Although writing about the real relationship has existed from the beginnings of the "talking cure," it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this article, a meta-analysis is presented on the association between the strength of the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r ϭ .38, 95% confidence interval [.30, .44], p Ͻ .001, d ϭ 0.80, N ϭ 1.502). This real relationshipϪoutcome association was independent of the type of outcome studied (treatment outcome, treatment progress, and session outcome) and of the source of the measure (whether the client or the therapist rated the real relationship and/or treatment outcome). We also present commonly used measures of the real relationship, limitations of the research, and patient contributions. The article concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship.
Clinical Impact StatementQuestion: What is the meta-analytic association between the strength of the real relationship from therapists' and patients' perspectives and the outcomes of psychotherapy? Findings: Computed across 16 studies, there is a statistically significant and moderate relationship (r ϭ .37, p Ͻ .001) between the strength of the real relationship and outcome, and this association is not dependent upon who made the ratings (therapists or patients) or type of outcome (session outcome, treatment progress, pretest to posttest change). Meaning: Therapists should pay close attention to the strength of their real relationships with patients and seek to cultivate and strengthen it during treatment. Next Steps: More quantitative and qualitative studies are needed on the real relationship and distal treatment outcomes, as well as on what factors moderate and mediate this relationship.