Differential Formation of the Relationship in Behavioral Therapy: On the Road to an Evidence- Based Personalized Shaping of the Therapeutic Relationship

Abstract

Initially, the role of therapeutic relationship and associated factors was almost completely ignored in the early days of behavioral therapy (BT) and the "cognitive revolution". However, the importance of the relationship between therapist and patient especially in clinical daily routine was also recognized relatively early in BT. Since then, BT has developed substantially. In particular, the active shaping of the therapeutic relationship as a function of various variables has become an integral part of every BT. In this review, concepts of relationship formation are presented that are attributed to cognitive-behavioral therapy and are taught as part of the psychotherapy training in German-speaking countries, focusing on the following three aspects: the orientation of the relationship towards (1) therapy phases, (2) needs, motives and expectations, and (3) childhood maltreatment. The current state of research suggests that generalized recommendations for action do not go far enough to actively shape the therapeutic relationship. Based on the individual problems of each patient, the realization of the therapeutic relationship in the sense of a differential relationship is described and discussed.