WHEN THERAPY RELATIONSHIPS MAKE A DIFFERENCE: CORRECTIVE RELATIONAL EXPERIENCES OF ADULT CLIENTS IN OPEN-ENDED INDIVIDUAL PSYCHOTHERAPY

Abstract

The present study examined the antecedents, types, and consequences of Corrective Relational Experiences (CREs), as well as whether these aspects of CREs (antecedents, types, and consequences) differ depending on client attachment anxiety and avoidance. Clients completed a measure of adult attachment (Experiences in Close Relationships scale; ECR; Brennan, Clark, & Shaver, 1998) before starting open-ended, individual psychotherapy at a psychodynamic-interpersonal therapy clinic. After completion of therapy, 31 clients completed post-therapy interviews assessing their therapy experience, including the occurrence and nature of CREs. Interviews were analyzed qualitatively using CQR (Hill, Thompson, & Williams, 1997; Hill et al., 2005; Hill, 2012). Results indicated that CRE antecedents typically included both positive client-therapist relationships as well as difficulties in therapeutic relationships. Therapists typically facilitated CREs by identifying or questioning client behavior patterns, as well as conveying profound trustworthiness (deep care, understanding, nonjudgmentalness, or credibility). Types of corrective shifts typically involved clients gaining a new understanding of behavior patterns or the therapist/therapy. Consequences of CREs generally included improvements in the therapy relationship, and improvements in the clients' intrapersonal well-being. Clients who did not have CREs variantly wished their therapist's theoretical orientation was a better match, while none of the clients who had CREs did so. Non-CRE clients had lower pre-therapy attachment anxiety and avoidance in comparison to clients who reported CREs. Antecedents, types, and consequences of CREs differed depending on client attachment anxiety and avoidance. Clients with high attachment anxiety seemed to have a greater interpersonal focus (e.g., indicated enacting their maladaptive behavior patterns with therapists prior to the CRE, had CREs focused on understanding clients' behavior patterns) while clients high in attachment avoidance seemed to have a greater intrapersonal focus (reported more client facilitators of CREs, especially deep disclosure prior to CREs, and more reduction in unwanted feelings after CREs). Implications for practice and research are discussed.