Conceptualizing the Therapeutic Relationship: Mediator or Moderator of Change?

Although the therapy relationship has long been recognized as an essential factor in the change process, there has been disagreement concerning whether the relationship is itself curative or rather supports the benefits of specific therapeutic techniques. To advance and clarify this conversation, this article conceptualizes the therapy relationship as both a mediator and/or moderator of change that can be used strategically in accord with case formulation for treatment goals. We begin with a brief overview of the relevant literature on the therapy relationship versus technique and the role of the therapy relationship as mediator or moderator across theoretical orientations. We then suggest an integrative framework by which clinicians and psychotherapy researchers may conceptualize the therapeutic relationship based on case conceptualization, where the requirements in each case and not theoretical orientation should determine the therapist's use of the therapy relationship. Finally, we discuss implications for psychotherapy research and practice.