The Therapeutic Relationship in Cognitive-Behavioral Therapy: Patient Perceptions and Therapist Responses

A working relationship between the patient and therapist is an essential part of any psychotherapy, yet few guidelines exist for this component of cognitivebehavioral treatment. Findings of therapy process and outcome research suggest that the therapeutic relationship strongly influences treatment results, and that interpersonal factors and technical applications interact in forming an effective alliance. Considering the perspective of the patient, we identify general expectations and individual differences that can have an impact on the therapeutic relationship. Individual differences are discussed in four areas of clinical interest: situational concerns; the effects of Axis I psychiatric disorders; sociocuhural influences; and personality structure and schemas. Efforts to understand the patient's perspective, based on an analysis of general expectations and individual differences, can assist therapists in optimizing the relationship component of cognitivebehavioral therapy.