The trusting relationship (therapeutic alliance)
Techniques matter, but they don’t work in a vacuum: the relationship between you and your psychologist is one of the factors that most influence the success of therapy. I explain what humanistic psychology contributed, what research says about the therapeutic relationship and how I look after it.
What is the humanistic approach?
Humanistic psychology emerged in the mid-20th century, with authors such as Carl Rogers, as an alternative to the approaches of the time. It starts from a positive and holistic view of the person: we all have a tendency to grow and develop, and difficulties arise when we live too much according to outside judgements and drift away from our real needs. Its great contribution was to place the therapeutic relationship at the heart of treatment, something all orientations later adopted, to a greater or lesser extent.
The therapist’s three attitudes according to Carl Rogers
Empathy
Understanding the difficulty from your point of view, and being able to convey that understanding to you.
Unconditional positive regard
A space without judgement, where you can talk about anything without feeling evaluated.
Genuineness
A sincere therapist, consistent between what they think, feel and say.
An honest view
Humanistic models have great strengths: their view of the whole person, the emphasis on growth and not only on the problem, and their usefulness for difficulties related to values or identity. But they also have limits: less high-quality empirical evidence than other approaches, sometimes vague concepts (such as “self-actualisation”) and more limited applicability for certain difficulties.
That is why I don’t work as an exclusively humanistic therapist. What I integrate from this approach is precisely what research strongly supports: the quality of the therapeutic relationship.
What research says about the therapeutic relationship
The therapeutic relationship is one of the most studied aspects of psychotherapy:
The therapeutic alliance predicts outcome
A meta-analysis of nearly 300 studies (Flückiger and colleagues, 2018) showed a consistent link between the quality of the alliance (agreement on goals, on tasks, and the bond) and the outcome of therapy, whatever the approach.
So does empathy
Another meta-analysis (Elliott and colleagues, 2018) showed that therapist empathy is associated with better outcomes.
Common factors
Some estimates attribute about 15% of improvement to specific techniques and about 30% to common factors (the relationship, expectations…), figures that are still debated.
This does not mean techniques don’t matter: effective techniques and a good relationship reinforce each other.
What makes a good therapeutic relationship
More than “getting on well”
The therapeutic relationship has its own characteristics, which set it apart from a friendship:
Mutual agreement
Goals and techniques are discussed and agreed explicitly.
Clear roles
Everything in the relationship is geared towards your well-being; my role is to put my knowledge and skills at your service.
Ethics and confidentiality
Professional confidentiality, respect for your values and rights, and no dual relationships.
A good alliance is also looked after when there are tensions: if something in therapy does not suit you, talking about it is part of the work, and adjusting course often improves the outcome.
What it brings in practice
Three reasons why I take particular care of the relationship:
Being able to talk about what is difficult
Without a safe space, it is hard to approach what hurts most or what you feel ashamed of.
Keeping up the effort
The relationship sustains motivation when change is hard or progress is slow.
Tailor-made therapy
Reviewing the therapy together allows us to adapt the approach to your needs.
The therapeutic relationship is also supported by clinical supervision with colleagues, which helps me review my work and not stay alone with my own perspective.
How I integrate it
Listening before intervening
The first sessions are for understanding you, not for applying techniques straight away.
Agreeing on the path
Goals and methods that make sense to you, clearly explained.
Reviewing together
I ask you how you are experiencing therapy and we adjust whatever is needed.
Combining it with effective techniques
The relationship is the foundation; on it I apply tools from CBT, ACT or EMDR.
I work with an integrative approach: I take from each model what is best validated and best suited to each person.
What it does not mean
It is not just talking
Listening is the foundation, but therapy has goals and a plan.
It is not a friendship
It is a professional relationship, with clear boundaries designed to protect you.
It is not always agreeing with you
Accepting you does not stop me from respectfully pointing out what may be keeping the difficulty going.
It is not improvising
Integrating approaches is based on assessment and evidence, not on intuition.
Gonzalo Garzo
Clinical psychologist · integrative approach
I have been a clinical psychologist since 2018, and I am also an anthropologist. For years I combined psychology with management positions (see my LinkedIn profile), before dedicating myself fully to clinical work.
I work with an integrative approach: third-wave CBT (ACT, DBT, mindfulness) and EMDR, adapted to each person’s needs.
I have lived in several countries and I work in English, French or Spanish, online or in La Rochelle.
Frequently asked questions
What if I don’t feel comfortable with my psychologist?
It is important to say so. Sometimes things can be adjusted; sometimes the best thing is to change professional, and that is completely legitimate.
Can online therapy allow a good relationship?
Yes. The therapeutic alliance is built by video call too, and many people even find it more comfortable.
Do you do Gestalt therapy?
No. From the humanistic approach, I mainly integrate the therapeutic attitudes and care for the relationship, which is what research supports best.
Why an integrative approach?
Because no model works the same way for everyone. Integrating allows the treatment to be adapted to each person and each difficulty.
Shall we talk?
Sources
- Bados, A. (2008). Modelos psicodinámicos, fenomenológico-existenciales y humanistas. Universidad de Barcelona.
- Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103.
- Cormier, W. H. and Cormier, L. S. (2000). Estrategias de entrevista para terapeutas. Desclée de Brouwer.
- Fernández-Álvarez, H. and Opazo, R. (2004). La integración en psicoterapia: manual práctico. Paidós.
- Flückiger, C., Del Re, A. C., Wampold, B. E. and Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340.
- Elliott, R., Bohart, A. C., Watson, J. C. and Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399-410.
- Norcross, J. C. and Lambert, M. J. (Eds.) (2019). Psychotherapy relationships that work (3rd ed.). Oxford University Press.
This page is for information only and does not replace a professional assessment.