Asia Pacific Education Review

, Volume 20, Issue 4, pp 533–542 | Cite as

The unfolding of the Korean client- and counselor-rated real relationship and the counseling outcome in Korea

  • Eunju Lee
  • Han Na ChoiEmail author


The purpose of this study is to examine the unfolding of counselor-client-rated real relationships over the course of counseling as well as to verify whether the change rate is associated with the treatment outcome with a Korean sample. In this study, data were collected from 71 Korean counselor/client dyads; the clients and counselors completed real-relationship measures (KRRI-C, KRRI-T) to assess the strength of their real relationship after the first, third, fifth, and eighth session of the counseling. Clients also completed the outcome measure (KOQ-30) before the first session and at the end of the eighth session. To analyze this, latent growth curve modeling (LGCM) was used. The results of the analysis are as follows: first, both client-rated and counselor-rated real relationship significantly increased linearly over the course of counseling sessions. Second, the client’s initial ratings and the change rate of the real relationship were significantly related with the treatment outcome. Third, the counselor’s initial ratings and the change rate of the real relationship were not related with the treatment outcome. Implications for future research and counseling practice are discussed.


Real relationship Counseling outcome Unfolding of the real relationship Latent growth curve modeling (LGCM) 



  1. Ain, S. (2011). The Real Relationship, Therapist Self-Disclosure, and Treatment Progress: A Study of Psychotherapy Dyads (Doctoral dissertation, University of Maryland).Google Scholar
  2. Ain, S. & Gelso, C. J. (2008). Chipping away at the blank screen: Self-disclosure, the real relationship, and therapy outcome. Poster presented at the annual convention of the North American Society for Psychotherapy Research, New Haven, CT.Google Scholar
  3. Ain, S. & Gelso, C. J. (2011). Client and therapist perceptions of the real relationship and therapist self-disclosure: A study of dyads. Paper presented at the 2011 Convention of the North American Society for Psychotherapy Research, Banff, Alberta, CanadaGoogle Scholar
  4. Cho, H., & Seo, Y. S. (2017). Korean counselors’ perceptions of the real relationship in counseling process. Asia Pacific Education Review, 18(1), 135–146.Google Scholar
  5. Choi, H. N. (2011). Validation study of the Korean version of Real Relationship Inventory-Therapist form. Korea Journal of Counseling., 12(1), 143–158.Google Scholar
  6. Choi, H. N., Lee, E. J., & Kim, M. H. (2015). The unfolding of the real relationship in counseling: Effect of counselor and client attachment. Korea Journal of Counseling, 16(6), 135–158.Google Scholar
  7. De Roten, Y., Fischer, M., Drapeau, M., Beretta, V., Kramer, U., Favre, N., et al. (2004). Is one assessment enough? Patterns of helping alliance development and outcome. Clinical Psychology & Psychotherapy, 11(5), 324–331.Google Scholar
  8. Foreman, S. A., & Marmar, C. R. (1985). Therapist actions that address initially poor therapeutic alliances in psychotherapy. American Journal of Psychiatry, 142, 922–926.Google Scholar
  9. Freud, S. (1957). Future prospects of psychoanalytic psychotherapy. In J. Strachey (Ed. & Trans.), Standard edition of the complete psychological works of Sigmund Freud (Vol. 11, pp. 139–151). London, England: Hogarth Press. (Original work published 1910)Google Scholar
  10. Fuertes, J. N., Gelso, C. J., Owen, J. J., & Cheng, D. (2013). Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Counseling Psychology Quarterly, 26(3–4), 294–312.Google Scholar
  11. Fuertes, J. N., Mislowack, A., Brown, S., Gur-Arie, S., Wilkinson, S., & Gelso, C. J. (2007). Correlates of the real relationship in psychotherapy: A study of dyads. Psychotherapy Research, 17, 423–430.Google Scholar
  12. Gaston, L. (1990). The concept of the alliance and its role in psychotherapy: Theoretical and empirical considerations. Psychotherapy, 27, 143–153.Google Scholar
  13. Gelso, C. J. (2009). The real relationship in a post-modern world: Theoretical and empirical explorations. Psychotherapy Research, 19, 253–264.Google Scholar
  14. Gelso, C. J. (2011). The real relationship in Psychotherapy: The hidden foundation of change. Washington, DC: American Psychological Association.Google Scholar
  15. Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy. The Counseling Psychologist, 13, 155–243.Google Scholar
  16. Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41, 296–306.Google Scholar
  17. Gelso, C. J., & Hayes, J. A. (1998). The psychotherapy relationship: Theory, research, and practice. New York: Wiley.Google Scholar
  18. Gelso, C. J., Kelly, F. A., Fuertes, J. N., Marmarosh, C., Holmes, S. E., Costa, C., et al. (2005). Measuring the real relationship in psychotherapy: Initial validation of the therapist form. Journal of Counseling Psychology, 52, 640–649.Google Scholar
  19. Gelso, C. J., Kivlighan, D. M., 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, 59, 495–506.Google Scholar
  20. Gelso, C. J., Kivlighan, D. M., Wine, B., Jones, A., & Friedman, S. (1997). Transference, insight, and the course of time-limited therapy. Journal of Counseling Psychology, 44, 209–217.Google Scholar
  21. Gelso, C. J., & Samstag, L. W. (2008). A tripartite model of the therapeutic relationship. In S. Brown & R. Lent (Eds.), Handbook of counseling psychology (pp. 267–283). New York: Wiley.Google Scholar
  22. Goden, B. R., & Robbins, S. B. (1990). The working alliance within time limited therapy. Professional Psychology: Research and Practice, 21(6), 476–481.Google Scholar
  23. Greenson, R. R. (1967). The technique and practice of psychoanalysis (Vol. 1). New York: International Universities Press.Google Scholar
  24. Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 37–69). New York: Oxford University Press.Google Scholar
  25. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy: Theory Research, Practice, Training, 48, 9.Google Scholar
  26. Horvath, A. O., & Marx, R. W. (1991). The development and decay of the working alliance during time-limited counseling. Canadian Journal of Counseling, 24, 240–259.Google Scholar
  27. Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41(2), 159–164.Google Scholar
  28. Kelly, F. A., Gelso, C. J., Fuertes, J. N., & Marmarosh, C. (2010). The real relationship inventory: Development and psychometric investigation of the client form. Psychotherapy Theory: Research, Practice, Training, 47(4), 540–553.Google Scholar
  29. Kenny, D. B., Kaniskan, B. D., & McCouach, B. (2014). The performance of RMSEA in models with small degrees of freedom. Sociological Methods & Research, 44(3), 486–507.Google Scholar
  30. Kim, C. D., Kwon, K. I., Han, Y. J., & Sohn, N. H. (2008). The Korean counselor’s factors which contribute to positive counseling outcomes. The Korea Journal of Counseling, 9(3), 961–986.Google Scholar
  31. Kivlighan, D. M., Gelso, C. J., Ain, S., Hummel, A. M., & Markin, R. D. (2015). The therapist, the client, and the real relationship: An actor–partner interdependence analysis of treatment outcome. Journal of Counseling Psychology, 62(2), 314–320.Google Scholar
  32. Kivlighan, D. M., Hill, C. E., Gelso, C. J., & Baumann, E. (2016). Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model. Journal of Counseling Psychology, 63(2), 149–161.Google Scholar
  33. Kivlighan, D. M., & Shaughnessy, P. (1995). Analysis of the development of the working alliance using hierarchical linear modeling. Journal of Counseling Psychology, 42(3), 338–349.Google Scholar
  34. Kivlighan, D. M., & Shaughnessy, P. (2000). Patterns of working alliance development: A typology of client’s working alliance ratings. Journal of Counseling Psychology, 47(3), 362–371.Google Scholar
  35. Knox, S., Hess, S. A., Peterson, D. A., & Hill, C. E. (1997). A qualitative analysis of client perceptions of the effects of helpful therapist self-disclosure in long-term therapy. Journal of Counseling Psychology, 44(3), 274–283. Scholar
  36. Lambert, M. J., & Barley, D. E. (2002). Research summary on the therapeutic relationship and psychotherapy outcome. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 17–36). New York: Oxford University Press.Google Scholar
  37. Lee, E., Yang, N., & Seo, E. (2007). A qualitative study on counseling in Korea. The Korea Journal of Counseling and Psychotherapy, 19(3), 587–607.Google Scholar
  38. Lee, E. J., & Choi, H. N. (2018). Longitudinal change patterns of working alliance and counseling outcome. Korean Journal of Counseling, 19(2), 365–385.Google Scholar
  39. Leong, F. T. L., & Lopez, S. (2006). Culture, race, and ethnicity in psychotherapy (Special issue). Psychotherapy: Theory, Research, Practice, Training, 43Google Scholar
  40. LoCoco, G., Gullo, S., Prestano, C., & Gelso, C. J. (2011). Relation of the real relationship and the working alliance to the outcome of brief psychotherapy. Psychotherapy, 48(4), 359.Google Scholar
  41. Markin, R. D., Kivlighan, D. M., Gelso, C. J., Hummel, A. M., & Spiegel, E. B. (2014). Clients’ and therapists’ real relationship and session quality in brief therapy: An actor partner interdependence analysis. Psychotherapy, 51(3), 413–423.Google Scholar
  42. Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J. (2009). The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome. Journal of Counseling Psychology, 56(3), 337–350.Google Scholar
  43. Shonfeld-Ringel, S. (2001). A re-conceptualization of the working alliance in cross-cultural practice with non-Western clients: Integrating relational perspectives and multicultural theories. Clinical Social Work Journal, 29(1), 53–63.Google Scholar
  44. Son, N. H., & Yu, S. K. (2012). A validity study on outcome questionnaire-30 (OQ-30) with Korean clients. Korea Journal of Counseling., 13(1), 1–15.Google Scholar
  45. Spiegel, E. B., Busa-Knepp, J., Ma, E., Markin, R. D., Ain, S., Hummel, A., Gelso, C. J. (2008). Unfolding of the real relationship and its connection to outcome. In Paper presented at the 116th annual convention of the American Psychological Association, Boston, MA.Google Scholar
  46. Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice. New York: Wiley.Google Scholar
  47. Tichenor, V., & Hill, C. E. (1989). A comparison of six measures of the working alliance. Psychotherapy: Research and Practice, 26, 195–199.Google Scholar
  48. Vermeersch, D. A., Lambert, M. J., & Burlingame, G. M. (2000). Outcome questionnaire: Item sensitivity to change. Journal of Personality Assessment, 74, 242–261.Google Scholar
  49. Watson, J. C., Schein, J., & Mcullen, E. (2010). An examination of clients’ in-session changes and their relationship to the working alliance and outcome. Psychotherapy Research, 20, 224–233.Google Scholar
  50. Wiley, M. O., & Ray, P. B. (1986). Counseling supervision by developmental level. Journal of Counseling Psychology, 33(4), 439–445.Google Scholar
  51. Wisch, A. F., & Mahalik, J. R. (1999). Male therapists’ clinical bias: Influence of client gender roles and therapist gender role conflict. Journal of Counseling Psychology, 46, 51–60.Google Scholar
  52. Woodhouse, S. S., Schlosser, L. Z., Crook, R. E., Ligiero, D. P., & Gelso, C. J. (2003). Client attachment to therapist: Relations to transference and client recollections of parental caregiving. Journal of Counseling Psychology, 50(4), 395–408.Google Scholar
  53. Yu, J. Y. (2015). Validation study of the Korean version of real relationship inventory-client form. Master’s thesis, Sookmyung Women’s University.Google Scholar
  54. Zilcha-Mano, S., Roose, S. P., Barber, J. P., & Rutherford, B. R. (2015). Therapeutic alliance in antidepressant treatment: Cause or effect of symptomatic levels? Psychotherapy and Psychosomatics, 84, 177–182.Google Scholar

Copyright information

© Education Research Institute, Seoul National University, Seoul, Korea 2019

Authors and Affiliations

  1. 1.Sookmyung Women’s UniversitySeoulKorea
  2. 2.Department of Education, College of Liberal ArtsSookmyung Women’s UniversitySeoulKorea

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