Development of a new observer-rated measure to assess the real relationship in psychotherapy sessions

Abstract

Objectives

Real relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions.

Methods

We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores.

Results

The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance.

Conclusion

The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome.

Keywords:

• real relationship
• therapeutic relationship
• therapeutic alliance
• observer-rated measure
• measure development

Acknowledgements

The authors are grateful to Charles J. Gelso for his expert support during the process of developing the real relationship observer rated measure. We also want to express our sincere gratitude to the patients who allowed their psychoanalytic treatment sessions to be audio recorded. We could not have done this research without their generosity. We are also grateful for our students who coded the sessions and provided helpful comments for developing the coding manual. And lastly, we wish to acknowledge our debt to the Psychoanalytic Research Consortium (www.psychoanalyticresearch.org) whose dedication to providing materials to researchers to facilitate research into long-term treatments made this study possible. The authors are grateful for the students in Vera Bekes' and Katie Aafjes-van Doorn's research labs for coding the transcripts, and for Federica Genova Francesco Gazzillo for reviewing a previous version of the manuscript.

Disclosure Statement

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

Supplemental Data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10503307.2024.2360459.