Only for Grade

Relational-Cultural Therapy: Theory, Research, and Application to
Counseling Competencies

Lisa L. Frey
University of Oklahoma

An overview of relational-cultural theory and Relational-Cultural Therapy (RCT) is provided. First, a
summary of the overarching framework for relational-cultural theory is offered. The theory’s roots in
feminist and psychodynamic theories are discussed, along with distinguishing aspects of relational-
cultural theory. The practice of RCT is reviewed, including research support regarding assumptions,
practice applications, and effectiveness. The unique role that teaching RCT can play in building
counseling competencies is explored with a focus on competencies related to therapeutic relationship-
building skills and awareness of individual-cultural diversity. It is contended that RCT can provide an
organized, systematic structure for the development of therapeutic relationship-building skills and a
framework on which to build when asking counseling trainees to reflect on issues of power, privilege,
oppression, and marginalization, including the ways in which those issues influence counseling. Specific
examples are provided to illustrate the application of RCT in fostering these counseling competencies.

Keywords: relational-cultural theory, counselor training, counseling competencies, cultural diversity,
therapeutic relationship skills

In writing about the training and practice implications of con-
textual models of therapy, Wampold (2001) emphasized that the-
oretical approaches to counseling must be grounded in psycholog-
ical principles and knowledge. Furthermore, there has been a
recent call within professional psychology to teach and measure
trainee competencies, including relationship and interpersonal
skills and awareness of individual-cultural diversity (e.g., Assess-
ment of Competency Benchmarks Work Group of the American
Psychological Association Board of Educational Affairs, 2007;
Hatcher & Lassiter, 2007; Norcross, 2010). Therefore, the overar-
ching purposes of this article are to review the psychological
foundations of Relational-Cultural Therapy (RCT), which is a
theoretical orientation that is garnering increasing attention within
the field of psychology, and to explore what the teaching of RCT
has to offer in building the counseling competencies of trainees.
First, the RCT framework and its empirical support will be pre-
sented, followed by an exploration of teaching implications related
to building counseling competencies.

The Theory and Practice of RCT

Relational-Cultural Theory

Overarching framework. Above all, RCT is a feminist ther-
apeutic approach. Enns (2004) outlined principles common to all
approaches to feminist counseling. These principles support the
welfare of all clients and include (a) privileging client perspectives
and lived experiences and viewing clients as capable collaborators
in moving toward strength-based change; (b) emphasizing an
egalitarian client-counselor relationship, along with a concurrent
awareness of the impact of power differentials related to the
counselor and client roles; (c) valuing diversity, with an emphasis
on exploring the complexity of intersecting social and cultural
identities and therapist self-reflection regarding personal privilege
and its impact on the counseling process and relationship; (d)
modeling and fostering personal, interpersonal, and sociopolitical
empowerment (Morrow & Hawxhurst, 1998); and (e) focusing on
change rather than adjustment as the goal of counseling, with an
emphasis on the overlap between personal issues and broader
sociopolitical and socioeconomic considerations (see Enns, 2004,
pp. 19 – 42 for a discussion of all principles). While specific
feminist theoretical orientations may vary in the degree to which
each principle is emphasized (Enns, 2004), the principles provide
a framework encompassing all feminist therapies, including RCT.

Although the assumptions of RCT are congruent with multicul-
tural counseling (e.g., importance of interdependence, counselor
self-reflection, and awareness of oppression), it is important to
note that cultural competence is the foundation to providing effec-
tive multicultural counseling (Sue & Sue, 2003). For instance,
RCT’s focus on interdependence and contextualism is compatible
with more collectivistic values. In discussing the application of
relational-cultural theory to African American women, Enns
(2004) noted, “With sensitivity to culture and daily challenges of

LISA L. FREY, PhD, is an Associate Professor in the Counseling Psychology
Program at the University of Oklahoma and the Director of the University
of Oklahoma Counseling Psychology Clinic. She is also a faculty member
in Women’s and Gender Studies. Her professional and research interests
focus on gender socialization, relational development, sexual orientation
and gender expression, sexual assault, and advocacy and community en-
gagement.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lisa L.
Frey, Department of Educational Psychology, University of Oklahoma,
820 Van Vleet Oval, Room 321, Norman, OK 73019-2041. E-mail:
melissa.frey-1@ou.edu

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Professional Psychology: Research and Practice © 2013 American Psychological Association
2013, Vol. 44, No. 3,

177

–185 0735-7028/13/$12.00 DOI: 10.1037/a0033121

177

women of color, the relational-cultural themes of this model can be
integrated with African American values that emphasize interde-
pendence, collective goals, and a unifying spiritual orientation”
(pp. 183–184). Despite this congruence, however, it is cultural
competence that provides counselors with the awareness, knowl-
edge, and skill to ethically and effectively work with diverse
clients.

RCT also has roots in psychodynamic approaches. A review of
seven central features that differentiate contemporary psychody-
namic process and technique from other therapies (Blagys &
Hilsenroth, 2000) shows that these features apply to the practice of
RCT. For instance, therapeutic interventions focused on affect and
emotional expression, interpersonal relations, and identification of
traumatic and/or troubling life experiences (Blagys & Hilsenroth,
2000) are descriptive of both psychodynamic and RCT practice.
Arguably RCT differs from traditional psychodynamic theory in
terms of certain underlying principles (e.g., feminist underpin-
nings, social justice focus, emphasis on development through
relationship vs. individuation and autonomy) but is congruent with
the central features of contemporary psychodynamic theoretical
approaches, particularly in terms of process.

Distinguishing theoretical assumptions of Relational-
Cultural Theory. The relational-cultural theoretical foundation
is built on the assumption that meaningful, shared connection with
others leads to the development of a healthy “felt sense of self”
(Jordan, 1997, p. 15). Contrary to traditional models based on the
“myth of the separate self” (Jordan, 2010, p. 2)—that is, consider
separation-individuation to be the primary path to self-
development—relational-cultural theory proposes that differentia-
tion and growth of the felt sense of self develops through mean-
ingful and mutual connections with others (Miller & Stiver, 1997).
Psychological health and maturity are conceptualized as continu-
ally evolving throughout the life span via increasing relational
complexity and mutuality, rather than through increasing separa-
tion and autonomy (Jordan, Kaplan, Miller, Stiver, & Surrey,
1991). This core assumption is more complex, and more challeng-
ing to traditional models, than it initially appears. Consider, for
example, the development of intimacy. Traditional models of
psychological development view separation-individuation of the
self as the prerequisite to the ability to achieve relationship inti-
macy. Relational-cultural theory, on the other hand, asserts that
intimate relationships are the conduit to the development of the
sense of self. That is, interdependence rather than independence is
the developmental pathway to intimacy and to an increasingly
complex felt sense of self.

In view of relational-cultural theory’s emphasis on relatedness,
four characteristics that represent central aspects of growth-
fostering relationships are delineated: (a) mutual engagement and
empathy, defined as mutual involvement, commitment, and sensi-
tivity in the relationship, including a willingness to impact and to
be impacted by another person; (b) authenticity, defined as the
freedom and capacity to represent one’s feelings, experiences, and
thoughts in the relationship, but with an awareness of the possible
impact of this authenticity on the other person; (c) empowerment,
defined as the capacity for action and sense of personal strength
that emerges from the relationship; and (d) the ability to express,
receive, and effectively process diversity, difference, and/or con-
flict in the relationship, and to do so in a way that fosters mutual
empowerment and empathy (Jordan, 2010; Liang, Tracy, Taylor,

Williams, Jordan, & Miller, 2002; Miller & Stiver, 1997). In
relational-cultural terms, connection occurs in relationships that
incorporate these four relational characteristics; disconnection,
which can be situational or chronic, occurs when these character-
istics are not present (Jordan, 2010). It is theorized that the chronic
absence of these qualities in important relationships results in a
pervasive lack of interpersonal connection and a sense of isolation
leading to distress (Jordan & Dooley, 2001; Miller, 1986). Further,
it results in the internalization of negative and growth-inhibiting
relational images (i.e., inner pictures or templates for relationship;
e.g., Jordan, 2010; Miller & Stiver, 1997).

A key tenet of relational-cultural theory is the “central relational
paradox” (Miller & Stiver, 1997, p. 81). Because some individuals
encounter chronic and serious disconnections in relationships, they
learn to keep feelings, experiences, and/or thoughts out of rela-
tionships, thus sacrificing authenticity and mutuality to experience
some semblance of acceptance and safety (Miller & Stiver, 1997).
For example, an individual with a history of childhood abuse might
withhold important feelings in significant adult relationships be-
cause of fears of further abuse or abandonment. Such survival
mechanisms are labeled by Miller and Stiver as “strategies of
disconnection” (p. 106). Use of these strategies, although not
necessarily consciously applied, allow an illusion of connection
(Walker, 2004a). Caught in the struggle between the need to
self-protect and the need for authentic relationship, the individual
yearns for and yet is terrified by genuine connection, resulting in
the central relational paradox (Miller & Stiver, 1997; Walker,
2004a).

The influence of Western sociocultural norms on sex role de-
velopment is incorporated throughout relational-cultural theory.
Although originally developed to explain women’s psychological
growth, research and theory have extended the application to men
(e.g., Bergman, 1995; Cochran, 2006; Frey & Dyer, 2006; Frey,
Beesley, & Miller, 2006; Frey, Beesley, & Newman, 2005; Frey,
Tobin, & Beesley, 2004; Vasquez, 2006). For instance, Bergman
suggested that men’s identity and self-esteem are socioculturally
shaped through a process of fostering competition or comparison
with others at the expense of healthy relational development.
Cochran also pointed out the influence of Western culture in
limiting men’s options for coping in healthy ways with loss and
sadness and emphasized the applicability of RCT in addressing
this issue therapeutically. Feminist scholars have long underscored
the cost to men of cultures built on patriarchal privilege. Although
men may not be directly exploited or oppressed by sexism and
patriarchy, they suffer consequences as a result of it (Hooks,
2000).

It is important to keep in mind, however, that the intent of
relational-cultural theory is to underscore the cost of all rigidly
imposed sex role standards. That is, the theory goes well beyond
any suggestion that women should be idealized. In response to the
sociocultural expectation that men will be autonomous and inde-
pendent, men may sacrifice relational skill development (Berg-
man, 1995). In contrast, women, who are generally expected to
carry primary relational responsibility, may sacrifice authenticity
to maintain relationships (Brown & Gilligan, 1992; Miller, 1986).

Although relational-cultural theory has been criticized because
the initial development was primarily based on the experiences of
White, middle class women (Enns, 2004), the theory and practice
of RCT has since been expanded to incorporate a more explicitly

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178 FREY

multicultural and social justice perspective (e.g., Adams, 2004;
Comstock et al., 2008; Jenkins, 2000; Turner, 1997; Vasquez,
2006; Walker, 2004a, 2004b). This growth is reflective of the
theory’s feminist roots and focus on the impact of oppression,
marginalization, and social stratification. Congruent with the as-
sumptions of relational-cultural theory, the applicability of tradi-
tional models based on separation-individuation to ethnic minori-
ties and women has long been questioned (e.g., Choi, 2002;
Gilligan, 1982; Green, 1990; Josselson, 1988). Walker (2004a)
observed that when separation and individuation are accepted as
the standards for psychological health and maturity, the develop-
mental experiences and cultural worldviews of many groups and
individuals, regardless of sex, are marginalized and pathologized.

The Practice of RCT

The practice of RCT emphasizes the critical role of the coun-
seling relationship and relational tools in healing. RCT does not
detail a list of specific techniques for implementing the framework,
but instead provides an orienting rationale and structure for how
relational tools can be applied.

Frey and Dyer (2006) pointed out that application of the
relational-cultural framework does not preclude the use of strate-
gies or techniques originating from other theoretical orientations.
For instance, Frey and Dyer described the application of RCT to
the restructuring of thinking errors about behavioral accountability
with male adolescents who engaged in sexually coercive behavior,
stating, “Often accountability is pursued [in therapy with sexually
aggressive adolescents] via confrontive or even punitive and sham-
ing interventions. From the perspective of the relational-cultural
model, accountability and responsibility are reframed as essential
to relational respect . . .” (p. 247). Thus, the expectation of ac-
countability is reframed in relational terms; the message is that the
youth has the capacity to be accountable and to move beyond past
actions to reconnection with self and others. In addition, it re-
frames accountability as resulting in relational respect and empow-
erment.

Jordan (2010) summarized the core components of RCT as: (a)
working with relational connections and disconnections, including
therapist commitment to working through disruptions in the ther-
apeutic relationship; (b) focusing on the development of mutual
empathy, including self-empathy; (c) working through and restruc-
turing negative relational images; (d) therapist responsiveness,
authenticity, and willingness to be impacted by the client; (e)
fostering relationship resilience; and (f) validating and incorporat-
ing clients’ cultural and social contexts. Congruent with the focus
of RCT, traditional psychotherapeutic constructs (e.g., counter-
transference, transference, resistance) are reconceptualized in re-
lational and strength-based terms (Miller & Stiver, 1997). For
instance, it is proposed that the function of resistance is to protect
the individual from authentic connection; that is, it is a strategy of
disconnection (Miller & Stiver, 1997). Transference is viewed as a
naturally occurring relational process emerging from relational
images that are inevitably threaded throughout relationships.
Counseling provides a setting in which the client and counselor
can explore and reprocess these images, particularly isolating
relational templates (Miller & Stiver, 1997).

Research Support for RCT

Support for RCT’s Theoretical Framework

There is considerable research regarding the contribution of
relational qualities such as belongingness, social connectedness,
authenticity, mutuality, and loneliness to psychological adjustment
(e.g., Kayser, Watson, & Andrade, 2007; Lee, Keough, & Sexton,
2002; Lee & Robbins, 1998; Lee & Robbins, 2000; Swift &
Wright, 2000). The development of measures operationalizing
these qualities as defined by relational-cultural theory, however,
has permitted more specificity in testing the central assumptions of
the framework. For example, the Relational Health Indices (RHI;
Liang et al., 2002) is a self-report scale developed to measure the
qualities of engagement, authenticity, and empowerment in peer,
community, and mentor relationships. Factor analysis of the RHI
has confirmed a similar three-factor structure (i.e., peer, commu-
nity, and mentor subscales; Frey et al., 2005; Liang et al., 2002) for
both women and men (Frey et al., 2005). The Mutual Psycholog-
ical Development Questionnaire (MPDQ; Genero, Miller, & Sur-
rey, 1992; Genero, Miller, Surrey, & Baldwin, 1992) is a self-
report scale developed to measure the perceived bidirectionality in
relationship mutuality. The MPDQ operationalizes the construct of
mutuality through the lens of relational-cultural theory. That is,
mutuality is understood as a bidirectional relational process in-
volving a shared willingness to be impacted and changed by the
other, as well as a growing willingness to participate authentically
and fully in the relationship (Jordan, 2010; Miller & Stiver, 1997).

A third instrument, the Connection-Disconnection Scale (CDS;
Tantillo & Sanftner, 2010) is a scenario-based, self-report instru-
ment for women with eating disorders that measures relationship
mutuality. Last, Hartling and Luchetta (1999) developed the Hu-
miliation Inventory (HI), which conceptualizes the consequence of
humiliation as involving chronic and overwhelming disconnection
leading to psychological and behavioral dysfunction.

Research regarding central constructs and assumptions.
As noted, the development of instruments operationalizing
relational-cultural constructs has supported more focused testing
of the theory. For example, Liang, Tracy, Taylor, and Williams
(2002) investigated the assumption that relational quality rather
than structural components of relationships (i.e., sex and ethnicity
match, frequency, and duration of contact) is the most significant
contributor to growth in relationships. Liang et al. found that
mentoring relationships characterized by authenticity, engage-
ment, and empowerment significantly predicted higher self-esteem
and less loneliness in college women beyond that predicted by
structural variables.

Frey et al. (2004) conducted a study testing relational-cultural
theoretical assumptions, including that a lack of relational quality
predicts increased psychological distress, in contrast to the tradi-
tional view that psychological distress leads to impaired relation-
ship quality. Consistent with relational-cultural theory, increased
relational quality predicted decreased distress. In addition, the
relational predictors accounted for significant variance even after
that accounted for by troubling family experiences, suggesting that
engaged and authentic peer and/or community relationships may
buffer or ameliorate the impact of problematic family experiences.
Subsequently, Frey et al. (2006) examined the relational-cultural
theoretical assumption that relational complexity continues to

179RELATIONAL-CULTURAL THERAPY

evolve through the life span, proposing that childhood attachment
is important but not sufficient in understanding relational health
and psychological adjustment. Congruent with the relational-
cultural framework, relational health predicted significant variance
beyond that accounted for by attachment, suggesting that ongoing
experiences of relational connection may mitigate attachment in-
security and lack of parental support (Frey et al., 2006). In partic-
ular, the results of both studies supported relational-cultural as-
sumptions that conceptualize relational development as “(a)
ongoing, active, and reciprocal and (b) involving continual elab-
oration about the meaning of relationships . . .” (Frey et al., 2006,
p. 308).

Of note is that both of the Frey et al. (2004, 2006) studies found
that predictive patterns differed for women and men. That is,
decreased psychological distress was predicted by community (i.e.,
group) relational health in men and women; peer (i.e., dyadic)
relational health was an additional predictor only for women. It
was concluded that these gendered patterns supported assumptions
of the relational-cultural framework (e.g., Bergman, 1995). Spe-
cifically, the results suggested that college men’s socialized need
for autonomy and status may be met through membership in the
community where they may experience a sense of belonging
without the risk of personal dyadic intimacy. However, women
may have the additional buffer of positive peer relationships when
experiencing problems in the community domain (and vice versa)
(Frey et al., 2006).

Spencer, Jordan, and Sazama (2004) applied a qualitative focus
group methodology in exploring the applicability of relational-
cultural theory to urban and suburban, racially and ethnically
diverse youths’ relationships with important adults. Major themes
identified included mutuality, respect, authenticity, and active en-
gagement as core characteristics of positive relationships. The
significance of mutuality in overcoming the power differential
existing between youth and adults was also identified. Spencer et
al. concluded that the themes reflected the four central character-
istics of growth-fostering relationships that have been identified in
relational-cultural theory.

Research examining practice applications. A number of
theoretical articles have focused on exploring the application of
RCT approaches to specific treatment populations, including
individuals with eating disorders (Trepal, Boie, & Kress, 2012),
individuals with self-injurious behaviors (Trepal, 2010), Latina
immigrants (Ruiz, 2012), and young adolescents (Tucker, Smith–
Adcock, & Trepal, 2011). Likewise, empirical studies exploring
RCT applications tend to be focused on specific treatment groups.

In a series of studies examining RCT approaches to individuals
with disordered eating, Sanftner, Tantillo, and Seidlitz (2004) first
explored mutuality in close relationships in a sample of eating
disordered women and concluded that disconnections in relation-
ships played a role in eating disorders. Sanftner et al. (2006) then
applied the relational-cultural framework in examining associa-
tions between college women’s eating disordered behaviors and
mutuality with mothers, fathers, and romantic partners. As ex-
pected, low mutuality predicted eating disordered beliefs, attitudes,
and behaviors, even after controlling for the level of emotional
involvement and perceived disapproval of parents and romantic
partners. Subsequently, Sanftner, Ryan, and Pierce (2009) inves-
tigated the relationship between body image and mutuality in
college women and men from the perspective of relational-cultural

theory. For both men and women, low mutuality with mothers and
fathers was associated with body dissatisfaction; for women, low
mutuality with romantic partners was also associated with body
dissatisfaction. It was concluded that results of these studies were
consistent with relational-cultural assumptions proposing that low
mutuality leads to relational images supporting eating disordered
attitudes and/or poor body image.

Sormanti, Kayser, and Strainchamps (1997) and Kayser, Sor-
manti, and Strainchamps (1999) investigated assumptions of the
relational-cultural framework in regard to women’s adjustment to
cancer. Specifically, the influence of mutuality, relationship be-
liefs, and relational coping strategies on psychosocial adjustment
were examined. Sormanti et al. found that beliefs about silencing
the self and the importance of prioritizing others’ needs over one’s
own were related to decreased health-related self-care behaviors.
Likewise, Kayser et al. found that mutuality in partner relation-
ships was related to improved quality of life and decreased de-
pression, and that mutuality and decreased silencing of the self
were related to increased agency in performing essential self-care.

Last, a home-based support program specifically designed to
implement the relational-cultural framework in working with at-
risk mothers was examined qualitatively by Paris and Dubus
(2005). Participants identified feeling more connected, cared for,
validated, and able to care for their infants as a consequence of
their relationships with their in-home support workers. Paris, Gem-
borys, Kaufman, and Whitehill (2007) offered a comprehensive
analysis of the program and attributed its effectiveness to the
well-defined relational-cultural treatment approach. This frame-
work provided direction for training and supervision, and gave
structure to in-home support workers regarding strategies for de-
veloping authentic and empowering relationships with the moth-
ers.

Research on RCT Effectiveness

RCT outcome research. There are a limited number of out-
come studies examining applications of RCT, although two studies
have shown promising results. First, Oakley, Addison, and Piran
(2004) conducted an outcome study applying a time-limited,
manualized RCT model to women receiving psychotherapy ser-
vices in a community-based setting. The study utilized both quan-
titative and qualitative methodology, with data collected on five
occasions between initial screening and 6 months posttreatment.
Participants reported (a) significant improvement between pre-
therapy and posttherapy on measures of depression, anxiety, alex-
ithymia, self-silencing, self-esteem, and psychological well-being;
(b) significant attainment of treatment goals; (c) maintenance of
gains at 3 month and 6 month follow-ups; and (d) strong satisfac-
tion related to the RCT model, the therapeutic relationship, and
personal gains.

An additional outcome study comparing short-term cognitive-
behavior therapy (CBT) and RCT groups for women diagnosed
with bulimia nervosa or binge-eating disorder was conducted by
Tantillo and Sanftner (2003). Participants were randomly assigned
to the groups, both of which provided a manualized, 16-week
intervention. Data on frequency of binge episodes, frequency of
vomiting episodes, bulimic behaviors, depression, and mutuality
was collected on five occasions between baseline and 12 months
posttreatment. Tantillo and Sanftner reported the groups were

180 FREY

equally effective, although participants in the RCT group reported
higher levels of perceived mutuality with the group.

Other applicable effectiveness research. Support for core
RCT assumptions underscoring the centrality and healing function
of relationships in human development is also emerging from the
fields of social neuroscience and interpersonal neurobiology.
Scholars in these fields (e.g., Cozolino, 2006; Schore, 1994; Sie-
gel, 1999) apply data from neuroscience, including research on
neural systems, to the development of interpersonal relationships.
Research on mirror neurons, the facial recognition system, lifelong
neuroplasticity and neurogenesis, and the social functions of brain
structures, for example, support the contention of interpersonal
neurobiologists that “It is the power of being with others that
shapes our brain” (Cozolino, 2006, p. 9). Referring to applied
psychology, Cozolino emphasized the importance of a therapeutic
relationship characterized by empathy, attunement, and interper-
sonal resonance, noting, “An intimate relationship with the thera-
pist reactivates attachment circuitry and makes it available to
neuroplastic processes” (p. 308).

Future Directions for Research

Research results examining the relational-cultural theoretical
framework are promising. In view of the correlational nature of
some of the research, however, limitations exist regarding assum-
ing causality. Also of note is that samples have largely focused on
female and/or male college-age participants or women with special
needs (e.g., dealing with cancer, at-risk mothers). Research designs
testing application of the theoretical framework to diverse individ-
uals, especially those in a community setting, would add to the
literature base.

Likewise, results of the existing outcome research on RCT are
encouraging, although further research focusing on clinical out-
come is needed. This is not particularly surprising given that the
model is relatively new. Outcome studies related to the application
of RCT with men as well as women would support expansion of
RCT; this point is particularly salient in view of evidence that RCT
is being increasingly applied to psychotherapy with men (e.g.,
Cochran, 2006; Vasquez, 2006).

Given the increasing attention to RCT in the field, the expansion
of relevant scholarly literature, and the unique aspects of the
theory, a consideration of what RCT has to offer in a training
context is warranted. In particular, the contribution that RCT can
make in building counseling competencies may provide helpful
guidance to clinical instructors and supervisors.

Teaching Implications

The Practicum Competencies Workgroup of the Association of
Directors of Psychology Training Clinics (ADPTC, 2006)1, incor-
porating input by the Council of Chairs of Training Councils
Practicum Competencies Workgroup, produced a document out-
lining baseline competencies and competency domains and related
skills that form the basis for psychology practicum training and
skill assessment (see Hatcher & Lassiter, 2007, for details regard-
ing development). This document identifies the development of
productive relationships with clients and their families, and with
colleagues, supervisors, support staff, and community profession-
als, as “a cornerstone of professional psychology” (pp. 7– 8). The

importance of developing respectful and effective relationships as
an indicator of readiness for practicum, internship, and entry to
practice is also emphasized by the Assessment of Competency
Benchmarks Work Group of the American Psychological Associ-
ation Board of Educational Affairs (2007). For instance, the
Benchmarks document includes skills such as “effectively negoti-
ates conflictual, difficult, and complex relationships including
those with individuals and groups that differ significantly from
oneself . . . maintains satisfactory interpersonal relationships . . .
(and) negotiates differences and handles conflict satisfactorily;
provides effective feedback to others and receives feedback non-
defensively . . .” (see Relationships domain, sections A & B,
Fouad et al., 2009, p. S12) as core competencies indicating read-
iness for practicum and internship.

Furthermore, the Council of Counseling Psychology Training
Programs’ (CCPTP; 2006) Model Training Values Statement Ad-
dressing Diversity highlights the importance of creating and fos-
tering a multicultural training environment in which all individuals
are valued and accepted. Thus, an additional aspect of training in
psychology is learning about and appreciating all human diversity.
The recognition of intersectionality, that is, that all individuals
have multiple and intersecting cultural and/or social identities is
key to understanding the complexity of relationships with clients
and colleagues. As supported by our profession’s ethical princi-
ples, psychologists are expected to be culturally competent, to
examine the effects of oppression and privilege, and to eliminate
the effects of biases from their work. The competencies outlined
by ADPTC (2006) and the Assessment of Competency Bench-
marks Work Group of the American Psychological Association
Board of Educational Affairs (2007) highlight specific training
competencies related to working with diverse others and develop-
ing an awareness of one’s own social and cultural identities.

RCT and Therapeutic Relationship-Building
Competencies

The importance of exposing student counselors to a variety of
theoretical orientations and therapeutic interventions is undeniable.
Fostering the development of critical thinking skills and exposure
to the scholarly literature regarding common factors models
(Wampold, 2001, 2010), multicultural counseling competencies,
culturally sensitive treatments, empirically supported relationships
(Norcross, 2002), empirically supported treatments, and a range of
counseling theories will enable students to not only build success-
ful professional careers but to have a sound framework from which
to continue to build competencies. Scholars have also called at-
tention to the central importance of teaching relationship develop-
ment skills. For instance, Wampold stated that “. . . the emphasis
in training should be placed on core therapeutic skills, including
empathic listening and responding, developing a working alliance,
working through one’s own issues, understanding and conceptu-
alizing interpersonal and intrapsychic dynamics, and learning to be
self-reflective about one’s work” (p. 230). Norcross (2010)
stressed the importance of psychology training programs providing
“explicit training in the effective elements of the therapy relation-
ship” (p. 134). Similarly, Cozolino (2006) stated:

1 Please note that this organization has recently been renamed to the
Association of Psychology Training Clinics, or APTC.

181RELATIONAL-CULTURAL THERAPY

Therapists tend to undervalue the impact of the human relationship as
they focus on diagnostics, treatment strategies, and management is-
sues. The research suggests that the training of therapists should
include more emphasis on skills related to resonance, attunement, and
empathic aspects of treatment. . . . This is not to say that the technical
aspects of therapy are unimportant, but rather to counterbalance the
trend toward understanding psychotherapy as a set of interventions we
do to clients, with a relationship we have with clients (Cozolino, 2004)
(pp. 311–312)

This guidance provides a persuasive rationale for teaching RCT
skills, whether or not counseling trainees embrace RCT as their
central guiding orientation. Clinical instructors and supervisors
frequently discuss with counseling trainees the importance of
developing therapeutic relationship skills, but less often provide an
organized, systematic structure for the development of these skills.
RCT can provide this structure by supplying (a) a framework for
developing an understanding of key relational components and
overall relationship development, (b) guiding principles for apply-
ing this understanding, and (c) markers for assessing the effective-
ness of relational interventions. To illustrate these aspects, a few
examples will be offered.

First, it is not uncommon for counseling trainees, especially
those early in training, to struggle with understanding the differ-
ence between therapeutic counselor authenticity and immediacy,
and “just being honest”—that is, counselor responses that do not
serve the client or support therapeutic change but are defended as
being honest reactions. Therapist analysis and identification of
“one true thing” (Jordan, 2010, p. 65) that can be communicated to
the client assists counseling trainees in differentiating such thera-
peutic v. potentially harmful responses. The focus of this RCT
intervention is to identify a response that will be authentic but will
also move counseling forward in a growth-enhancing way for the
particular client. Consider, for example, a new client who presents
with a relational image focused on adapting herself to the other to
protect against rejection. The client talks at length about how wise
the counselor is and that she is not capable of thinking of solutions
as effective as she believes the counselor’s “advice” will be. The
counselor could respond authentically by saying, “I look forward
to both of us sharing our thoughts and our wisdom” (i.e., one true
thing). Alternatively, the counselor could respond with, “I’m not
going to give you advice. That’s not what counseling is about-it
would just allow you to avoid responsibility for your decisions.”
The latter response could be argued as being “authentic” by a
novice counselor; however, it is likely to cause relational discon-
nection and a sense of inadequacy in a client who is new to
counseling and fearful of rejection. The concept of “one true thing”
offers a concrete strategy that facilitates the counselor’s critical
analysis regarding use of authenticity as a therapeutic tool, includ-
ing its role as a change agent.

The RCT construct of the central relational paradox also pro-
vides a structure from which to teach counseling trainees to re-
frame client ambivalence, lack of authenticity, and/or fear of
mutuality as survival strategies rather than as evidence of coun-
selor ineptitude or the client’s “resistance.” This understanding,
described in RCT terms as honoring the strategies of disconnection
(Miller & Stiver, 1997), decreases defensive blaming and patholo-
gizing of client responses by the counselor and motivates the
counselor toward engagement rather than avoidance or premature
confrontation of such client relational responses.

A similar teaching challenge pertains to assisting counseling
trainees in reframing disruptions in the strength and quality of the
counselor-client relationship (i.e., the therapeutic alliance; Nor-
cross, 2010) as opportunities rather than as indicators of the
inevitable end of the relationship. Counselor-client relationship
disruption is often extremely anxiety-provoking to counseling
trainees, exacerbating their competency-related fears (including
how they will be perceived by supervisors) and decreasing their
willingness to take appropriate therapeutic risks in an effort to
“play it safe.” Safran, Muran, Samstag, and Stevens (2002) and
Norcross (2010) emphasized the importance of therapists identi-
fying and exploring ruptures in the therapeutic alliance in a way
that is responsive, authentic, nondefensive, and acknowledges the
therapist’s contribution to the rupture. Safran et al. point to
evidence underscoring the value of therapists developing such
skills: “. . . the importance of dealing effectively with alliance
ruptures may extend beyond allowing the treatment to continue
and the technical aspects of treatment to work; it may actually be
an intrinsic part of the change process” (p. 245). This statement is
congruent with assumptions of RCT, which conceptualize
counselor-client conflict or disconnection as inevitable and poten-
tially growth-enhancing: “Working with conflict and difference in
therapy becomes crucial . . . the therapist must be present with the
differences that arise and open to admitting and learning from his
or her contribution to the conflict or disconnections that ensue
from the interactions” (Jordan, 2010, p. 5). As a central aspect of
RCT, considerable attention is given to guiding counselors in
decreasing defensive responding and developing skills for working
through disconnections, advancing the counselor-client relation-
ship, and expanding the client’s relational capacity (Jordan, 2010;
Jordan, Walker, & Hartling, 2004; Miller & Stiver, 1997).

More specifically, through careful supervision in application of
the RCT framework, counseling trainees can develop a conceptual
understanding regarding the dynamics of relationship ruptures or
disconnections and a skill set for constructively navigating such
disruptions. For example, supervisors often encounter counseling
trainees who perceive a disruption in the therapeutic relationship to
be a fatal blow. Not uncommonly, the disruption is subsequent to
an error in “anticipatory empathy” (Jordan, 2010, p. 52), that is, an
error in anticipating the client’s affective response. Anticipatory
empathy generally emerges from the counselor’s knowledge of the
client and understanding of how experiences and interactions
impact the client. As noted previously, training in RCT conveys
that such client-counselor relationship disruptions are expected
and offer opportunities for relational growth rather than indicating
an irreversible failure on the part of the student counselor. A
supervisory focus on determining blame for the disconnection
(e.g., counselor empathic failure, client resistance) is reductionis-
tic; instead, in taking a RCT approach, the focus becomes process-
ing the disconnection. That is, the central goal shifts to exploring
counselor responses that (a) engage the conflict (e.g., “You seem
very quiet and distant. I suspect I missed something important you
were telling me.”), (b) explore the complexity of the contributing
relational factors (e.g., “You’re right-I did say you seemed hostile,
and before I heard all of what you had to say. It makes sense that
it wasn’t a very helpful response. What was going on for you when
I said that?”), and (c) move toward a new, shared understanding
(e.g., “I appreciate your willingness to have this honest conversa-
tion with me. It actually makes me feel more connected to you.

182 FREY

What was it like for you to talk this through?”) (Jordan & Dooley,
2000). Not to be overlooked is that this approach also provides a
relational-cultural experience in the supervisor-supervisee rela-
tionship via encouraging open discourse regarding conflict or
disconnection and attending to the quality of supervisory (not only
supervisee) listening.

RCT and Competencies Related to
Individual-Cultural Diversity

Comstock et al. (2008) outlined the ways in which the RCT
framework supports the development of multicultural and social
justice competencies, including providing a framework from
which to understand the influence of socialization processes in-
volving power, oppression, privilege, and marginalization on re-
lational development. The literature base examining multicultural
and cross-cultural applications of RCT and relational-cultural the-
ory is expanding (e.g., Coll, Cook–Nobles, & Surrey, 1997; Rosen,
1997; Tatum, 1997; Turner, 1997; Vasquez, 2006; Walker, 2004b;
Walls, 2004), and offers a range of scholarly readings for teaching
and fostering student counselors’ self-examination and critical
thinking skills. For instance, RCT incorporates the construct of
cultural controlling images, defined as culturally developed, false
narratives about social or cultural groups, or individuals identify-
ing as members of such groups, that (a) delineate how the groups
or individuals should be treated and (b) serve to maintain inequi-
ties in power and access to resources (Collins, 1990). This con-
struct promotes an understanding of the mechanisms by which
power inequities related to difference are constructed and main-
tained in cultures (Walker, 2004a). The concept of controlling
images is a concrete anchor on which to build when asking
counselors to reflect on the many ways in which privilege and
“-isms” impact therapeutic relationships and client and counselor
relational images.

A useful teaching strategy for fostering self-reflection and crit-
ical analysis related to controlling images (and multicultural coun-
seling competencies) is the use of a focused journal. In the focused
journal, counseling trainees are expected to choose a reading topic
related to clinical work with a current client who differs from the
trainee in terms of sex, race and ethnicity, sexual orientation,
gender expression, religion or spirituality, or able-bodiedness. For
each journal submission, counseling trainees are asked to read a
scholarly article (preferably qualitative or quantitative research)
related to the chosen diversity topic. Journal entries are expected to
integrate (a) self-reflection and critical analysis on the topic, spe-
cifically as related to the construct of controlling images; and (b)
material presented in the scholarly article, with a focus on appli-
cation to clinical work. This is a challenging task, but one that can
be an important learning experience for a counseling trainee.

Although the previous focus has been on the detailed develop-
ment of two particular competency domains, it is important to
underscore RCTs potential contributions to trainee development in
other core competency areas. For instance, RCT also promotes
competencies related to (a) reflective practice (e.g., use of self,
reflection-in-action) and self-assessment; (b) advocacy (e.g.,
awareness of social, political, economic, and cultural factors in
service provision); and (c) scientific knowledge (e.g., examining
counselor contribution to therapeutic process and outcome, broad-
ening complexity of case conceptualizations) (Fouad et al., 2009).

Careful focus on core competency domains when teaching RCT
allows the practicum instructor and/or clinical supervisor to sup-
port trainees’ transfer of theory to practice in a way that is targeted
and skill-based.

Conclusions

Overall, there is a growing body of literature related to testing of
the relational-cultural theoretical framework and applications of
RCT. As has been reviewed, RCT can contribute to counselor
development through the provision of a conceptual framework for
understanding and critically analyzing relational development;
concrete strategies for the development of therapeutic relation-
ships; and opportunities to build competencies in the domains of
therapeutic relationship-building, awareness of individual-cultural
diversity, and multicultural counseling. Continued attention to
well-designed qualitative and quantitative research would contrib-
ute to the continued expansion and improvement of relational-
cultural theory and practice.

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Received December 24, 2012
Revision received April 1, 2013

Accepted April 8, 2013 !

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185RELATIONAL-CULTURAL THERAPY

Working With the Process Dimension in Relational Therapies: Guidelines
for Clinical Training

Edward Teyber and Faith McClure Teyber
California State University

This article offers guidelines for training relationally oriented therapists. We highlight core concepts that
are widely used across relationally oriented therapies. We focus on the process dimension and the
therapeutic relationship, and illustrate how process comments are the moderator variable that makes each
of the core concepts more effective. Guidelines are provided for clinical instructors to help their trainees
use these challenging, but potent, interventions that bring intensity to the therapeutic relationship and
help provide the corrective emotional experience.

Keywords: interpersonal process, process dimension, relational therapies, clinical training

We love this work, and feel privileged to spend our time helping
clients and training therapists. Combined, we have been practicing
relationally oriented therapies for over 75 years. Long ago, we
both entered graduate school with interests in child therapy—
sustaining core sensibilities that are evident in the attachment-
informed, developmental, and familial perspectives that still guide
us with clients of all ages. Over the years, we have sought super-
vision, training, and our own personal therapy in differing inter-
personal/relational approaches, and have been enriched by each of
these traditions. Like many, we see more similarities than differ-
ences across relational approaches, and we are heartened by the
pioneering work of Stephen Mitchell (1988) and many other
theorists who seek more coherence and collaboration across dif-
ferent interpersonal/relational approaches (Goldfried, 2006; Nor-
cross, 2002). Thus, the aim of this special issue is to foster a more
universal relational orientation and shared identity among clini-
cians—and we are honored to participate in this effort toward
self-definition.

Our approach links core treatment concepts, widely used across
relationally oriented therapies: the Working Alliance; Rupture and
Repair; Attuned Responsiveness and Empathic Understanding; the
Internalization of important relationships as Mental Representa-
tions; and a Collaborative and Egalitarian stance toward the client.
We also believe that important aspects of clients’ presenting prob-
lems will emerge in the therapeutic relationship. In particular, we
believe that clients change in treatment by finding a corrective
emotional experience (CEE) in their relationship with the therapist.
Here they experientially find— often for the first time— both a
“safe haven” (empathic responsiveness to their vulnerability and
distress) and a “secure base” (active support for their individuation
and differentiation) in their relationship with the therapist. In this

way, they “earn security” and function more flexibly and effec-
tively with greater reflective capacity (Teyber & McClure, 2011).

Clinical training is complex and multifaceted, and we focus here
on what we believe to be the most far-reaching but challenging
topic: How relationally oriented therapists can use “process com-
ments” to make each of these relational treatment constructs more
effective. We believe the focus on process— on the here-and-now
interaction between the therapist and client—is not just one of
many possible interventions; it is an indispensable common de-
nominator of effective therapists and links together relationally
minded clinicians (Yalom & Leszcz, 2005). Process comments are
forthright, but collaborative, bids from therapists to explore what is
most salient about what is occurring between them right now.
However, here is the bind we have long struggled with as clinical
instructors. We believe process comments are the moderator vari-
able that makes these relational constructs work. They bring im-
mediacy and intensity to the therapeutic relationship and give us a
way to enter the client’s distress and engage directly with their
core concerns. However, they are unfamiliar and often intimidat-
ing to new therapists, and challenging both for instructors to teach
and for trainees to adopt. Thus, the purpose of this article is to
highlight common difficulties that process-oriented interventions
evoke for many trainees and provide guidelines for instructors to
help with trainees’ anxiety about working within the relationship
and with such immediacy. Trainees cannot adopt these process-
oriented interventions about “you-and-me” by just reading articles
or discussing them in class—they need instructors to role play or
demonstrate them before they can begin to say, “Oh, that’s what
you mean” or, better yet, “Yeah, I can do that.” Without these
behavioral role models that help trainees “see” these challenging
interactions, too many promising trainees will turn away because
of the ambiguities and feelings of inadequacy that are commonly
evoked by using immediacy interventions. Anxious trainees may
turn toward more prescriptive therapies that focus solely on the
presenting problem. These manualized approaches are reassuring
because they provide more structure and direction— but offer less
because they do not conceptualize or intervene with clients’ prob-
lems in a relational context. Instructors aim to empower student
therapists to take the personal risks evoked by breaking familial

This article was published Online First April 28, 2014.
Edward Teyber and Faith McClure Teyber, Department of Psychology,

California State Universit

Correspondence concerning this article should be addressed to Edward

Teyber, Department of Psychology, 5500 University Parkway, California
State University, San Bernardino, CA 92407. E-mail: eteyber@csusb.edu

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–341 0033-3204/14/$12.00 DOI: 10.1037/a0036579

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mailto:eteyber@csusb.edu

http://dx.doi.org/10.1037/a0036579

and social rules. Here they invite clients to explore together what
may be going on in their relationship that may inform what is also
going wrong in their personal lives. Thus, our goal is to help
instructors overcome trainees’ anxiety about utilizing themselves
and become more adept at working “in the moment” with clients.

The CEE: The Core Relational Factor for Change

We believe that a common distinguishing factor across rela-
tional therapies is an appreciation of the developmental, famil-
ial, and cultural context for understanding clients and guiding
treatment plans. There is a shared sensibility that clients’ sig-
nificant and enduring problems developed in caregiving rela-
tionships, are being amplified in current relationships, and can
be resolved within therapeutic relationships. In this way, a
cardinal concept across relational therapies is the CEE (Cas-
tonguay & Hill, 2012). To effect change, relational therapists
are trying to disconfirm or expand Internal Working Models
(IWMs) and avoid replaying in treatment what has gone wrong
in other important relationships— especially along the process
dimension or way in which the therapist and client are inter-
acting together. Although such reenactments are inevitable at
times, we do not want them to characterize the ongoing inter-
action with the therapist. Instead, we can make process com-
ments to identify or highlight maladaptive interactions, and to
change them by making them overt and talking them through
with the client. Providing this experience of change—that some
relationships can now be different and not go down familiar,
expected but unwanted lines—is a core component of change in
relational approaches (Teyber & McClure, 2011).

Further, empathic attunement (relatedness) coupled with support
for differentiation (separateness) also allows the therapist to pro-
vide clients with a new and corrective response to the problematic
patterns than they have experienced with important others in the
past—and come to expect in current relationships. Change occurs
as these new ways of relating with the therapist expands clients’
cognitive schemas, alters their beliefs about themselves and ex-
pectations of others, and allows them to increase their interper-
sonal range. We find that, across varying approaches to relation-
ally oriented treatments, this remains a consistent model of change.
However, this model requires the therapist to be able to talk about
“you and me” and “what is going on between us,” and to collab-
oratively discern whether the therapist– client interaction is being
slotted into problematic schemas, or if it disconfirms familiar
templates and provides new relational options.

Teaching Trainees to Use Process Comments and
Intervene in the Moment

We look now at a group of closely related interventions that
therapists can use to work in the moment and use the therapeutic
relationship as the primary vehicle to facilitate change and provide
a CEE. Therapists within diverse relational approaches have writ-
ten about these interventions—and termed them metacommunica-
tions, immediacy interventions, and so forth. However, we prefer
to follow Irvin Yalom working in a group psychotherapy modality,
and Virginia Satir and other early family systems theorists, who
call these interventions “process comments.” We will see below
that there are many types of process comments, but they have been

used similarly and have a common purpose across varying rela-
tional approaches. Each type of process comment requires the
therapist’s “Use-of-Self” to intervene in the here and now and talk
with clients about what may be going on between them in their
current interaction. For example, Therapist (T): “I just broached
a sensitive topic, and I’m wondering how you are feeling about me
doing that?” Our aim is to help relationally oriented trainees learn
how to use process comments to: Help clients enter treatment with
a lower drop-out rate; Establish and sustain a stronger working
alliance; Address resistance and schema distortions; Clarify the
client’s problems with more specificity and better discern a treat-
ment focus; and Restore ruptures. Process comments link these
widely appreciated relational interventions and make each of them
more potent. They allow therapists to engage clients in far more
meaningful ways and, when used compassionately, bring about
more genuine and collaborative relationships. We also believe that,
across treatment approaches, the “capacity to engage” is a defining
therapist variable that differentiates more and less effective ther-
apists within each treatment brand—and process comments help
create meaning and enhance therapist– client engagement (Teyber
& McClure, 2000).

Process comments make the interaction between the therapist
and client overt and put the relationship “on the table” as a topic
for discussion. There is a distinction between the overtly spoken
content of what is discussed and the process dimension of how
the therapist and client interact. The single biggest challenge for
instructors is to help trainees contain their anxiety and work
through how process comments often conflict with their famil-
ial rules and cultural prescriptions. Instructors wish to invite
discussion about how unacceptable it was for most trainees to
break the social rules and talk with family members about “you
and me” and their current interaction. Instructors should antic-
ipate that, initially, most trainees will find it blunt or disre-
spectful to use “you and me” language. Instructors help by
doing two things. First, instructors want to discourage trainees
from using these types of interactions in their personal lives,
where they often will not be well-received. Second, instructors
need to be aware that many trainees will inaccurately slot their
discussions about these process interventions into their own
familiar, but problematic, developmental experience of being
painfully confronted, put on the spot, or intruded upon. Thus,
instructors want to clarify that these process interventions
should never be confrontational, intrusive, or judgmental. In-
stead, they are merely observations, tentatively suggested,
about what may be occurring between the therapist and client.
With this Use-of-Self, the therapist is judiciously using her own
experience of the client to wonder aloud about what might be
going on between them right now, and offers this as an invita-
tion for further dialogue and mutual sharing of perceptions.
Researchers find that process comments offered tentatively (“It
sounds like . . .”; “I’m wondering if . . .”; “Maybe . . .”) are
more effective than direct challenges (“I think you . . .”; Miller,
Benefield, & Tonigan, 1993). Let’s illustrate how therapists can
use process comments with “skillful tentativeness,” as an invi-
tation to explore their relationship: T: As you’re talking about
him and what went on between you two, I’m wondering if you
might be saying something about our relationship as well? Does
that ever come up between us, too? Client (C): Well, yeah,
you’re the therapist—you’re always in control of what goes on

335TEYBER-PROCESS

in here.1 In these ways, process comments commonly reveal
significant unspoken conflict between the therapist and client.

Activating Stalled Relationships and Altering
Maladaptive Patterns

Above, we see that process comments also uncover covert
issues—significant misunderstandings or faulty expectations that
are going on in the therapeutic relationship without the therapist’s
awareness. Process comments make overt unspoken problems that
will cause ruptures and reenactments in the therapeutic relation-
ship, and give relational trainees the opportunity to sort them
through and resolve them (Safran, Muran, & Proskurov, 2009).
Process comments are also a useful option for trainees when they
feel the interaction has become repetitive or “stuck,” or treatment
has lost its focus: T: I’ve gotten lost a bit. I’m not quite sure where
we are going with this right now; maybe I’m not getting what’s
most important for you here. Can you help me out?

Process comments bring collaboration and immediacy as the
therapist and client stop talking about “others out there, back then”
and begin talking instead about “you and me, right now.” Process
comments also give trainees a way to highlight faulty relational
patterns, and a way to intervene and change problematic scenarios
as they are occurring by clarifying and responding differently than
their schemas dictate. To illustrate this experiential relearning:
T: I’m wondering if something important might be going on
between us right now? I know people don’t usually talk so directly,
but maybe it could help us understand what’s been going wrong
with others as well. Did we become disengaged when I said that?
What do you think?

Interpersonal Feedback

In addition to activating stalled relationships and altering mal-
adaptive relational patterns, instructors need to role play how
process comments give clients useful interpersonal feedback that
others are reluctant to provide. This type of process comment may
highlight contradictions, incongruities, or mixed messages in what
the client just said; acknowledge the unspoken subtext or embed-
ded relational statement about “you and me” in what was just said;
or help clients recognize discrepancies between what they are
saying and doing: T: You are telling me such a sad thing, Paul, but
you are saying it in an off-handed way—as if it doesn’t really
matter. Help me understand the two different messages I’m get-
ting—such a heartbreaking story being told in a half-interested
manner? As we have been emphasizing, the significant challenge
for instructors is to help their trainees grasp that the input they are
giving is helpful and effective if given diplomatically and sensi-
tively. However, doing so collides with the interpersonal coping
strategies many trainees bring—to be “nice,” and avoid potential
interpersonal conflict or disapproval—at any cost. Many trainees
cannot adopt a process-oriented approach unless instructors pro-
vide a sustained focus on working through this pervasive counter-
transference propensity.

Metacommunication and Therapeutic
Impact Disclosure

Clearly, these here-and-now interventions that address “you-
and-me” break the social rules and often make trainees anxious.

However, they also make the therapeutic relationship more mean-
ingful—they foster the Working Alliance and uncover what’s
really wrong for the client, and give trainees the opportunity to
provide reparative experiences. For example, Donald Kiesler, a
pioneer in this work, discusses “therapeutic impact disclosure.”
With this type of process comment, the therapist uses her own
immediate experience of the client— or what is going on between
them right now—to provide feedback about how the client’s way
of relating is affecting the therapist (and likely others, too; Kiesler
& Van Denberg, 1993). Here, the therapist is disclosing selectively
chosen feedback about the impact this client is having on her at
this moment—which some refer to as the therapist’s “Use-of-self”:
T: I’m feeling like you are jumping from topic to topic, Jasmine,
and I’m having trouble keeping up. I’m losing the point you’re
trying to make. Is this something that just goes on between us
sometimes, or have others told you that they feel confused or have
trouble following you, too? What are your thoughts as I wonder
about this?

Closely related, object relations and communication theorists
“metacommunicate” to provide feedback about their current inter-
action, especially as a way to register the unspoken emotional
quality of a relationship. T: I could be wrong about this, Pat, but
I have a feeling I would like to check out with you. Sometimes I
feel if I disagree with you, you’ll be angry and leave. You know,
if I see something differently, you’ll walk out the door at the end
of the session and I won’t see you again. Is this just me or is there
something to it? Here again, the challenge for instructors is to
reframe straight talk as helpful to clients and not disrespectful—as
it was often framed in their families of origin. Thus, instructors
need to have trainees practice and rehearse safe and supportive
ways to make these all-important (but often unspoken) relationally
defining messages overt, rather than avoid them and act as if
nothing important is occurring.

Self-Involving Versus Self-Disclosing Statements

In the counseling literature, “self-involving statements” center
on Use-of-Self. Whereas self-disclosing statements refer to the
therapist’s own past or personal life experiences (e.g., T: My father
did that, too . . .), self-involving statements express some of the
counselor’s selected thoughts or filtered emotional reactions to
what the client has just said or done. Self-disclosing comments
often take the client’s focus away from her own experience and
shift it onto the therapist—which is especially familiar and prob-
lematic with clients who were parentified or have a preoccupied
attachment style. In contrast, self-involving statements keep the
focus on the client and reveal information about what is happening
in the relationship or how something the client has said or done is
affecting the therapist: T: No, I don’t feel “judgmental” about what
you did with him Saturday night, but I am concerned about your
safety and how you put yourself in situations where you could be
hurt.

Sharing certain personal reactions to what clients have just said
or done conveys personal involvement and resonance, and
strengthens the Working Alliance. T: I’m feeling uncomfortable,
Bob. You’re talking in a loud, angry voice right now. How do

1 Throughout this article, clients’ personal information is disguised and
clients are not identifiable.

336 TEYBER AND TEYBER

others usually respond when you do this? Therapists offer clients
a gift when they provide such invaluable interpersonal feedback,
which others have shrunk from sharing. Our aim as instructors is
to help trainees find supportive, noncritical ways to help clients see
themselves from others’ eyes, learn about the impact they have on
others (such as regularly making others feel intimidated, over-
whelmed, bored, and so forth), and function better by developing
greater reflective capacity (Fonagy, Gergely, Jurist, & Target,
2002). Trainees need instructors to respond empathically to their
anxiety as they begin to make self-involving statements. Here
again, new therapists fear offending the client because they were
socialized to believe that “nice” people don’t approach conflict.
However, instructors can teach trainees how to enhance reflective
capacity in their clients by role playing how effective therapists are
willing to take the personal risk to explore with clients, thought-
fully and always with the intention to safeguard the client’s self-
esteem, what others may be feeling and thinking but don’t want to
risk saying.

Use-of-Self to Provide CEEs

As we continue to see, it is often anxiety arousing for new
therapists to use themselves and begin working in this more
forthright way— especially for trainees who grew up in authori-
tarian or dismissive families. Instructors can assure trainees that as
they become more experienced and confident, it will become far
easier for them to take the risk of “not knowing” and explore more
open-endedly what may be occurring in the client–therapist rela-
tionship. Here we are talking about “Use-of-Self.” When feeling
confused or stuck, for example, more confident therapists can
share their questions and concerns—filtered parts of their own
internal dialogue—with the client. For example, T: I felt like we
were engaged and working well together at the beginning of the
hour. But now it feels like something has changed—as if I lost you
somewhere. Is this my misunderstanding, or maybe you’re feeling
that something’s not quite right either? What’s going on for you as
I wonder about this? With such Use-of-Self, trainees often have the
best opportunity to make their most significant interventions:
T: Right now, I’m wondering if you might be thinking that I, too,
want you to “just forget about this and let it go”—like your mother
said when you told her that your Uncle had molested you. C: Well
of course you do—isn’t that what therapists always do—tell you to
forgive and forget or you’ll never get over it! T: Oh no, I’m not
thinking that at all. I support this strong part of you that doesn’t
want to give in to the denial and go along with the pressure to stop
disrupting the family . . . In this way, Use-of-Self can often lead to
significant corrective experiences. Initially, many trainees will not
grasp the significance of this interaction, however, and instructors
need to highlight the profound meaning and impact that is under-
way in this exchange.

“But What if the Process Comment Doesn’t Work?”

Trainees frequently fear that the client will misunderstand their
good intentions and feel awkward, blamed, or criticized by their
process comment. Trainees need instructors to register and be
empathic to this concern—and address it in depth. Many trainees
will have a preoccupied attachment style, and this fear will be a
cardinal issue for them. The preoccupied trainee is anxiously

worried about doing “something wrong” or “making a mistake”
that will make the client disapprove of them or leave their rela-
tionship. This anxious insecurity has pervaded their lives, and they
have defended against it by adopting a pleasing interpersonal
coping style. However, this is contrary to the forthright commu-
nication that process comments require. If forthright communica-
tion does make the client uncomfortable, as it could occasionally,
trainees will need instructors to behaviorally demonstrate how they
can restore the rupture by addressing it with the client, and sort it
through. T: I’m wondering if you misunderstood me right there
and felt I might be criticizing you, too? C: Well, yeah . . . T: Thank
you so much for telling me that. What I was actually trying to
convey was . . . Making this misunderstanding overt and restoring
the rupture will be an important reparative experience for almost
all clients. Here clients find that they can actually resolve conflict
and “reconnect” with others—which they typically have not been
able to do with spouses and significant others or, developmentally,
when conflict threatened ties with their own attachment figures.
T: You just interrupted me again, and I said this seems to occur
often. That’s a very direct thing for me to say, and maybe you
disagree or didn’t like me saying that? Can we talk about how it
was to hear me say that? C: Well, I don’t like hearing that, but
maybe I do interrupt. That’s how we talked in my family—I never
could finish a sentence . . . nobody could.

Process Comments: A Common Denominator of
Effective Therapists

Relationally oriented instructors aim to help new trainees begin
exploring process comments with their clients and invite dialogue
about what might be going on between them. Rather than focus
solely on the content of what they are talking about, the therapist
can “wonder aloud” and tentatively inquire about how they seem
to be responding to each other or interacting together (i.e., their
process). As we are emphasizing, many trainees initially struggle
with process comments for fear of appearing “confrontational”—
even if they already recognize many instances when this could be
helpful: T: (internal dialogue) OK, I can see that he’s talking to me
right now just like he does to everyone else. Great, I’m getting just
as frustrated as they do. But how can I possibly bring this up
without alienating him . . .?!

When instructors initially introduce process comments, trainees
often misconstrue them. Trainees with a secure attachment style
usually find it easy and congruent to work in this personal and
forthright manner. In contrast, dismissive trainees commonly mis-
construe the instructor’s emphasis on empathy and collaboration as
being superficially “nice” or even “weak.” Fearful–avoidant train-
ees will be highly ambivalent about the instructors’ invitation to
speak directly with clients about their current interaction. On the
one hand, it once evoked intense anxiety or even dread to break the
“rules of attachment” and speak directly about the serious prob-
lems or maltreatment that was occurring, and fail to comply with
familial rules and keep secrets. On the other, the instructor’s
permission to have a voice and “say what you see” is nothing less
than a liberation that offers hope for a new way to live. Most
commonly, however, trainees will be preoccupied and misconstrue
process comments as confrontational and threatening to relational
ties. Most trainees, sadly, have lacked role models who spoke to
them in this straightforward yet empathic manner that the instruc-

337TEYBER-PROCESS

tor is introducing. Below, we further illustrate process comments
and show how they may be used in differing relational interven-
tions.

(1) We think of process comments as a basic stance toward
the client that reflects a broadly relational method of
treatment. They invite the therapist to intervene and
work on the client’s problems within the immediacy of
the therapist– client relationship. At the beginning of
treatment, for example, trainees can speak directly with
clients about their current interaction as they use accu-
rate empathy to establish a Working Alliance by repeat-
edly giving clients the experience that, “My therapist
gets me”: T: As I listen, it sounds like you felt com-
pletely erased when he said that—as if you didn’t exist.
Am I getting that right, or can you help me capture it
better? With this type of process comment, accurate
empathy becomes more of a collaborative interpersonal
process than a personal characteristic of the therapist.

(2) For relationally oriented trainees, learning how to talk
about what’s going on between “you-and-me” also helps
clients enter into treatment successfully. It helps thera-
pists both recognize and respond to potential signs of
resistance or ambivalence about entering therapy: T: I
see our time is almost up, and I’m wondering how it’s
been for you to talk with me today? It would help if we
could talk about what’s felt good to you in this first
session, and what hasn’t been so helpful that we might
do differently next time? C: Well, I have liked talking
with you, but in my culture, we don’t talk to others
about family problems . . . Commonly, such process
comments effectively reveal clients’ ambivalence about
continuing treatment and make this a topic that can be
sorted through rather than acted out. Such responses
address the long-standing problem that approximately
30% of clients drop out after the initial intake, and 40%
to 60% drop out prematurely in the first three to six
sessions without achieving any therapeutic benefit (Cal-
lahan & Hynan, 2005). In this way, the best time to use
process comments is when the therapeutic relationship
is struggling, the Alliance is threatened, or most simply,
when the therapist is not liking the way in which the
therapist and client are interacting together.

(3) We believe a common feature across relational ap-
proaches is to break the social rules and help clients
move beyond surface topics or talk primarily about
others, and offer instead bids to enter their own feelings,
concerns, and reactions more fully. Intervening directly
within the therapeutic relationship can also be a produc-
tive way to help clients focus internally on their own
experience: T: You know it feels to me like we are arm
wrestling a bit. You keep talking about what others are
doing, and I keep asking instead about what you are
thinking or how you wanted to respond. Let’s put our
heads together and figure this out—what do you see
going on between us? Trainees need instructors to
model ways to engage more directly with clients’ sub-

jective feelings and concerns, rather than colluding with
them in staying on surface topics and providing well-
intended but superficial reassurances and problem-
solving advice.

(4) As instructors, we try to help new relational therapists
overtly invite and welcome the full intensity of what-
ever feelings the client is experiencing into the im-
mediacy of the therapist– client relationship (Green-
berg, 2002). Oftentimes, the most significant way
therapists can respond to the client’s strong feelings is
through Use-of-Self and self-involving statements or
selective disclosure of personal reactions: T: I can see
how much this has hurt you, and how sad you’re
feeling. I feel connected with you right now, and hope
you’re not feeling alone as you said you have felt in
the past. How is it for you to risk sharing this special
part of yourself with me? C: I am sad, but this is
different—I’m not alone with it . . . Responding in
this new and different way to the client’s feelings
often provides a CEE.

(5) Another common feature across relational therapies is
to provide interpersonal feedback. Instructors want to
help trainees draw on Use-of-Self and use some of
their own reactions toward the clients to intervene
with feedback about the impact the client is having on
them and possibly others: T: May I have permission
to share some feedback with you about how you come
across to me at times—and perhaps others too?
Maybe you’re not so aware of how this may affect
others, but right now you are . . . Can we look at this
together? Here again, we see that training relationally
oriented therapists is challenging and complex. In-
structors are asking trainees to respond in new and
different ways that violate familial and cultural rules.
This can engender significant anxiety—which can be
difficult for instructors to help trainees contain in the
beginning.

(6) Collaboratively exploring and trying to understand
the current interaction between the therapist and the
client facilitates work with transference or schema/
IWM distortions: T: How do you think I am going to
react if you decide to do that? What am I going to be
thinking or feeling toward you? C: Well, you’ll act
nice, but I know you’ll really be judging me . . . Early
in their training, it seems unimaginable for many new
therapists to ever pose such a question. However,
process comments like this are powerful uncovering
techniques. They highlight the client’s IWMs—their
pathogenic beliefs about themselves and faulty ex-
pectations of the therapist and others—which helps to
clarify the treatment focus. Instructors often have
difficulty teaching trainees how to develop a treat-
ment focus. Process comments, which inquire about
the client’s perceptions of the therapist’s thoughts
and reactions, reveal the client’s key concerns and

338 TEYBER AND TEYBER

help both therapist and client discern what’s really
wrong.

(7) To facilitate the Working Alliance, the therapist’s
role is to sustain an empathic, respectful, and inter-
ested attitude toward the client. However, this em-
pathic stance routinely falters, as “ruptures” in the
Working Alliance commonly occur (Safran et al.,
2009). Alliance ruptures occur for different reasons:
because of hostility from angry, provocative, or con-
trolling clients (referred to as “Client Negativity”);
reenactments that some clients re-create that embroil
the therapist in familiar, but problematic, relational
scenarios; and the simple human misunderstandings
that occur in every meaningful relationship. Let’s see
how process comments can help.

Beginning with the problematic but often ignored topic of Client
Negativity, being irritable, demanding, or critical are defining
diagnostic features for many clients. Most trainees haven’t antic-
ipated receiving this “negativity” as part of their new career.
However, some clients will be dominating, intrusive, competitive,
sexualizing, and so forth with their therapist—just as they are with
others. Additionally, some clients are going to elicit or “pull”
therapists into argumentative, distancing, rescuing, and other types
of familiar conflictual exchanges. Disturbingly, however, research-
ers find that even experienced therapists tend to respond “in kind”
toward the client with their own countercriticism, judgmentalism,
punitiveness, or withdrawal. When these “complementary” re-
sponses occur, it leads to poor treatment outcomes. Thus, core
conditions of empathy are quickly lost as clients with angry,
distrustful, or rigid interpersonal styles successfully evoke coun-
tertherapeutic hostility and control— even with highly trained and
experienced therapists (Binder & Strupp, 1997). Here again, pro-
cess comments give us effective ways to respond to the common
but often avoided issue of Client Negativity: T: You’ve just
criticized me there, Susie, and I’ve felt that a few times before.
Help me understand how others usually respond when you do that?
With Use-of-Self, instructors can help trainees reflect on and use
their negative reactions to ask themselves (internally): Right now,
I’m feeling like withdrawing. This isn’t just my issue, I’m hearing
that she is making others feel this way too. How can I find an
effective way to help her see the impact she is having on others?

Even with clients who present as “agreeable,” simple misunder-
standings occur at points in most therapeutic relationships. Unfor-
tunately, researchers find that clients often do not voice their
concerns and bring up the problems they are having with their
therapists, and, creating an unwanted cycle, therapists often avoid
or do not ask about them (Hill, Thompson, Cogar, & Denman,
1993). Clearly, many new and experienced therapists are person-
ally uncomfortable and avoid approaching interpersonal conflict. It
is imperative that instructors prepare trainees to expect, verbally
acknowledge, and work to restore disrupted relationships. Unac-
knowledged and unresolved misunderstandings between client and
therapist are not benign—they undermine the Working Alliance
and lead to poor treatment outcomes (Johnson et al., 1995). Rather
than ignoring the conflict, or responding in kind with countercrit-
icism, blame, or disengagement, process comments give therapist
a relationally affirming way to address the problem as it is occur-

ring. Instructors can role play with trainees how to neutrally
observe or tentatively wonder aloud about potential problems or
misunderstandings that may occur: T: Right now, it feels to me as
though I keep doing the wrong thing. You keep asking for help but,
when I offer suggestions, you say “Yes, but . . .” Let’s work this
out—what do you see going on between us?

Treatment stalls unless therapists and clients can talk about
problems in their relationship and sort them through. Working
them out as they arise provides a valuable social laboratory where
clients can learn how to address and resolve conflict with others.
However, most new therapists find it far easier to be supportive
than to inquire about potential conflict between “you-and-me” or
try to sort through problems directly. As with their clients, many
trainees did not learn to address or resolve problems in their
families of origin where, too often, there was no secure mechanism
to restore the ruptures that occurred with their own attachment
figures. And, as emphasized, many trainees grew up in families
that held strong but often unspoken rules against addressing prob-
lems openly, or witnessed conflict escalate in hurtful ways. In sum,
instructors need to rehearse with trainees nondefensive ways to
respond to interpersonal conflict.

Empowering New Therapists to Work With
the Process Dimension

As instructors, we need to appreciate how anxiety arousing it
can be for new therapists to “jump off the cliff,” and say, for
example, T: I’m wondering if you ever find it hard with me, too,
to speak up and say what you think or want? It will make sense to
some new therapists that what tends to go wrong for clients in
other relationships will also come into play with the therapist at
times, and that it could be helpful to talk together about that. As
emphasized, however, process comments will be challenging in
the beginning. Many trainees have little confidence and, under-
standably, are reluctant to have what little self-confidence they
may possess shaken by stepping outside of familiar bounds. And,
even if they think this type of intervention might be useful, they
often struggle to discern whether they are objectively observing
the client’s behavior or if their perceptions reflect their own
countertransference: T (internally): Is this just me, or does she
make everybody feel this way?

Instructors need to encourage trainees to “wait and see” if this is
a pattern that recurs. Trainees are advised to consult a supervisor
before sharing their observation in session in order to distinguish
countertransference from clients’ maladaptive behavior. Neverthe-
less, most trainees feel unsure of how to bring up what they are
considering, and to find a helpful or diplomatic way to make this
overt—without making the client feel criticized or blamed. And, of
course, all have seen directness used hurtfully—in angry confron-
tations or blaming personal attacks intended to win arguments, put
someone down, or induce shame or guilt. Therapists never want to
do any of this, of course. Diminishing clients’ self-esteem or sense
of safety in these unwanted ways will impede clients’ ability to
make progress in treatment. Instructors can demonstrate how to
use process comments in collaborative and respectful ways that
help trainees earn credibility, rather than make clients feel awk-
ward or confronted. Observing instructors is essential because the
communication is more in the nonverbals than in the words used.

339TEYBER-PROCESS

Process comments will be effective when the therapist’s tone is
respectful—and ineffective if it is critical or condescending.

Instructors will often observe a two-step sequence with their
trainees when, at first, trainees find they are beginning to recognize
the process dimension and see when something important is going
on between them. Second, however, it usually takes more time
until trainees feel confident enough to speak up and begin explor-
ing the process dimension. Instructors help when they validate
trainees’ reality-based feeling that it is something of a personal risk
to suggest: T: I’m curious about something that might be going on
between us right now, and wondering if . . . What are your
thoughts about this possibility? Although trainees will be accurate
with some of their process observations, others will not resonate
with clients. Trainees have not failed in any way or made a mistake
when the observation they have tentatively suggested doesn’t fit;
they are just making a respectful attempt to understand and help,
and most clients will appreciate these good intentions. The aim
here is not to be “right.” Instead, trainees are trying to initiate a
mutual dialogue with the client—so together they can explore and
learn from what may be going on between them: T (nondefen-
sively, in a friendly and welcoming tone): OK, what I’m suggesting
doesn’t quite fit. Help me say it more accurately. What are your
words for what might be going on between us?

Nevertheless, trainees should not be in a hurry to make process
comments until they feel ready to do so. Typically, it takes a year
or so before trainees feel comfortable saying what they see and
venturing this with clients. Further, instructors want to encourage
trainees to respect their own sense of timing and listen to their own
feeling that, “This just isn’t going to work right now” versus “Now
might be a good time to say this.” It’s important that trainees
choose when and how to make these interventions.

Instructors also help trainees by jointly conceptualizing what
has gone awry for the client in other relationships, and consider
how similar relational themes might play out in the way they are
interacting together. Formulating these “working hypotheses”
helps trainees anticipate the types of faulty expectations, schema-
driven distortions, and reenactments that this client may be prone
to play out, and therefore be better prepared to respond to what this
particular client is likely to present in treatment. In this way they
can better “see” what is going on between them and “hear” what
the client is really saying—as the client is saying it, rather than
“getting it” later (e.g., trainee reviewing videotape thinks to him-
self: “Right there she’s telling me that everybody feels over-
whelmed by her. She’s probably telling me she’s worried that I’m
feeling that way, too. Why do I get it now, and not then when she’s
saying it?!”).

In sum, working hypotheses go far in helping trainees make
sense of their own experience in the hour and better grasp what is
transpiring in their interpersonal process as it is occurring. When
trainees find themselves reacting toward the client in unwanted
ways, such as feeling bored, discouraged, argumentative, and so
forth, their working hypotheses will expand their reflective capac-
ities and help them be nondefensive and consider ways problem-
atic relational patterns may be being reenacted. This is also a good
time to consult with a supervisor about process comments they
may want to venture, in order to begin exploring their subjective
reactions and working hypotheses with the client. Trainees cannot
attempt process-oriented interventions without active guidance
from a supportive supervisor. As trainees become less concerned

about performance anxieties, and supervisors help them under-
stand where they are trying to go in treatment with this particular
client, they will find how helpful it is when they can link aspects
of the problem the client is talking about with others to their
current interaction—and begin changing this in their relationship
first.

To ease the transition toward more forthright engagement, in-
structors can help trainees provide contextual remarks that facili-
tate the bid for more open or authentic communication. For ex-
ample, the first time the therapist addresses the process dimension,
the therapist can create safety for the client by offering an intro-
ductory remark that acknowledges the shift to a different type of
discourse: T: May I break the social rules for a minute and ask
about something that might be going on between us?

Therapists will not alienate clients if they respond respectfully,
share their observations tentatively (e.g., Sometimes I find myself
wondering if . . .), invite collaboration (e.g., “What do you
think?”), and provide these types of transition comments. These
contextual remarks help clients understand the therapist’s good
intentions, as they help clients shift from surface conversation to a
more straightforward approach that invites deeper personal en-
gagement. Rather than being threatened by this invitation, most
clients will welcome and be reassured by this bid to talk about
what’s really wrong. All agree—these present-centered interven-
tions that bring a greater level of engagement and intensity are the
most anxiety-arousing for new therapists to adopt (Hill, 2009). To
use the process dimension effectively, instructors need to help
trainees do two things. First, they must balance the challenge of
metacommunication with being supportive and protective of cli-
ents’ self-esteem (Kiesler, 1996). Process comments, like any
other interventions, can be made in blunt, accusatory, or otherwise
ineffective ways. Warmth, tact, curiosity, and a sense of humor can
all go a long way toward making every intervention more effec-
tive. Second, trainees can check in with their clients and talk about
the process intervention they just made: (T: How was it for you
when I said that? I know people don’t usually speak so directly
about what’s going on between them). In the initial session, we
educate clients about the treatment process by explaining that we
will try to help by speaking forthrightly and, in turn, we invite
them to speak up and express any concerns about us or treatment
directly. Then, we also inquire, “How would it be for you to talk
with me in this more straightforward manner?”

Let’s now explore countertransference further and other situa-
tions when process comments will not work. Trainees do not want
to jump in with process comments in a spontaneous or cavalier
manner. They want to be thoughtful about when and how they use
these powerful interventions, and always consider the possibility
that their own observations or reactions may reflect more about
their own countertransference than it does about the client or their
interaction. As a rule of thumb, experienced therapists usually wait
to comment until they have seen an interaction occur two or three
times. When in doubt about whether an observation has more to do
with the therapist or the client, it is best to wait, gather additional
observations, and consult a supervisor before raising the issue with
the client. Again, all process comments are simply observations—
offered tentatively, as possibilities for mutual clarification, not as
truth or fact. Differentiating the client’s concerns from the thera-
pist’s own personal issues is one of the most important compo-
nents of clinical training.

340 TEYBER AND TEYBER

By looking honestly at their own contribution to problems or
misunderstandings, trainees facilitate an egalitarian relationship
that holds genuine meaning for both. However, this increasing
mutuality may activate trainees’ own personal problems or coun-
tertransference at times (Yalom & Leszcz, 2005). In order to work
relationally, however, trainees need to relinquish hierarchical con-
trol over the relationship, which can arouse anxiety for trainees
who need to be the authority or personally distanced in the role of
expert. Additionally, trainees may be concerned that this genuine
responsiveness, emotional presence, or egalitarian stance will lead
to a loss of appropriate therapeutic boundaries and result in over-
involvement or acting out. One of the most important functions of
supervision is to help trainees track this interpersonal process and
recognize when their own countertransference is prompting them
to become overidentified with— or too distant from—the client.
Countertransference is most likely to create problems when train-
ees disregard it. Trainees who are aware that they are always
susceptible to countertransference, and explore this with their
supervisors, should feel unfettered about working in a process-
oriented manner.

In closing, the primary concern for trainees about making pro-
cess comments is concern about appearing confrontational—fear-
ing clients will feel “confronted” in some aggressively challenging
or exposing way. Trainees do not want to be confrontational just as
most clients do not want to be confronted. However, a process
comment, if used sensitively, seeks to communicate forthrightly
yet empathically and without blame or disrespect. Instructors help
trainees by clarifying that if they think the process comment they
are considering making is going to lead the client feel confronted
or blamed, don’t make it. Instead, trainees can wait for another
time that feels better or, better yet, (with Use-of-Self) make a
different process comment and talk with the client concerning their
reservations about sharing this observation: T: There’s something
I’m thinking about right now, but I’m feeling unsure about ad-
dressing it with you. I’m concerned you might misunderstand my
good intentions, and feel criticized or blamed, which I certainly
don’t want. May I ask for permission to speak frankly with you?

The goal with process comments, as with relationally oriented
therapies in general, is to create a new and reparative relationship
for clients where it’s safe to talk about their distress and whatever
matters most to them—which includes how understanding and
changing what’s going on between “you and me” is often the best
way to begin changing what’s wrong with others.

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Received February 25, 2014
Accepted February 28, 2014 �

341TEYBER-PROCESS

http://dx.doi.org/10.1111/j.1468-2850.1997.tb00105.x

http://dx.doi.org/10.1037/1541-1559.2.1.65

http://dx.doi.org/10.1037/13747-000

http://dx.doi.org/10.1037/10447-000

http://dx.doi.org/10.1037/0022-0167.40.3.278

http://dx.doi.org/10.1002/cpp.5640010103

http://dx.doi.org/10.1007/978-1-59745-444-5_9

Working With the Process Dimension in Relational Therapies: Guidelines for Clinical Training

The CEE: The Core Relational Factor for Change
Teaching Trainees to Use Process Comments and Intervene in the Moment
Activating Stalled Relationships and Altering Maladaptive Patterns
Interpersonal Feedback
Metacommunication and Therapeutic Impact Disclosure
Self-Involving Versus Self-Disclosing Statements
Use-of-Self to Provide CEEs
“But What if the Process Comment Doesn’t Work?”
Process Comments: A Common Denominator of Effective Therapists
Empowering New Therapists to Work With the Process Dimension
References

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