A grounded theory of the conceptualisation of the therapeutic relationship by practitioners of cognitive-behavioural therapy (CBT)

The concept of the therapeutic relationship has been emphasised by
different therapeutic traditions. In Cognitive-Behavioural Therapy (CBT)
the therapeutic relationship has received more attention in recent years
after being considered less important than the application of cognitivebehavioural
techniques to outcome. Qualitatively the therapeutic
relationship in cognitive-behavioural therapy has generally been described
as the working alliance. This study has sought to explore how
practitioners of CBT conceptualise the therapeutic relationship in their
work. Data were collected in the form of audio recorded semi-structured
interviews with eight psychologists, some of whom were also CBT
therapists. A constructivist version of grounded theory was chosen to
analyse the data, which reflected epistemological and methodological
considerations. The core dynamic suggests that the therapeutic
relationship in CBT is an individual, ever-changing concept shaped by
each therapist's training, experience, ongoing practice and reflection. The
participants' practice of CBT was influenced by, and influential to the
personal meaning they attributed to the therapeutic relationship. The
therapists' prior training and experience provided the conceptual basis for
the understanding of the therapeutic relationship. This conceptualisation
was adapted to fit the participants' work contexts. A process of reflection
enabled the clinicians to incorporate ideas they held about CBT and the
therapeutic relationship into their work, and allowed for the continual
adaptation and refinement of the concept of the therapeutic relationship.
Suggestions for further research are made considering that practitioners
of CBT come from diverse professional backgrounds and there are
implications for the training and practice of this range of practitioners.

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