Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy
The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.
KeywordsCloseness Therapist-client relationship The real relationship Grounded theory
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- Brattland, H., Høiseth, J. R., Burkeland, O., Inderhaug, T. S., Binder, P. E., & Iversen, V. C. (2016). Learning from clients: A qualitative investigation of psychotherapists’ reactions to negative verbal feedback. Psychotherapy Research. https://doi.org/10.1080/10503307.2016.1246768.PubMedGoogle Scholar
- Dryden, W. (2012). The therapeutic relationship in CBT. In W. Dryden & R. Branch, The CBT handbook (pp. 83–100). London: Sage.Google Scholar
- Glaser, B. (2007). Remodeling grounded theory. Historical Social Research, 19, 47–68.Google Scholar
- Hatcher, S. L., Kipper-Smith, A., Waddell, M., Uhe, M., West, J. S., et al. (2012). What therapists learn from psychotherapy clients: Effects on personal and professional lives. The Qualitative Report, 17(48), 1–21.Google Scholar
- Henwood, K. L., & Pidgeon, N. (2006). Grounded theory. In G. Breakwell, S. Hammond, C. Fife-Shaw & J. Smith (Eds.), Research methods (pp. 342–365). London: Sage.Google Scholar
- Holman, G., Kanter, J., Tsai, M., & Kohlenberg, R. J. (2017). Functional analytic psychotherapy made simple: A clinician’s guide to using the Awareness-Courage-Love (ACL) model in session. Oakland: New Harbringer.Google Scholar
- Jeffrey, M. K., & Tweed, A. E. (2015). Clinician self-disclosure or clinician self- concealment. Lesbian, gay and bisexual mental health practitioners’ experiences of disclosure in therapeutic relationships. Counselling and Psychotherapy Research, 15, 41–49.Google Scholar
- Kohlenberg, R. J., Kohlenberg, B. S., & Tsai, M. (2008). Intimacy. In M. Tsai, R. J. Kohlenberg, J. Kanter, B. S. Kohlenberg, W. C. Follette & G. M. Callaghan (Eds.), A guide to functional analytic psychotherapy (pp. 131–144). New York: Springer.Google Scholar
- Linehan, M. M. (2015). Cognitive-behavioral treatment of borderline personality disorder (2nd edn.). New York: Guilford.Google Scholar
- Pierson, H., & Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in cognitive behavior therapy (pp. 205–228). London: Routledge.Google Scholar
- Swales, M. A., & Heard, H. L. (2007). The therapy relationship in dialectical behavior therapy. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 185–204). New York: Routledge.Google Scholar
- Villatte, M., Villatte, J. L., & Hayes, S. (2015). Mastering the clinical conversation: Language as intervention. New York: Guilford.Google Scholar
- Wilson, K. G., & Merwin, R. M. (2008). Therapeutic relationship. In M. Hersen (Ed.), Encyclopedia of behavior modification and behavior therapy with adult clinical applications (pp. 586–590). Thousand Oaks: Sage.Google Scholar
- Wilson, K. G., & Sandoz, E. K. (2008). Mindfulness, values, and the therapeutic relationship in acceptance and commitment therapy. In S. F. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship (pp. 89–106). New York: Guilford Press.Google Scholar
- Young, J. E., Klosko, J. S., & Weishaar, M. (2003). Schema therapy: A practitioner’s guide. New York: Guilford.Google Scholar