future Task Forces be established periodically to review these findings, include new elements of the relationship, incorporate the results of non-English language publications (where practical), and update these conclusions.

Practice Recommendations:

  1. Practitioners are encouraged to make the creation and cultivation of a therapy relationship, characterized by the elements found to be demonstrably and probably effective, a primary aim in the treatment of patients.
  2. Practitioners are encouraged to adapt or tailor psychotherapy to those specific patient characteristics in ways found to be demonstrably and probably effective.
  3. Practitioners are encouraged to routinely monitor patients’ responses to the therapy relationship and ongoing treatment. Such monitoring leads to increased opportunities to reestablish collaboration, improve the relationship, modify technical strategies, and avoid premature termination.
  4. Concurrent use of evidence-based therapy relationships and evidence-based treatments adapted to the patient is likely to generate the best outcomes.

Training Recommendations:

  1. Training and continuing education programs are encouraged to provide competency-based training in the demonstrably and probably effective elements of the therapy relationship.
  2. Training and continuing education programs are encouraged to provide competency-based training in adapting psychotherapy to the individual patient in ways that demonstrably and probably enhance treatment success.
  3. Accreditation and certification bodies for mental health training programs should develop criteria for assessing the adequacy of training in evidence-based therapy relationships.

Research Recommendations:

  1. Researchers are encouraged to progress beyond correlational designs that associate the frequency of relationship behaviors with patient outcomes to methodologies capable of examining the complex associations among patient qualities, clinician behaviors, and treatment outcome. Of particular importance is disentangling the patient contributions and the therapist contributions to relationship elements and ultimately outcome.
  2. Researchers are encouraged to examine the specific mediators and moderators of the links between the relationship elements and treatment outcome.
  3. Researchers are encouraged to address the observational perspective (i.e., therapist, patient, or external rater) in future studies and reviews of “what works” in the therapy relationship. Agreement among observational perspectives provides a solid sense of established fact; divergence among perspectives holds important implications for practice.

Policy Recommendations:

  1. APA’s Division of Psychotherapy, Division of Clinical Psychology, and other practice divisions are encouraged to educate its members in the benefits of evidence-based therapy relationships.
  2. Mental health organizations as a whole are encouraged to educate their members about the improved outcomes associated with using evidence-based therapy relationships, as they frequently now do about evidence-based treatments.
  3. We recommend that the American Psychological Association and other mental health organizations advocate for the research-substantiated benefits of a nurturing and responsive human relationship in psychotherapy.
  4. Finally, administrators of mental health services are encouraged to attend to the relational features of those services. Attempts to improve the quality of care should account for treatment relationships and adaptations.

Products of the Task Force

Norcross, J. C. (Ed.). (2010). Evidence-based therapy relationships. Module on SAMHSA’s National Registry of Evidence-based Programs and Practices: NREPP/SAMHSA Website

Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York: Oxford University Press.

Norcross, J. C. (Ed.). (2011). Evidence-based therapy relationships. Psychotherapy, 48(1).

Norcross, J. C., & Wampold, B. E. (Eds.). (2011). Adapting psychotherapy to the individual patient. Journal of Clinical Psychology, 67(2).