Relational complexity and conflict in psychotherapy

Abstract Psychotherapy tends to be more effective when therapist and patient form a strong working alliance. However, existing accounts of the therapeutic relationship underplay its complexity and ambiguity. I offer a new account grounded in the theory of relational models, arguing that the therapeutic relationship is an unusually tangled combination of communal, egalitarian, authority, and market elements. Coordinating an effective healing relationship requires therapist and patient to align their modes of relating in the face of this complexity. That task is made more challenging by the relationship’s uniqueness, by the intrinsic ambiguity of psychotherapy itself, and by the tacit relational assumptions and idiosyncrasies of the two parties. I argue that misalignments based on the use of discrepant relational models by therapist and patient are likely to be common and should take predictable forms. Implications for the theoretical and empirical study of psychotherapy are discussed.