Journal of Addiction Research & Therapy
Open Access

Substance use disorder; Psychotherapy treatment; Humanistic counseling; Substance abuse; Community support groups

Relational Depth (RD) is a relatively new construct in the counseling and psychotherapy literature. The term RD was first coined by Dave Mearns as an extension of more contemporary conceptualizations of person-centered therapy with a blending of elements of existential theory [1]. More specifically, RD is “a state of profound contact and engagement between two people, in which each person is fully real with the Other and able to understand and value the Other’s experiences at a high level”. This definition of RD seemingly captures its most fundamental aspects: the encounter, the high level of realness or genuineness between the client and the counselor, and the understanding and valuing of one another. Substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use. Majority of treatment has occurred in specialty substance use disorder treatment programs with little involvement by primary or general health care, a shift is occurring toward the delivery of treatment services in general health care practice. For those with mild to moderate substance use disorders, treatment through the general health care system may be sufficient, while those with severe substance use disorders (addiction) may require specialty treatment.

Phenomenon of counseling relationship therapy

Although a number of therapies have had varying degrees of success, no single treatment has been shown to be effective for all individuals diagnosed with alcohol abuse or dependence. In recent years, interest in the field has increasingly focused on patient-treatment matching to improve outcome. The hypothesis is that more beneficial results can be obtained if treatment is prescribed on the basis of individual patient needs and characteristics as opposed to treating all patients with the same diagnosis in the same manner. RD theorists described this phenomenon as occurring in both discrete moments in therapy, as well as being a general quality of a counseling relationship [2]. Whereas, much of the contemporary research into RD appears to have focused on the distinct moments of contact between the client and counselor, one can also refer to a therapeutic relationship and its general quality of RD. Mearns and Cooper described that such moments contain a blending of a high degree of the counselor’s attitudinal or facilitative conditions of person-centered counseling including genuineness, unconditional positive regard, and empathic understanding. Additionally, a counselor who develops RD demonstrates an intention to offer something more than a therapeutic alliance and supportive conditions; she intends to bring her own perceptions and experiences related to the therapeutic encounter into the therapeutic relationship [3].

This study revealed several findings relevant to motivation to change in SUD treatment, in particular with regard to one’s recognition of an SUD. As expected, one’s involvement in substance abuse community support strongly predicted one’s recognition of a substance use problem.

Despite its person-centered and existential underpinnings, Mearns and Cooper described RD as a pantheoretical construct not limited to humanistic therapies. Moreover, therapists from a variety of theoretical orientations have identified experiences of RD. RD has been explored in clients and counselors from experiences of the self, experiences of the other person in moments of depth, and of the therapeutic relationship in general psychotherapy. However, the RD literature appears to lack studies of client experiences of RD in special clinical populations. One such population includes clients receiving treatment for substance use disorders (SUDS).

Despite the limitations identified in the present study, it would seem that RD is, at minimum, a variable worth further investigation in addictions research. Miller and Moyers called for the additional study of treatment process variables, as well as relational factors in addictions research [4]. In response to this challenge, the present study has revealed that client experiences of RD may have a meaningful relationship with the client’s recognition of an SUD [5]. It remains unclear, however, how RD might contribute to this relationship, and more research is needed to this end. Additionally, the present study’s findings appear to support that client participation in substance abuse community support groups may be a helpful adjunct to SUD treatment, particularly with regard to recognition of a substance use problem. Whether these additional treatment processes work in conjunction in their relationship with recognition of a substance use problem, is also unknown. Taken together, one might conclude that client experiences of RD in individual counseling and client involvement in substance abuse community support groups seem to be beneficial to a holistic SUD treatment approach.

In his conclusion of the RD research literature, Cooper concluded that most therapists and clients can identify having experienced RD. Furthermore, it seems that researchers have discovered some factors associated with RD such as presence, genuineness, intimacy, mutuality, and a sense of losing track of time. Whereas researchers have identified some helpful therapist characteristics for facilitating moments of RD such as trustworthiness; realness; and intent to understand beyond a typical professional level, the client appears to exert some control over whether they decide to enter into moments of depth. Experiencing these moments of depth has been described across studies in generally positive and encouraging ways, and the experience of RD may be associated with client-reported significant events in therapy and therapeutic outcomes. Clients and counselors have reported positive benefits from experiences of RD in numerous qualitative studies, and initial findings suggested that RD and mutual experiences of UPR, empathic understanding, and congruence may be associated with therapeutic outcomes.

Acknowledgment

The authors are grateful to the journal editor and the anonymous reviewers for their helpful comments and suggestions.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest for the research, authorship, and/or publication of this article.

1. https://www.scribd.com/document/411751723/Dave-Mearns-Person-Centred-Counselling
2. Schmid PF (2001) Authenticity: The person as his or her own author. Dialogical and ethical perspectives on therapy as an encounter relationship. And beyond. Rogers’ therapeutic conditions: Evolution, theory and practice 1:213-228.

Indexed at, Google Scholar

3. Susan W, Robert E, Mick C (2012) The prevalence and characteristics of relational depth events in psychotherapy. Psychother Res. 22:139-158.

Indexed at, Google Scholar, Crossref

4. Knox R (2008) Clients' experiences of relational depth in person-centred counselling. Couns Psychother Res 8:139-158. 

Indexed at, Goggle Scholar, Crossref

5. Mick C (2002) Therapists’ experiences of relational depth: A qualitative interview study. Couns Pyschother Res 5:87-95.

Indexed at, Google Scholar, Crossref