How does relational psychotherapy work?

Nov 9

TL;DR - Relational psychotherapy focuses on how you experience yourself in relationship. It looks at the patterns shaping trust, closeness, conflict, dependence and belonging, and pays attention to what is happening in your life now. The aim isn’t simply to explain your past, but to understand how it is playing out as patterns in your relationships today.

What is relational psychotherapy?

Relational psychotherapy is a way of working that cares about exploring both the relationships in your life and how you experience yourself within them.

As we are always in a world with others, our relationships influence who we believe we are and how we show or hide ourselves from others. As this process lives in the present, how we make meaning from it is active and ongoing.

We look at our past experiences of closeness, difference, dependence, conflict, love, and belonging in the past so we can decide how we want them to continually shape our present.

Looking at what was, opens choice and agency with what might be – and this is ultimately freeing for those of us who have felt hopelessly stuck in relational loops.

Why brings most people to relational therapy?

Whatever the relationship, I think most of us have cringed looking back at what seems painfully clear. But hindsight has one enormous advantage: we're no longer inside it. The red flags flying high as a kite back then were likely distant dots on the horizon.

When we're in a relationship, what we notice is shaped by our hope, attachment, attraction, love, fear, loyalty, chemistry and longing. This is how we see the world. This is being human.

Sometimes we may see something that pricked at us - a red flag - but shift our focus onto the positives.

Sometimes we genuinely don't see any red flags at all. Not even a peachy-orange one. We see fields of green.

And when relationships hurt, painful patterns keep repeating, or we find ourselves wondering how am I here again? relational psychotherapy gives us somewhere to become curious about what is going on.

How does the past show up in our present relationships?

Relational therapy isn’t about drawing a straight line from that happened then to this is why I’m like this now. We're too complicated for that.

Our past can only live in our mind, which is only accessible to us in the present, just as the future is accessible through what we imagine, assume, hope and expect it to be. We can't go back, nor can we go forwards. So, psychotherapy must work with what’s present and alive, too.

We’d explore your experiences around trust, expressing needs, needing and depending on others - and how withdrawing from them protects you. We're curious about how you disagree, please others, try to stay connected, and guard a sense of belonging – to name a few.

We want to understand how your relational patterns have worked for you in your past relationships. How it works for you and against you in your relationships now - and how they're both shaping how you might be in your future relationships.

And as we mentally move back and forth between these, we try to stay open minded so our relational patterns can reveal themselves to us, through what we're talking about, how we talk about it, and how we respond to what comes up from it.

The reason we might do this is that with curiosity comes different possibilities, different perspectives, and ultimately, different ways of relating.

How are they different?

They become we choose because we understand what we are choosing - rather than blindly moving towards from habit. These leave us stuck and with a very limited sense of choice.

What makes relational psychotherapy relational?

What makes relationally focused therapy distinctive not just what you tell me about your relationships but your experience in the 'here and now' in session.

Having a living example of what being with another person is like for you, which can be very, very helpful when we’re focusing on relationship dynamics.

You could say the therapy relationship is not a backdrop to the therapy - it is part of the therapy itself. This makes sense because the ways we learned to stay connected developed in relationship.

If you're wondering what this approach might feel like in a session, I've written separately about what happens in the way I generally practice, as a relationally focused psychotherapist.

Feeling better matters - but is that the whole point?

Some therapy focuses primarily on helping symptoms reduce or patterns become more manageable. Relational psychotherapy cares about this too but doesn’t stop there.

We want to understand what's giving rise to these symptoms or patterns in the first place.

What feeds them and how they have become woven into the way you experience yourself, other people, and your relationships with them.

This distinction matters. Knowing the reasons why you feel anxious in relationships is a useful start. Understanding your internal experience of this anxiety unfolding is more useful.

The psychologist and therapist Jonathan Shedler, PhD. writes clearly and simply about this distinction.

His work repeatedly explores the psychological processes driving symptoms, and how those processes can become so familiar they feel like an entire way of being. One so big it shapes who you believe you are and becomes an identity.

When we start breaking down the whole ‘story’ it can help ease some of the overwhelm and hopelessness we might feel. Symptoms and problems are more than painful experiences, they carry messages worth listening to before rushing to banish them point blank.

What does effective psychotherapy try to do?

Shedler answers this in a wonderfully no-nonsense, easy-to-read series of articles (linked at the end).

He describes effective psychotherapy as paying close attention to emotion, recurring patterns, the ways we move away from difficult experience, how earlier relationships continue to shape present ones, and what happens in the therapeutic relationship itself.

These ideas aren't exclusive to a relational or psychodynamic style. However, they will be present in most approaches described as relational - regardless of a psychotherapist’s modality or exact title.

What does effective psychotherapy not try to do?

I like something else about Shedler's writing - he's refreshingly clear about what psychotherapy is not, which is ultra important to keep in mind.

Psychotherapy is not someone telling you what decisions to make.
It isn't endless reassurance, validation, or agreeing with everything you say.
It doesn't mean treating you as though you're fragile, broken, or incapable of change – we’re always trying to track your capacity and work within it.

This doesn't mean this type of psychotherapy is less empathic. Quite the opposite, actually.

Empathy means taking your experience seriously - seriously enough to stay curious about it all of it. Not judging them. Not minimising them or blowing them up. Nor avoiding challenging assumptions about problems and patterns which may be spoken about as if they're a life sentence.

There’s care in this approach. It’s warm too particularly for parts of your experience that’s previously felt shut out in the cold.

What can relational psychotherapy help with?

Relational difficulties tend to be interconnected and at times create a bind where the very thing that helps us protect ourselves from pain also gets in the way of what we want - like these do:

You might feel lonely in a relationship and long to feel closer, but letting someone really see you feels risky.
You hold something back.
Your partner experiences you as distant.
They react.
You react.
You feel less understood, and even less inclined to open up.
Neither of you feel connected.
And round it goes.

This is to be expected from the complicated human beings that we are.

It might not be in a relationship with a partner.

This may show up in family dynamics that pull you out of who you want to be and back into old roles. You may know what you want to say when this happens, but the words disappear under pressure.

In fallouts, a game plays out. One of right and wrong. Good and bad. Connection and rejection. Love and hate. Relational psychotherapy gets curious about all of it. Because you are in all of it - and you're in it with others.

Is this kind of relational psychotherapy evidence-based?

Yes, insofar as there is decades of psychotherapy research that shows the quality of the therapeutic relationship matters significantly. Large studies across different therapy approaches consistently find that a strong working alliance between the therapist and client is associated with better outcomes.

There is also a substantial positive evidence base for psychodynamic psychotherapy, which is a relational psychotherapy, that focuses on emotion, recurring patterns, personality, and relationships.

Research & further reading

If you are into the research behind this article, these are some of the sources informing this article.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.

Flückiger, C., Del Re, A. C., Wampold, B. E. & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.

Leichsenring, F. et al. (2023). The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria. World Psychiatry, 22(2), 286–304.

Moser, M. et al. (2026). Long-Term Psychodynamic Psychotherapy for Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Depression and Anxiety, 2026, 6172409.

British Association for Counselling and Psychotherapy. What works in counselling and psychotherapy relationships. Good Practice across the Counselling Professions 004.