Rogers (1957; 1959) claim that the client's minimal perception of therapist empathy, unconditional positive regard and congruence as necessary and sufficient for constructive personality change has been supported equivocally. This necessary and sufficient hypothesis implies the therapeutic relationship is unilaterally therapist created via the provision of a set of specific therapeutic attitudes and delivered to the client. Recent research from the psychotherapy literature has pointed towards the role of reciprocal positive interaction between client and therapist. However, despite the common view of the therapeutic relationship as unilateral, Rogers (1959) referred to the reciprocal nature of the therapeutic conditions, therefore, suggesting the therapeutic relationship is a bidirectional process. The current study explores the mutual and reciprocal experiencing of the therapeutic conditions, their development over the early stages of the therapeutic relationship and subsequent association with an objective measure of outcome. The study analysed data relating to the quality of the mutual affective therapeutic environment from sixty two bona fide counselling/psychotherapy dyads in a naturalistic longitudinal design.
Levels of the therapeutic conditions as provided and perceived by both clients and therapists were assessed using a shortened version of the B-L RI after the first and third session and clients also completed the CORE-OM at the first and third session. The results showed that the psychotherapy was generally effective and that client s views of the quality of the therapeutic relationship were a better predictor of outcome than therapists. Test of the effect of mutual experiencing of the therapeutic conditions were carried out using hierarchical linear multiple regression. The results showed a significant interaction between client and therapist views of the quality of the therapeutic relationship at session three with outcome at session three. This suggested that the association between the client view of the relationship and outcome was stronger when both clients and therapists rated mutually high levels of the therapeutic relationship conditions provided by the therapist. This result was also present when considering the mutual levels of the therapeutic conditions that client and therapist perceived in the other.
These findings suggest that the perception of mutually high levels of the therapeutic conditions is able to predict outcome and supports the view that the mutual and reciprocal affective environment is associated with positive therapeutic change. The implications for practice are that clients must be considered as the central change agent in their own therapy. In effect, the study has shown that it is the client's own feelings towards the therapist and their interaction with how the therapist feels towards the client that is an important factor in predicting outcome. It would seem that even when clients have experienced significant psychological distress, the client's organismic striving for relationship remains and the extent this is perceived and received by the therapist is related to a positive outcome for the client. As a result of this, psychotherapy practitioners could benefit their clients by considering themselves as part of a bi-directional relational dyad. Further research is required as a result of the current findings and suggests the need to explore the nature, form and experience of mutuality within the therapeutic relationship.
A Doctoral Thesis. Submitted in partial fulfillment of the requirements for the award of Doctor of Philosophy of Loughborough University.