Hostname: page-component-76d6cb85b7-jhrpq Total loading time: 0 Render date: 2026-07-13T01:57:58.742Z Has data issue: false hasContentIssue false
  • English
  • Français

The Therapeutic Relationship in Cognitive-Behavioral Therapy

Published online by Cambridge University Press:  01 November 2008

Robert L. Leahy
Robert L. Leahy*
Affiliation:
American Institute for Cognitive Therapy, New York, USA
*
Reprint requests to Robert Leahy, American Institute for Cognitive Therapy, 136 East 57th Street, Suite 1101, New York City, New York 10022, USA. E-mail: leahy@cognitivetherapyNYC.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitive behavioral therapy has often been criticized for ignoring the role of the therapeutic relationship. In this article, I outline several dimensions for case formulation and intervention that suggest that the cognitive-behavioral approach can be a powerful theoretical model for understanding the causes of and the strategies for overcoming impasses in therapy. I review how the clinician and patient can collaborate in understanding the importance of case conceptualization, validation, emotional philosophies, victim resistance, schematic resistance, schematic mismatch, sunk-cost commitment, and self-handicapping. The relevance of these factors for both patient and therapist are discussed. During the last decade there has been increased interest in the nature of the therapeutic relationship in cognitive behavioral therapy (Gilbert, 1992; Safran, 1998; Safran and Muran, 2000; Greenberg, 2002; Leahy, 2001; Gilbert and Irons, 2005; Leahy, 2005; Bennett-Levy and Thwaites, 2007; Gilbert and Leahy, 2007). Cognitive behavioral therapists have proposed that the therapeutic relationship reflects interpersonal schemas, earlier attachment problems, emotional processing, failures in validation and compassion, and a variety of processes underlying non-compliance or resistance. Resolving “ruptures” in the therapeutic relationship provides an often essential opportunity for using the relationship as a means to modify cognitive and emotional problems (Safran, Muran, Samstag and Stevens, 2002; Katzow and Safran 2007). In light of the emphasis on “empirically supported treatments” (such as CBT) there is the risk that the alliance in therapy may be foreshadowed by the techniques and protocols used in CBT, perhaps giving credibility to Mahoney's (1991) earlier claim that therapy can become “technolatry”.

Keywords

Therapeutic relationshippsychotherapycognitive behavioral therapyresistance

Information

Type
Process Issues
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 769 - 777
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Beck, J. S. (2005). Cognitive Therapy for Challenging Problems: what to do when the basics don't work. New York: Guilford.Google Scholar
Bennett-Levy, J. and Thwaites, R. (2007). Self and self-reflection in the therapeutic relationship: a conceptual map and practical strategies for the training, supervision and self-supervision of interpersonal skills. In Gilbert, P. and Leahy, R. L. (Eds.), The Therapeutic Relationship in Cognitive-Behavioural Psychotherapies (pp. 255–282). New York: Routledge.Google Scholar
DeRubeis, R. J., Brotman, M. A. and Gibbons, C. J. (2005). A conceptual and methodological analysis of the nonspecifics argument. Clinical Psychology: Science and Practice, 12, 174–183.Google Scholar
DeRubeis, R. J. and Feeley, M. (1990). Determinants of change in cognitive therapy for depression. Cognitive Therapy and Research, 14, 469–482.CrossRefGoogle Scholar
Ellis, A. (1962). Reason and Emotion in Psychotherapy. Secaucus, NJ: Citadel Press.Google Scholar
Feeley, M., DeRubeis, R. J. and Gelfand, L. A. (1999). The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 67, 578–582.CrossRefGoogle ScholarPubMed
Flitcroft, A., James, I. A., Freeston, M. and Wood-Mitchell, A. (2007). Determining what is important in a good formulation. Behavioural and Cognitive Psychotherapy, 35, 325–333.CrossRefGoogle Scholar
Foertsch, C., Manning, S. Y. and Dimeff, L. (2003). Difficult-to-treat patients: the approach from dialectical behavior therapy. In Leahy, R. L. (Ed.), Roadblocks in Cognitive-Behavioral Therapy: transforming challenges into opportunities for change (pp. 255–273). New York: Guilford Press.Google Scholar
Gaston, L., Marmar, C. R., Gallagher, D. and Thompson, L. W. (1991). Alliance prediction of outcome beyond in-treatment symptomatic change as psychotherapy progresses. Psychotherapy Research, 1, 104–112.CrossRefGoogle Scholar
Gilbert, P. (1992). Counselling for Depression. London: Sage.Google Scholar
Gilbert, P. and Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In Gilbert, P. (Ed.), Compassion: conceptualisations, research and use in psychotherapy (pp. 263–325). Hove, UK: Brunner-Routledge.CrossRefGoogle Scholar
Gilbert, P. and Leahy, R. L. (Eds.) (2007). The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies. New York: Routledge.CrossRefGoogle Scholar
Gillespie, M., Smith, J., Meaden, A., Jones, C. and Wane, J. (2004). Clients’ engagement with assertive outreach services: a comparison of client and staff perceptions of engagement and its impact on later engagement. Journal of Mental Health, 13, 439–452.CrossRefGoogle Scholar
Gottman, J. M., Katz, L. F. and Hooven, C. (1996). Parental meta-emotion philosophy and the emotional life of families: theoretical models and preliminary data. Journal of Family Psychology, 10, 243–268.CrossRefGoogle Scholar
Greenberg, L. S. (2002). Emotion-Focused Therapy: coaching clients to work through their feelings. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Haarhoff, B. (2006). The importance of identifying and understanding therapist schema in cognitive therapy training and supervision. The New Zealand Journal of Psychology, November.Google Scholar
Hayes, S. C., Strosahl, K. D., and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York, Guilford.Google Scholar
Ivey, A. E. and Ivey, M. B. (2003). Intentional Interviewing and Counselling: facilitating client change in a multicultural society. Pacific Grove, CA: Brooks/Cole.Google Scholar
Janoff-Bulman, R. (1992). Shattered Assumptions: towards a new psychology of trauma. New York: Free Press.Google Scholar
Katzow, A. W. and Safran, J. D. (2007). Recognizing and resolving ruptures in the therapeutic alliance. In Gilbert, P. and Leahy, R. L.. (Eds.), The Therapeutic Relationship in Cognitive-Behavioural Psychotherapies (pp. 90–105). New York: Routledge.Google Scholar
Kellogg, S. H. and Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62, 445–458.CrossRefGoogle ScholarPubMed
Klein, D. N., Schwartz, J. E., Santiago, N. J., Vivan, D., Vocisano, C., Castonguay, L. G., Arrow, B., Blalock, J. A., Manber, R., Markowitz, J. C., Riso, L. P., Rothbaum, B., McCullough, J. P., Thase, M. E., Borian, F. E., Miller, I. W. and Keller, M. B. (2003). Therapeutic alliance in depression treatment: controlling for prior change and patient characteristics. Journal of Consulting and Clinical Psychology, 6, 997–1006.CrossRefGoogle Scholar
Kuyken, W., Padesky, C. A. and Dudley, R. (2008). Collaborative Case Conceptualization. New York: Guilford.Google Scholar
Leahy, R. L. (1999). Strategic self-limitation. Journal of Cognitive Psychotherapy, 13, 275–293.CrossRefGoogle Scholar
Leahy, R. L. (2000). Sunk costs and resistance to change. Journal of Cognitive Psychotherapy, 14, 355–371.CrossRefGoogle Scholar
Leahy, R. L. (2001). Overcoming Resistance in Cognitive Therapy. New York, Guilford.Google Scholar
Leahy, R. L. (2003). Emotional schemas and resistance in cognitive therapy. In Leahy, R. L.. (Ed.), Roadblocks in Cognitive-Behavioral Therapy: transforming challenges into opportunities for change (pp. 91–115). New York: Guilford Press.Google Scholar
Leahy, R. L. (2005). A social cognitive model of validation. In Gilbert, P.. (Ed.), Compassion: conceptualisations, research and use in psychotherapy (pp. 195–217). London: Brunner-Routledge.Google Scholar
Leahy, R. L. (2007)a. Emotional schemas and resistance to change in anxiety disorders. Cognitive and Behavioral Practice, 14, 36–45.CrossRefGoogle Scholar
Leahy, R. L. (2007)b. Schematic mismatch in the therapeutic relationship: a social-cognitive model. In Gilbert, P. and Leahy, R. L.. (Eds.), The Therapeutic Relationship in Cognitive-Behavioural Psychotherapies (pp. 229–254). New York: Routledge.Google Scholar
Leahy, R. L. (in press). Resistance: an emotional schema therapy approach. In Cognitive Behavior Therapy: a guide for the practicing clinician (vol. II). Simos, G.. (Ed.) London: Routledge.Google Scholar
Leahy, R. L., Beck, J. and Beck, A. T. (2005). Cognitive therapy for the personality disorders. In Strack, S.. (Ed.), Handbook of Personology and Psychopathology (pp. 442–461). Hoboken, NJ: Wiley.Google Scholar
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford.Google Scholar
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P. and Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.CrossRefGoogle ScholarPubMed
Mahoney, M. J. (1991). Human Change Processes: the scientific foundations of psychotherapy. New York: Basic Books.Google Scholar
Martin, D. J., Gorske, J. P. and Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450.CrossRefGoogle ScholarPubMed
Needleman, L. D. (1999). Cognitive Case Conceptualization: a guidebook for practitioners. Mahwah, NJ: Lawrence Erlbaum.CrossRefGoogle Scholar
Orlinsky, D. E., Ronnestad, M. H. and Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: continuity and change. In Lambert, M. J.. (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behavioral Change (pp. 307–390). New York: Wiley.Google Scholar
Persons, J. B. (1993). Case conceptualization in cognitive-behavior therapy. In Kuehlwein, K. T. and Rosen, H.. (Eds.), Cognitive Therapies in Action: evolving innovative practice (pp. 33–53). San Francisco, CA: Jossey-Bass.Google Scholar
Persons, J. B. and Tompkins, M. A. (1997). Cognitive-behavioral case formulation. In Eells, T. D.. (Ed.), Handbook of Psychotherapy Case Formulation (pp. 314–339). New York: Guilford Press.Google Scholar
Rollnick, S., Mason, P. and Butler, C. (1999). Health Behaviour Change: a guide for practitioners. London: Churchill Livingstone.Google Scholar
Safran, J. D. (1998). Widening the Scope of Cognitive Therapy: the therapeutic relationship, emotion and the process of change. Northvale, NJ: Aronson.Google Scholar
Safran, J. D. and Muran, J. C. (2000). Negotiating the Therapeutic Alliance: a relational treatment guide. New York: The Guilford Press.Google Scholar
Safran, J. D., Muran, J. C., Samstag, L. W. and Stevens, C. (2002). Repairing alliance ruptures. In Norcross, J. R.. (Ed.), Psychotherapy Relationships That Work (pp. 235–254). New York: Oxford University.Google Scholar
Safran, J. D. and Segal, L. S. (1990). Interpersonal Process in Cognitive Therapy. New York: Basic Books.Google Scholar
Tompkins, M. A. (1999). Using a case formulation to manage treatment nonresponse. Journal of Cognitive Psychotherapy, 13, 317–330.CrossRefGoogle Scholar
Trepka, C., Rees, A., Shapiro, D. A., Hardy, G. E. and Barkham, M. (2004). Therapist competence and outcome of cognitive therapy for depression. Cognitive Therapy and Research, 28, 143–157.CrossRefGoogle Scholar
Van Der Molen, H., Hommes, M., Smit, G. and Lang, G. (1995). Two decades of cumulative microtraining in the Netherlands: an overview. Educational Research and Evaluation: An International Journal on Theory and Practice, 1, 347–387.CrossRefGoogle Scholar
Young, J. E., Klosko, J. S. and Weishaar, M. (2003). Schema Therapy: a practitioner's guide. New York: Guilford.Google Scholar
Submit a response

Comments

No Comments have been published for this article.