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The Therapeutic Relationship in CBT for Psychosis: Client, Therapist and Therapy Factors

Published online by Cambridge University Press:  04 September 2009

Catherine Evans-Jones ,
Emmanuelle Peters  and
Chris Barker
Catherine Evans-Jones
Affiliation:
Wokingham Community Mental Health Team, Berkshire, UK
Emmanuelle Peters*
Affiliation:
King's College London, Institute of Psychiatry, and South London and Maudsley NHS Foundation Trust, UK
Chris Barker
Affiliation:
University College London, UK
*
Reprint requests to Emmanuelle Peters, Psychology, PO77, HWB, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: e.peters@iop.kcl.ac.uk Supplementary files are available online in the table of contents for this issue: http://journals.cambridge.org/jid_BCP
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Abstract

Background: This study investigated which factors are associated with the therapeutic relationship in Cognitive-Behavioural Therapy for psychosis (CBTp). Method: Measures were taken between sessions two to nine in 24 therapist-client dyads. Clients and therapists completed the Working Alliance Inventory and measures of client (gender, age, ethnicity, positive and negative symptoms of psychosis, length of illness, admissions, social contacts, employment, cognitive insight, reaction to hypothetical contradiction), therapist (empathy, expertness, attractiveness, trustworthiness, number of years qualified and previous CBTp clients seen, confidence in CBTp), and therapy (number of sessions and CBTp interventions carried out, presentation of a formulation) factors. Results: On average, clients and therapists rated the therapeutic relationship as good, with clients giving higher ratings. None of the client variables was related significantly to the quality of the relationship. However, a number of therapist and therapy factors were linked to a better therapeutic relationship, namely clients' ratings of therapist empathy, expertness, attractiveness, and trustworthiness and, at trend level, a greater number of sessions and of CBTp interventions, and the presentation of a formulation. Conclusions: These results suggest that therapists are able to develop a good therapeutic relationship with clients with psychosis, regardless of the severity of the psychosis and the confidence and experience of the therapist, although non-significant findings need interpreting with caution due to the lack of a full range of therapeutic alliances. The findings also suggest that the basic tenets of CBTp, such as empathy and collaborative goals, may be important factors for the development of the therapeutic relationship.

Keywords

Cognitive behavioural therapytherapeutic relationshippsychosis
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 37 , Issue 5 , October 2009 , pp. 527 - 540
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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