What actually is ‘Quality of Relationship’ and can it be Enhanced?

It's an important question, as it is the nebulous catch-all phrase increasingly used to capture the essential factor which apparently makes therapy work - or not!

But when we probe a little deeper what people actually mean by the innocuous phrase (which is easily accepted as consensual - we all want quality of relationship, don't we? Who wouldn't?), the answers then a) become vague and b) the apparent consensus breaks down as everybody reverts back to the particular 'credo' of their particular therapeutic approach.

The other reason it's an important question is because - for the purposes of a therapeutic process - apparently ‘quality of relationship’ is not a static, simple and straightforward affair, according to some recent pronouncements from some of the authorities. Even interdisciplinary giants like Allan Schore have moved away from the notion that it is the therapist’s task to keep the traumatised client safely within their ‘window of tolerance’. Schore has come round to the notion that working at the edge of the window of tolerance is where transformative therapy happens. That means: therapy needs to be safe, but not too safe.

And childhood development experts have been telling for some time us that a child does not grow in an environment of supposed eternal harmony, but matures through cycles of rupture and repair in the bond with the parent.

So maybe ‘quality of therapeutic relationship’ does not simply equate with some lasting harmony (to merely compensate for whatever inconsistent, interrupted, traumatically ruptured attachment bond we see at the root of the wound) ? Psychoanalysts, especially the Kleinians, have of course known and insisted on this all along, emphasising as therapeutic the ‘working through’ of the wound, including the mourning of what never was and the acceptance of what was. They rightly question the therapist’s motive for even having the impulse to help, to ease the pain or to provide a ‘corrective emotional experience’.

It could be argued that, in dogmatically adhering to this uncomfortable minority view, they tend to throw out the baby with the bathwater in the other direction. But what we can take away from this is that both rupture and repair are necessary ingredients in ‘working through’.

So the kind of constant and unfluctuating loving acceptance which many humanistic practitioners require themselves to provide and which they equate with ‘quality of relationship’ cannot possibly be the whole story.

For a start, there are many different kinds of loving, both on the client’s and the therapist’s side, and more often than not they are experienced as in conflict with each other. Therefore, empathy, intimacy, support are far from simple - they cannot in any lasting fashion be internally generated and cannot simply be given by the therapist, just by virtue of stepping into the therapeutic position. Each mode of loving - however true in itself - can also acquire defensive functions and purposes, to counteract or override another - more uncomfortable - other version of love: sexualised love can appear to keep at bay a deeper feared dependency; on the other hand, regression and neediness may be more comfortable avenues for closeness than - in Freud’s terms - the terror of Oedipal rejection. So even a therapeutic stance as apparently safe and straightforward as reparative parenting can have profoundly damaging effects, making ‘quality of relationship’ a minefield rather than the walk in the park it is often presented as.

Or take as another example what existential or Gestalt therapists might consider as the essence of ‘quality of relationship’: authentic, dialogical engagement. From my perspective here, it’s just half of the therapeutic process. A necessary half, but authenticity is only as good as the degree of inauthenticity it can embrace and relate to. A lot of the time my humanistic supervisees insist on a dialogical attitude when it flies in the face of their perception of the actual phenomenology: they readily perceive that the client may be lost in some regressive experience or acting out some internalised pattern. But often they refuse the conclusion: at this point in time there seems to be nobody at home to have a dialogue with. The client may be caught in perceiving each and every dialogical offering on the part of the therapist as a further criticism, for example, but the therapist is so invested in a dialogical ideal that they fail to accept that it’s currently not attainable. Or, more to the point: not only unattainable, but counterproductive and maybe counter-therapeutic. They end up as fixed in their supposedly therapeutic reaction as the client is in their supposedly un-dialogical transference reaction. Having used the idea of the I-Thou relationship to question the historical dominance of ‘medical model’ assumptions in psychotherapy, it was an important step to re-include both I-Thou and I-it relating as valid ingredients in therapy (see Mackewn, J.)

We could go through all the diverse schools and modalities of the therapeutic field, and notice how traditionally each approach deemed itself as having the monopoly on truly therapeutic relating and its own definition of what constitutes ‘quality of relationship’. With hindsight now we recognise how each approach traditionally has its valid, but unfortunately quite partial sensibility to the complex whole of human relating. And in the past these partial positions were reified, absolutised and elevated into general theories and claims which invariably excluded the wisdom and equally partial validity of contrary approaches. In our bright and modern integrative times, it appears we have left these dark ages of tribal dogmatisms behind, but I often still meet strong elements of one-dimensional assumptions in the various approaches when it comes to ‘quality of relationship’. Our first task as practitioners, therefore, is to learn to appreciate the various modes of relating advocated by the various approaches from within. To become evenly and fluidly versatile within the different kinds of qualities of relating which are the preferred province of the different traditions.

But developing such an all-round integrative appreciation is only a first step, as the deeper crux of the problem does not lie in our traditionally partial, fragmented and dogmatic approach to the quality of relationship. Like the proverbial wise men around the elephant, it must be helpful to learn to experience the wholeness of the elephant through the wisdom of the others. But the deeper challenge is that it is not only our approach to it that is conflicted; rather: the conflict lies in the nature of the beast itself. The ‘quality of relationship’ is in itself a necessarily conflicted and paradoxical notion.

However we define them, all the supposed elements and ingredients that make for ‘quality of relationship’ are indeed sometimes simple and just present, but often they are also many-headed beasts, biding their time and waiting for a safe arena and container to emerge into the light of day. Having emerged, they frequently take center stage in the consulting room in ways which shock the therapist who was resting on their laurels. Usually, good experiences between client and therapist provide the very safety which paves the way into the unsafe territories. So the safety of the good magnetically attracts the emergence of the bad and thereby creates its own undoing - such is the creativity of the unfolding process.

But, going a step further, these kinds of conflicts are not only inherent in the rupture-repair cycles of the therapeutic relationship over time. They are always already present in the ‘here-and-now’ of the client’s experience: the client has habitual patterns of relating which both communicate as well as protect against the unresolved pain driving those patterns.

The client both wants to be accepted as they are (in their habitual mode) and at the same time there is somewhere always already a desperate need for change. According to the Jungians, the client has an internal conflict along the ego-Self axis - we could translate this as: a conflict between their established habitual mode of personality and an as-yet-unlived or so-far-repressed emergent self.

Which side of that conflict needs the therapist’s support more ? Which side should therapy champion ?

Habitual mode versus emergent self ? Which side are you on ?

Whichever one I go with as the therapist, I cannot get it simultaneously right for two mutually exclusive realities. That means: as the therapist I will necessarily and inevitably get it wrong. For the therapist it is not so much a question of finding the ‘right’ intervention, but surrendering to one or the other of two ‘wrong’ ones. I see this as inexorably inherent in the essence of therapy, once we accept the existence of internal conflict in the client as a given. Once we make that the starting point of our exploration, it follows that the client’s conflict will have to become the therapist’s conflict, as surely as night follows day. Here we are entering the territory of enactment - which I take to be the conundrum at the heart of relational therapy. More of this some other time. But what we can say at this point, regarding the quality of relationship and the working alliance: it means that - paradoxically - the working alliance needs to break down at times in order for it to exist and deepen.

‘Quality of relationship’ then is a complex, complicated, inherently paradoxical and elusive affair, constantly changing and re-configuring, swinging through cycles of rupture and repair, enactment and re-establishment of alliance. More like a bar of soap in the bath than a fool-proof recipe for mashed potatoes. Not so much an arrow towards the target as a hall of mirrors where - if I mess with arrows at all - I’m just as likely to shoot myself in the foot.