Development of a psychotherapy process prototype for the Real Relationship

Abstract

Objective

The Real Relationship (RR) describes the aspect of the psychotherapy relationship that is based on a genuine connection and a realistic view between patient and therapist. In the current study, we aimed to develop a Psychotherapy Process Q-set (PQS) prototype of the RR to facilitate post-hoc assessment of the RR in psychotherapy session recordings. We also aimed to measure the association between the RR-PQS and current PQS measures of theoretical treatment principles and the working alliance.

Method

We developed an RR-PQS prototype based on ratings of an ideal RR session by eight RR experts. We assessed the associations between the RR-PQS and existing cognitive behavioral and psychodynamic process prototypes, and seven PQS items known to predict the working alliance.

Results

RR experts agreed on the ideal RR session ratings to a high degree (ICC = 0.89). The RR-PQS was moderately related to both cognitive behavioral (r = 0.66, p < 0.01), and psychodynamic prototypes (r = 0.56, p < 0.01). PQS items predictive of the working alliance were characteristic of the RR-PQS.

Conclusion

The RR-PQS prototype appears to behave in theoretically predicted ways and may be a valid measure of the RR.

Keywords:

• Real relationship
• Psychotherapy Process Q-Set
• prototype
• observer-rated measures
• transtheoretical construct

Acknowledgements

The authors would like to thank each of the eight Real Relationship experts for providing their Psychotherapy Process Q-sort ratings for our study. They would also like to thank Charles J. Gelso for his support in the development of the project and for his feedback during conference presentations, and they would also like to thank Kenneth N. Levy for assisting us in contacting experts in the RR.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Notes

1 However, it is important to note that although the seven items of the PTIS are composed of PQS items that are characterized in negative terms (e.g., “Patient does not feel understood by the therapist”) when these items are rated negatively for a session, it reflects the opposite of the item, that the patient does feel understood, for example.