Relation of the Real Relationship and the Working Alliance to the Outcome of Brief Psychotherapy Gianluca Lo Coco and Salvatore Gullo University of Palermo Claudia Prestano University of Messina Charles J. Gelso University of Maryland In this study, the (a) association of the client- and therapist-rated strength of the real relationship to the outcome of brief psychotherapy, and (b) extent to which the real relationship predicted outcome above and beyond the predictive power of the working alliance were examined. A total of 50 clients at the counseling center of a university in Italy received brief therapy and completed measures before treatment, after the third session, and at the end of treatment. From the clients’ perspective, both the Genuineness element of the real relationship and the Bond scale of the working alliance were found to relate significantly to treatment outcome. When we examined the real relationship and working alliance as predictors in a hierarchical regression format, the client-rated real relationship, especially the Genuine- ness element, did predict outcome and, moreover, added significantly and substantially to the working alliance in predicting outcome. Neither the strength of the real relationship from the therapist’s perspective nor the therapist-rated working alliance was found to relate to outcome. The findings are discussed in the context of methodological differences with other investigations of the real relationship. Keywords: real relationship, working alliance, brief psychotherapy A large body of theoretical and empirical work has accumulated over the years to suggest that the therapeutic relationship between psychotherapists and their clients has a substantial impact on the outcome of treatment (Norcross, 2002; Lambert & Barley, 2002; Goldfried & Davila, 2005). However, there is also a growing consensus (Gelso, 2009b; Horvath, 2009) that researchers should be examining relationship constructs that go beyond, and are more specific than, highly global conceptions of “the therapeutic rela- tionship.” One such more specific conceptualization of the rela- tionship is the tripartite model developed by Gelso and his collab- orators (Gelso & Carter, 1985, 1994; Gelso & Hayes, 1998; Gelso & Samstag, 2008). Drawing on the theoretical work of Greenson (1967), these researchers divided the overall therapeutic relation- ship into three interrelated components: a working alliance, a transference– countertransference configuration, and a real rela- tionship. In a psychotherapy session, all three components are conceptualized to “operate simultaneously, with each moving from foreground to background at certain points in the work, and with each influencing and being influenced by the other” (Gelso, 2009a, p. 258). Among these three components, the working alliance has been the one to be most vigorously investigated empirically, and this component has been consistently found to be an important factor in treatment success (Horvath, 2006; Samstag, 2006). Transference and countertransference have been the topics of an enormous body of theoretical literature, and these too have been investigated empirically. Although the evidence is less straightforward than for the working alliance, it does seem that both transference (e.g., Høglend et al., 2008) and countertransference (see review by Gelso & Hayes, 2007), in general, influence treatment process and outcome importantly. Of the three components of the tripartite model, the real rela- tionship has been the least studied. This component has been defined as “the personal relationship existing between two or more people reflected in the degree to which each is genuine with the other and perceives and experiences the other in ways that befit the other” (Gelso, 2009a, pp. 254 –255). In keeping with this defini- tion, the real relationship is seen as being composed of two fundamental elements, genuineness and realism. Genuineness may be seen as the participants’ degree of authenticity with each other, whereas the realism element implies experiences and perceptions that “befit the other,” rather than inaccurate or distorted percep- tions that may be because of earlier unresolved conflicts. The real relationship component of the overall therapeutic rela- tionship is thought to exist from the first moment of contact between therapist and client, and it has been theorized to be a part of all relationships in general, and therapeutic relationships in particular. It is thought to be similar to the working alliance but different from it in the sense that the working alliance is the work collaboration, whereas the real relationship exists independent of the work of therapy and is instead reflective of the personal connection between the therapist and client (Gelso, 2009a, 2009b). This article was published Online First May 23, 2011. Gianluca Lo Coco and Salvatore Gullo, Department of Psychology, University of Palermo; Claudia Prestano, University of Messina; and Charles J. Gelso, Department of Psychology, University of Maryland. Correspondence concerning this article should be addressed to Gianluca Lo Coco, Department of Psychology, University of Palermo, Viale delle Scienze, edificio 15, 90128, Palermo, Italy. E-mail: g.lococo@unipa.it Psychotherapy © 2011 American Psychological Association 2011, Vol. 48, No. 4, 359 –367 0033-3204/11/$12.00 DOI: 10.1037/a0022426 359 THIS ARTICLE HAS BEEN CORRECTED. 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