Considering the real relationship: Reaction to Gelso's “The real relationship in a postmodern world: Theoretical and empirical explorations”

Dr. Gelso’s work on the real relationship is a tribute to the vitality of the scientist-practitioner model. Gelso’s long clinical experience has convinced him of the importance of the real relationship in therapy and has led to the line of theory and research summarized in this issue. In his article, Gelso presents a mixed theoretical-clinical account of the real relationship followed by a summary of research based on his Real Relationship Inventory (RRI). His chief finding is that the RRI, when pitted against an alliance measure, accounts for additional variance in therapy outcome. Both these clinical data and the empirical results suggest he is on to something. What is it, and how can we best think about it? This brief critique focuses first on theory and then on measurement. Gelso’s theoretical approach to the real relationship continues a long tradition in psychotherapy research of partitioning the doings of therapy into multiple components. The most basic split is between technique and relationship. Gelso’s tripartite model of the relationship further breaks relationship into three components: alliance, real relationship, and transference. As long as we recognize that these are conceptual categories, that these are ways of looking at any given event, moment, utterance, attitude, exchange, and so on, this partitioning is fine. The problem comes when we begin to use these conceptual categories concretely. This component point of view leads us to see aspects of therapy in mutually exclusive categories, classifying specific events or actions as transference, technique, alliance, and so on. Perhaps this is understandable because we tend to think of these concepts in terms of exemplary instances, in which, for example, a focused effort is made to work on goals with the client, a specific technical move is made, or the therapist overtly expresses genuine appreciation for the client. So, for example, the classification ‘‘alliance’’ may be defined as overt efforts to engage the client in the work of therapy. Thus, activities intended to induce change in the client are technique; efforts to promote bonding, collaboration, or goal setting are alliance; attitudes and behaviors that are genuine and real are real relationship; and those that are distorted by past experience are transference. The component approach narrows our understanding of what is happening in therapy, which can be broadened by recognizing that any given activity, attitude, and so on in therapy serves multiple purposes and thus cannot, in general, belong in an exclusive category. I have been interested in this problem in the context of alliance (Hatcher & Barends, 2006), which also tends to get partitioned into specific alliance-directed attitudes or activities, separate from, for example, technique. This partitioning leads to such questions as whether technical activities or alliance activities are more influential, a question that has become a lively facet of the psychotherapy research literature. Take, for example, a 2005 qualitative study by Bedi, Davis, and Williams in which clients were asked to identify what their therapists did that most helped them feel allied and committed to the therapy. By a wide margin, they identified techniques as most helpful in this regard rather than activities classified by researchers as