Concluding Comments
In this article, we have presented a way to
think about the roles of technique and the rela-
tionship in the therapeutic change process from a
different perspective than is typically considered.
Specifically, we have suggested that technique
and the relationship serve to facilitate general
principles that are the keys to the change process,
including the facilitation of expectations that
therapy will help, the establishment of an optimal
therapeutic alliance, offering feedback that can
help increase awareness, the encouragement of
corrective experiences, and an emphasis on con-
tinued reality testing. As noted earlier, these ideas
have been presented before (Goldfried, 1980),
and have even been extended. For example, Beut-
ler, Consoli, and Lane (2005) have attempted to
specify client variables that need to be considered
in any intervention, such as whether or not a
client will be receptive to a directive or nondi-
rective approach to intervention. Further research
is needed to help us better understand the param-
eters associated with the role of technique and
relationship in fostering the general change prin-
ciples. For example, questions need to be ad-
dressed about how different components of the
therapeutic alliance (e.g., client-therapist bond,
agreement on goals, and agreement about meth-
ods) are related to change, and how this may vary
as a function of such variables as nature of the
clinical problem, client characteristics, and type
of technique. However, these ideas have not yet
become part of mainstream thinking, and with
this article, we hope to move the research agenda
further in that direction.
Fortunately, there are others who share our
goals. In a critique of the current randomized
clinical
trial
approach
to
therapy
research,
Westen,
Morrison,
and
Thompson-Brenner
(2004) argued, among other things, that it is not
possible to delineate exactly what needs to be
done therapeutically when working with certain
clinical problems (e.g., depression). To follow a
manual that clearly specifies exactly what the
therapist needs to do provides constraints on clin-
ical judgment—often to the detriment of thera-
peutic success (Castonguay et al., 1996; Henry,
Goldfried and Davila
428
Strupp, Butler, Schacht, & Binder, 1993; Roth &
Fonagy, 1996). At the other extreme, to provide
no clinical guidelines leaves us where psycho-
therapy research was a half century ago, when
still in its infancy. Rather than studying compet-
ing theory-based treatment interventions whose
specifications leave no room for clinical judg-
ment, Westen and his colleagues recommend that
we shift our research approach and study concep-
tions and principles of change. Moreover, shifting
the research focus in this way would also impact on
training, and would open the door to more collab-
oration and integration between relationship-based
and technique-based orientations.
