The Therapeutic Relationship

In this chapter, we focus on the therapeutic relationship and demonstrate how second-order change is central to the process by which therapists develop effective relationships with clients. In support of this, we introduce the contextual model as offered by Jerome and Julia Frank (Frank & Frank, 1991). The contextual model is a framework that has strong empirical support for predicting psychotherapy outcomes. Context model components suggest a synergistic connection between the therapeutic relationship and techniques or treatment methods. We will show how the golden thread of second-order change weaves its way through the contextual model. When viewing this in the larger psychotherapy tapestry, it becomes clear that the therapeutic relationship and methods are cut from the same cloth. Because they contain the same material, the therapeutic relationship and intervention methods are inseparable. The contextual model also points to the ultimate purpose ofpsychotherapy: reversing demoralization and restoring hope. We end the chapter with a discussion about the implications of this viewpoint for "The Great Psychotherapy Debate" (Wampold, 2001).