There is overwhelming agreement that the therapeutic relationship is one of the essential ingredients for making therapy effective and promoting a healing context between the client and therapist. Over the past decades, vast amounts of research have offered support for this claim (Norcross, 2002; Norcross, 2011; Wiseman and Tishby, 2015; Norcross and Lambert, 2018). In psychotherapy research, the relationship is mostly characterized in affectual terms, as “the feelings and attitudes that counseling participants have toward one another” (Gelso and Carter, 1985: 159), and is seen as composed of a variety of elements such as empathy, collaboration, the alliance, rupture repair and others (see Norcross and Lambert, 2018). Further, relationship elements are often assessed in terms of subjective measures, behavioral observations or feedback questionnaires. Interaction-focussed research, on the other hand, views the relationship as a discursive accomplishment, constantly negotiated between participants, turn-by-turn (Pomerantz and Mandelbaum, 2005). Whereas psychotherapy research tends to be directed at what works (regarding evidence-based measures of effectiveness), interaction research is interested instead on how, for instance, a certain intervention is discursively performed in a given conversational context (Strong and Smoliak, 2018).

Psychotherapy researchers have argued that close interactional analysis can promise “to fill the gaps in psychotherapy theory by conceptualizing and describing the moment-by-moment exchange between therapist and client” (Stiles, 2008: 1). In this mini review, we offer a discussion of “how” discursive research may be able to fulfill this promise, by summarizing past studies on relationship construction and the discursive ways in which relationships are established and managed (e.g., as ‘close’ vs. ‘distant’). Rather than competing with psychotherapy research aims, interactional studies, should be viewed as complementary (Stiles, 2008). Thus, a discursive lens may “elaborate psychotherapeutic abstractions” such as the relationship (or a given aspect of theory) and, as a result, may also have the potential to demonstrate how and why different aspects of therapy and the therapeutic relationship contribute to helpful therapy. Qualitative, discursive approaches may also allow for insights into how different aspects of the therapeutic relationship combine and work together [e.g., alliance and collaboration/self-disclosure and emotional expression (Norcross and Lambert, 2018)], in contrast to quantitative research approaches that often treat them as separate, stand-alone practices (Norcross and Lambert, 2018, 311), although in real-time interaction neither therapist nor patient experiences or produces them separately.

The therapeutic relationship is generally considered an – if not the most –important factor for successful therapy and much research has focused on its conceptualization and description. Drawing from psychodynamic research paradigms, Gelso and Carter (1985) have characterized the relationship in therapy as comprising three different components. First, therapy largely consists of actions that are geared towards getting therapeutic work accomplished, which includes setting goals and agreeing on tasks. This, according to Gelso and Carter, is the working alliance component of the relationship. Second, it is argued that aspects of the therapist-client relationship may largely involve projections “based on his or her own wishes and fears stemming from unresolved issues in the past” (Gelso, 2009, p. 255), known as a transference-countertransference configuration. Third, the real relationship, is defined “as the personal relationship existing between two or more people as reflected in the degree to which each is genuine with the other and perceives and experiences the other in ways that benefit the other” (Gelso, 2009: 254–55). A major challenge to this relationship model, as Gelso (2009) himself acknowledges, is that it generally does not find much support in postmodern circles, as it invites critique in terms of defining ‘reality’, who may act as arbiters of ‘reality’ and also whether ‘what is real’ can actually be known. Putting questions of reality aside, however, we find that the model is important due to its emphasis on the ‘task-based’ component of the therapeutic relationship. As Kozart (2002, p. 220) argues, “the clinical relationship is not merely a means to define clinical goals and implementing tasks; rather, the goals and tasks are the means to strengthen a relationship that has an intrinsically therapeutic effect.”; that is, in Kozart (2002) ethnomethodological view, relationships in the therapy setting are not so much accomplished as an explicit topic in interaction, but rather through clients’ and therapists’ joint, ‘common sense’ attention on working towards the achievement of therapeutic goals.

Alongside – and in certain respects diverging from – Gelso’s tripartite relationship model, quantitative-statistical paradigms have developed concepts and categories to differentiate aspects of the relationship and to assess them quantitatively in terms of being demonstrably or probably effective. Some of these elements include empathy, collaboration, the alliance and dealing with alliance ruptures (for a full list, see Norcross and Lambert, 2018). Whereas those approaches have been able to demonstrate that these aspects contribute significantly to good therapy outcomes, they have not shown how these elements are instantiated or even relate to each other (Horvath, 2006). To understand the process and the inner workings of relationship construction, we refer to studies that investigate interaction in therapy. Proceeding in this manner allows us to connect two approaches that have so far in general been treated as separate, one as stemming from a quantitative, the other from a qualitative-interactional paradigm.

For the remainder of this review, we provide a summary of the “discursive turn” in psychotherapy relationship research. For reasons of space, we restrict ourselves to studies on individual therapy (for interactional studies on the relationship in couple or family therapy see Muntigl and Horvath, 2016; Kykyri et al., 2019; Nyman-Salonen et al., 2021; for interpreter-mediated therapy Scarvaglieri and Muntigl, 2022).

It has long been recognized by linguistic scholars that language has a social, relational component (Malinowski, 1923; Bühler, 1934; Jakobson, 1960). Brown and Gilman (1960) influential paper on power and solidarity showed how certain language selections (e.g., tu and vous) may constitute relationships between speakers along those dimensions. Drawing from Goffman (1967) work on face, Brown and Levinson (1987) built extensively on Brown and Gilman’s initial observations, illustrating how speakers’ linguistic selections, which comprise facework, orient to various relationship dimensions (power, social distance and imposition of the face-threatening action). Scholars of social interaction have argued that talk itself is organized along relational terms, for example, to promote social solidarity and avoid conflict (Goffman, 1967; Davidson, 1984; Heritage, 1984; Sacks, 1987). This kind of (pro-social) organization, according to Enfield (2006: 399–400) goes even further to suggest that the (pro-social) organization recurrently found in talk, indexes an affiliation imperative that “compels interlocutors to maintain a common degree of interpersonal affiliation (trust, commitment, intimacy), proper to the status of the relationship, and again mutually calibrated at each step of an interaction’s progression.”

The psychotherapy relationship has become a Central topic in discourse studies (see Scarvaglieri et al., 2022). In this section, we briefly review some of the burgeoning areas of discursive research by focussing on aspects of the relationship pertaining to what conversation analysts have termed affiliation and alignment (Stivers, 2008; Steensig, 2020). According to Steensig (2020), these concepts represent different types of cooperative responses, with affiliation referring to the affectual level and alignment to the structural, task/goal-oriented level – the counterparts to these concepts, disaffiliation and disalignment, generally index a certain quality of non-cooperativeness. These concepts may be seen as ‘loosely connected’ to the alliance, with affiliation related to ‘interpersonal bonds’ (but also to Gelso’s real relationship) and alignment to tasks/goals. Our discussion will also address two other areas import for relationship accomplishment: empathy and disaffiliation-repair (or rupture-repair) sequences.

Our mini review has briefly outlined some important discursive, interactional studies that have focussed on how various relationship elements are realized, in situ, at the micro-level of conversation. This research is also beginning to shed light on how different elements are achieved within the same interventions. For example, some research has begun to explore connections (similarities and differences) between affiliation and alignment/cooperation (Muntigl and Horvath, 2014; Scarvaglieri, 2020) or affiliation and empathy (Muntigl, 2023). More work is needed to identify and explain how these elements are jointly realized, discursively, and how a certain relationship quality is achieved and maintained in the process.

Another area of interactional research that is still in its infancy pertains to the non-vocal level and its importance for negotiating relationships. For example, it has also been argued that nonverbal synchrony can be a marker of ‘well-being’ (Nyman-Salonen et al., 2021) – see also Streeck (2009) for related discussions on the topic of synchrony. A recent study by Peräkylä et al. (2023) has begun to address this gap by showing how non-vocal resources such as body position and gaze direction work to display engagement or disengagement, thus providing a poignant picture of the relationship quality between persons at a given moment in time. To conclude, discursive studies not only provide an important lens on the multi-faceted ways in which relationships are achieved, they also provide a complement to existing work in psychotherapy research, showing how relationship elements form an integral part of talk and work together in a synergistic fashion.

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