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Empirically Supported Therapy Relationships: Conclusions and
Recommendations of the Division 29 Task Force
Steering Committee1
Task Force on Empirically Supported Therapy Relationships
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Steven J. Ackerman (student member),
Lorna Smith Benjamin (University of Utah),
Larry E. Beutler (University of California - Santa Barbara),
Charles J. Gelso (University of Maryland),
Marvin R. Goldfried (SUNY - Stony Brook),
Clara Hill (University of Maryland),
Michael J. Lambert (Brigham Young University),
John C. Norcross (chair),
David E. Orlinsky (University of Chicago), and
Jackson Rainer (liaison to Publication Board)
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Conclusions of the Task Force
 The therapy relationship (as defined in Chapter 1) makes substantial and consistent contributions to
psychotherapy outcome independent of the specific type of treatment.
 Practice and treatment guidelines should explicitly address therapist behaviors and qualities that
promote a facilitative therapy relationship.
 Efforts to promulgate practice guidelines or evidence-based lists of effective psychotherapy without
including the therapy relationship are seriously incomplete and potentially misleading on both clinical
and empirical grounds.
 The therapy relationship acts in concert with discrete interventions, patient characteristics, and
clinician qualities in determining treatment effectiveness. A comprehensive understanding of effective
(and ineffective) psychotherapy will consider all of these determinants and their optimal combinations.
 Adapting or tailoring the therapy relationship to specific patient needs and characteristics (in
addition to diagnosis) enhances the effectiveness of treatment.
 The following list embodies the Task Force conclusions regarding the empirical evidence on
General Elements of the Therapy Relationship primarily provided by the psychotherapist. Definitions
and examples of each element are provided in the respective chapters.
Demonstrably Effective
Therapeutic Alliance
Cohesion in Group Therapy
Empathy
Goal Consensus and Collaboration
Promising and Probably Effective
Positive Regard
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Congruence/Genuineness
Feedback
Repair of Alliance Ruptures
Self-Disclosure
Management of Countertransference
Quality of Relational Interpretations
 The following list embodies the Task Force conclusions regarding the empirical evidence on
Customizing the Therapy Relationship to Individual Patients on the basis of patient behaviors or
qualities. For example, clients presenting with high resistance have been found to respond better to
self-control methods and minimal therapist directiveness, whereas patients with low resistance
experience improved outcomes with therapist directiveness and explicit guidance. Definitions and
examples of the following patient characteristics are provided in the respective chapters.
Demonstrably Effective as a Means of Customizing Therapy
Resistance
Functional Impairment
Promising and Probably Effective as a Means of Customizing Therapy
Coping Style
Stages of Change
Anaclitic/Sociotropic and Introjective/Autonomous Styles
Expectations
Assimilation of Problematic Experiences
 Current research on the following patient characteristics is insufficient for a clear judgment to be
made on whether customizing the therapy relationship to these characteristics improves treatment
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outcomes. Definitions and examples of the following patient characteristics are provided in the
respective chapters.
Attachment Style
Gender
Ethnicity
Religion and Spirituality
Preferences
Personality Disorders
 The preceding conclusions do not by themselves constitute a set of practice standards, but represent
current scientific knowledge to be understood and applied in the context of all the clinical data
available in each case.
Recommendations of the Task Force
General Recommendations
1. We recommend that the findings and conclusions of this Task Force be widely disseminated in
order to enhance awareness and use of what “works” in the therapy relationship.
2. At the same time, readers are encouraged to interpret these findings in the context of the
limitations of the Task Force’s work, as explicated in the opening chapter of this report.
3. These findings and conclusions represent initial steps in aggregating and codifying available
research. We recommend that future Task Forces be established periodically to review these
findings, include new elements of the relationship, incorporate the results of non-English
publications (where practical), and update the conclusions.
Practice Recommendations
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4. Practitioners are encouraged to make the creation and cultivation of a therapy relationship
characterized by the elements found to be demonstrably and probably effective in this report a
primary aim in the treatment of patients.
5. Practitioners are encouraged to adapt the therapy relationship to specific patient characteristics
in the ways shown in this report to enhance therapeutic outcome.
6. Practitioners are encouraged to routinely monitor patients’ responses to the therapy relationship
and ongoing treatment. Such monitoring leads to increased opportunities to repair alliance
ruptures, to improve the relationship, to modify technical strategies, and to avoid premature
termination.
7. Concurrent use of empirically supported relationships and empirically supported treatments
tailored to the patient’s disorder and characteristics is likely to generate the best outcomes.
Training Recommendations
8. Training programs in psychotherapy are encouraged to provide explicit and competency-based
training in the effective elements of the therapy relationship.
9. Accreditation and certification bodies for mental health training programs are encouraged to
develop criteria for assessing the adequacy of training in empirically supported therapy
relationships in their evaluation process.
10. Both graduate training and continuing education programs are encouraged to offer modules on
empirically supported therapy relationships and on systematically adapting the therapy
relationship to the individual patient.
Research Recommendations
11. Researchers are encouraged to examine the specific mediators and moderators of the links
between demonstrably effective relationship elements and treatment outcome.
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12. Researchers are encouraged to progress beyond experimental designs that correlate frequency
of relationship behaviors and outcome measures to methodologies capable of examining the
complex associations among patient qualities, clinician behaviors, and therapy outcome.
13. Researchers are encouraged to avoid a “therapist-centric” view of the therapeutic relationship
and to study both patients’ and therapists’ contributions to the relationship and the ways in
which those contributions combine to impact treatment outcome.
14. Although the cumulative research convincingly shows that the therapy relationship is crucial to
outcome, relatively little is known about how to create and sustain the relationship and about
why the relationship works. These are vital questions for future research.
15. Observational perspective (i.e., therapist, patient, or external rater) is a fundamental
consideration that ought to be addressed in future studies and reviews of “what works” in the
therapy relationship. Agreement among observational perspectives provides a solid sense of
established fact; divergence among perspectives holds important implications for clinical
practice.
16. Since many of the important variables reviewed in this report are not subject to randomization
and experimental control, we recommend that standard research paradigms include the use of
rigorous qualitative methods and statistically controlled correlational designs.
Policy Recommendations
17. The APA Division of Psychotherapy is encouraged to educate its members and leaders in the
benefits of empirically supported therapy relationships.
18. Mental health organizations as a whole are encouraged to educate their members about the
improved outcomes associated with using empirically supported relationships along with
evidence-based methods.
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19. Finally, we recommend that the APA Division of Psychotherapy and mental health
organizations advocate for the research-substantiated benefits of a facilitative and individually
responsive human relationship in psychotherapy.