The real relationship, therapist immediacy, and client experiencing level: A dyad study of psychotherapy process and connection.

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Walden, Tamara Tashiko
Gelso, Charles J
The present study examined the strength of the real relationship (RR) in relation to session quality, therapist immediacy (T-IMM), and client experiencing level (C-EXP) in six psychotherapy dyads over the course of time-limited treatment. Six clients and three therapists completed measures of RR and session quality immediately after each session. Trained judges rated the amount, appropriateness, depth, quality and resolution of T-IMM and the peak and mode level of C-EXP using audio recordings and transcripts post-treatment. This study used the Actor Partner Interdependence Model (APIM; Kenny & Cook, 1999), Structural Equation Modeling (SEM), and Hierarchical Linear Modeling (HLM) to analyze the data due to nesting and interdepence. No significant associations were detected between therapist or client ratings of RR and session quality, between therapist ratings of RR and T-IMM, or between therapist or client ratings of RR and C-EXP. Client perceptions of RR were significantly related to T-IMM rating dimensions, though not significantly related to T-IMM amount or occurrence. The results indicate that regardless of the amount, when therapist immediacy is used appropriately, with depth, quality or resolution, clients perceive stronger real relationships with their therapists. Implications for practitioners and researchers regarding the findings are discussed. In addition, due to the unique racial/ethnic minority (REM) composition of the majority of the dyads, cultural implications for research and practice are considered.