Relational-Cultural Therapy: Theory, Research, and Application to Counseling Competencies

Lisa L. Frey University of Oklahoma

An overview of relational-cultural theory and Relational-Cultural Therapy (RCT) is provided. First, a summary of the overarching framework for relational-cultural theory is offered. The theory’s roots in feminist and psychodynamic theories are discussed, along with distinguishing aspects of relational- cultural theory. The practice of RCT is reviewed, including research support regarding assumptions, practice applications, and effectiveness. The unique role that teaching RCT can play in building counseling competencies is explored with a focus on competencies related to therapeutic relationship- building skills and awareness of individual-cultural diversity. It is contended that RCT can provide an organized, systematic structure for the development of therapeutic relationship-building skills and a framework on which to build when asking counseling trainees to reflect on issues of power, privilege, oppression, and marginalization, including the ways in which those issues influence counseling. Specific examples are provided to illustrate the application of RCT in fostering these counseling competencies.

Keywords: relational-cultural theory, counselor training, counseling competencies, cultural diversity, therapeutic relationship skills

In writing about the training and practice implications of con- textual models of therapy, Wampold (2001) emphasized that the- oretical approaches to counseling must be grounded in psycholog- ical principles and knowledge. Furthermore, there has been a recent call within professional psychology to teach and measure trainee competencies, including relationship and interpersonal skills and awareness of individual-cultural diversity (e.g., Assess- ment of Competency Benchmarks Work Group of the American Psychological Association Board of Educational Affairs, 2007; Hatcher & Lassiter, 2007; Norcross, 2010). Therefore, the overar- ching purposes of this article are to review the psychological foundations of Relational-Cultural Therapy (RCT), which is a theoretical orientation that is garnering increasing attention within the field of psychology, and to explore what the teaching of RCT has to offer in building the counseling competencies of trainees. First, the RCT framework and its empirical support will be pre- sented, followed by an exploration of teaching implications related to building counseling competencies.

The Theory and Practice of RCT

Relational-Cultural Theory

Overarching framework. Above all, RCT is a feminist ther- apeutic approach. Enns (2004) outlined principles common to all approaches to feminist counseling. These principles support the welfare of all clients and include (a) privileging client perspectives and lived experiences and viewing clients as capable collaborators in moving toward strength-based change; (b) emphasizing an egalitarian client-counselor relationship, along with a concurrent awareness of the impact of power differentials related to the counselor and client roles; (c) valuing diversity, with an emphasis on exploring the complexity of intersecting social and cultural identities and therapist self-reflection regarding personal privilege and its impact on the counseling process and relationship; (d) modeling and fostering personal, interpersonal, and sociopolitical empowerment (Morrow & Hawxhurst, 1998); and (e) focusing on change rather than adjustment as the goal of counseling, with an emphasis on the overlap between personal issues and broader sociopolitical and socioeconomic considerations (see Enns, 2004, pp. 19–42 for a discussion of all principles). While specific feminist theoretical orientations may vary in the degree to which each principle is emphasized (Enns, 2004), the principles provide a framework encompassing all feminist therapies, including RCT.

Although the assumptions of RCT are congruent with multicul- tural counseling (e.g., importance of interdependence, counselor self-reflection, and awareness of oppression), it is important to note that cultural competence is the foundation to providing effec- tive multicultural counseling (Sue & Sue, 2003). For instance, RCT’s focus on interdependence and contextualism is compatible with more collectivistic values. In discussing the application of relational-cultural theory to African American women, Enns (2004) noted, “With sensitivity to culture and daily challenges of

LISA L. FREY, PhD, is an Associate Professor in the Counseling Psychology Program at the University of Oklahoma and the Director of the University of Oklahoma Counseling Psychology Clinic. She is also a faculty member in Women’s and Gender Studies. Her professional and research interests focus on gender socialization, relational development, sexual orientation and gender expression, sexual assault, and advocacy and community en- gagement. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lisa L. Frey, Department of Educational Psychology, University of Oklahoma, 820 Van Vleet Oval, Room 321, Norman, OK 73019-2041. E-mail: melissa.frey-1@ou.edu

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Professional Psychology: Research and Practice © 2013 American Psychological Association 2013, Vol. 44, No. 3, 177–185 0735-7028/13/$12.00 DOI: 10.1037/a0033121

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women of color, the relational-cultural themes of this model can be integrated with African American values that emphasize interde- pendence, collective goals, and a unifying spiritual orientation” (pp. 183–184). Despite this congruence, however, it is cultural competence that provides counselors with the awareness, knowl- edge, and skill to ethically and effectively work with diverse clients.

RCT also has roots in psychodynamic approaches. A review of seven central features that differentiate contemporary psychody- namic process and technique from other therapies (Blagys & Hilsenroth, 2000) shows that these features apply to the practice of RCT. For instance, therapeutic interventions focused on affect and emotional expression, interpersonal relations, and identification of traumatic and/or troubling life experiences (Blagys & Hilsenroth, 2000) are descriptive of both psychodynamic and RCT practice. Arguably RCT differs from traditional psychodynamic theory in terms of certain underlying principles (e.g., feminist underpin- nings, social justice focus, emphasis on development through relationship vs. individuation and autonomy) but is congruent with the central features of contemporary psychodynamic theoretical approaches, particularly in terms of process.

Distinguishing theoretical assumptions of Relational- Cultural Theory. The relational-cultural theoretical foundation is built on the assumption that meaningful, shared connection with others leads to the development of a healthy “felt sense of self” (Jordan, 1997, p. 15). Contrary to traditional models based on the “myth of the separate self” (Jordan, 2010, p. 2)—that is, consider separation-individuation to be the primary path to self- development—relational-cultural theory proposes that differentia- tion and growth of the felt sense of self develops through mean- ingful and mutual connections with others (Miller & Stiver, 1997). Psychological health and maturity are conceptualized as continu- ally evolving throughout the life span via increasing relational complexity and mutuality, rather than through increasing separa- tion and autonomy (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991). This core assumption is more complex, and more challeng- ing to traditional models, than it initially appears. Consider, for example, the development of intimacy. Traditional models of psychological development view separation-individuation of the self as the prerequisite to the ability to achieve relationship inti- macy. Relational-cultural theory, on the other hand, asserts that intimate relationships are the conduit to the development of the sense of self. That is, interdependence rather than independence is the developmental pathway to intimacy and to an increasingly complex felt sense of self.

In view of relational-cultural theory’s emphasis on relatedness, four characteristics that represent central aspects of growth- fostering relationships are delineated: (a) mutual engagement and empathy, defined as mutual involvement, commitment, and sensi- tivity in the relationship, including a willingness to impact and to be impacted by another person; (b) authenticity, defined as the freedom and capacity to represent one’s feelings, experiences, and thoughts in the relationship, but with an awareness of the possible impact of this authenticity on the other person; (c) empowerment, defined as the capacity for action and sense of personal strength that emerges from the relationship; and (d) the ability to express, receive, and effectively process diversity, difference, and/or con- flict in the relationship, and to do so in a way that fosters mutual empowerment and empathy (Jordan, 2010; Liang, Tracy, Taylor,

Williams, Jordan, & Miller, 2002; Miller & Stiver, 1997). In relational-cultural terms, connection occurs in relationships that incorporate these four relational characteristics; disconnection, which can be situational or chronic, occurs when these character- istics are not present (Jordan, 2010). It is theorized that the chronic absence of these qualities in important relationships results in a pervasive lack of interpersonal connection and a sense of isolation leading to distress (Jordan & Dooley, 2001; Miller, 1986). Further, it results in the internalization of negative and growth-inhibiting relational images (i.e., inner pictures or templates for relationship; e.g., Jordan, 2010; Miller & Stiver, 1997).

A key tenet of relational-cultural theory is the “central relational paradox” (Miller & Stiver, 1997, p. 81). Because some individuals encounter chronic and serious disconnections in relationships, they learn to keep feelings, experiences, and/or thoughts out of rela- tionships, thus sacrificing authenticity and mutuality to experience some semblance of acceptance and safety (Miller & Stiver, 1997). For example, an individual with a history of childhood abuse might withhold important feelings in significant adult relationships be- cause of fears of further abuse or abandonment. Such survival mechanisms are labeled by Miller and Stiver as “strategies of disconnection” (p. 106). Use of these strategies, although not necessarily consciously applied, allow an illusion of connection (Walker, 2004a). Caught in the struggle between the need to self-protect and the need for authentic relationship, the individual yearns for and yet is terrified by genuine connection, resulting in the central relational paradox (Miller & Stiver, 1997; Walker, 2004a).

The influence of Western sociocultural norms on sex role de- velopment is incorporated throughout relational-cultural theory. Although originally developed to explain women’s psychological growth, research and theory have extended the application to men (e.g., Bergman, 1995; Cochran, 2006; Frey & Dyer, 2006; Frey, Beesley, & Miller, 2006; Frey, Beesley, & Newman, 2005; Frey, Tobin, & Beesley, 2004; Vasquez, 2006). For instance, Bergman suggested that men’s identity and self-esteem are socioculturally shaped through a process of fostering competition or comparison with others at the expense of healthy relational development. Cochran also pointed out the influence of Western culture in limiting men’s options for coping in healthy ways with loss and sadness and emphasized the applicability of RCT in addressing this issue therapeutically. Feminist scholars have long underscored the cost to men of cultures built on patriarchal privilege. Although men may not be directly exploited or oppressed by sexism and patriarchy, they suffer consequences as a result of it (Hooks, 2000).

It is important to keep in mind, however, that the intent of relational-cultural theory is to underscore the cost of all rigidly imposed sex role standards. That is, the theory goes well beyond any suggestion that women should be idealized. In response to the sociocultural expectation that men will be autonomous and inde- pendent, men may sacrifice relational skill development (Berg- man, 1995). In contrast, women, who are generally expected to carry primary relational responsibility, may sacrifice authenticity to maintain relationships (Brown & Gilligan, 1992; Miller, 1986).

Although relational-cultural theory has been criticized because the initial development was primarily based on the experiences of White, middle class women (Enns, 2004), the theory and practice of RCT has since been expanded to incorporate a more explicitly

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multicultural and social justice perspective (e.g., Adams, 2004; Comstock et al., 2008; Jenkins, 2000; Turner, 1997; Vasquez, 2006; Walker, 2004a, 2004b). This growth is reflective of the theory’s feminist roots and focus on the impact of oppression, marginalization, and social stratification. Congruent with the as- sumptions of relational-cultural theory, the applicability of tradi- tional models based on separation-individuation to ethnic minori- ties and women has long been questioned (e.g., Choi, 2002; Gilligan, 1982; Green, 1990; Josselson, 1988). Walker (2004a) observed that when separation and individuation are accepted as the standards for psychological health and maturity, the develop- mental experiences and cultural worldviews of many groups and individuals, regardless of sex, are marginalized and pathologized.

The Practice of RCT