Client-centered practice, therapeutic relationship, and the use of research evidence.

July/August 2002, Volume 56, Number 4 This article offers suggestions for using research evidence in the daily practice of client-centered occupational therapy. Although others have shown that evidencebased practice and client-centered practice are congruent with and complementary to each other for clinical decision making (e.g., Egan, Dubouloz, von Zweck, & Vallerand, 1998; Law, Baum, & Dunn, 2001), no one to the best of my knowledge has combined them by way of a model of effective interpersonal relationship. Such a model can offer useful guidance for when and how to use research evidence in daily practice. A particular type of interpersonal relationship is central to the definition of client-centered occupational therapy. Law, Baptiste, and Mills (1995) described clientcentered occupational therapy as “an approach to service which embraces a philosophy of respect for, and partnership with, people receiving services” (p. 253). This approach is close kin to the therapeutic alliance described in psychotherapy (Gelso & Carter, 1985; Luborsky, 1994) and other health interventions, including rehabilitation (Prigatano et al., 1994). The therapeutic alliance involves the formation of at least two general types of relationship bonding: rapport and the working alliance.1 Rapport is formed as individuals grow to like one another and experience the other as genuinely warm, respectful, and understanding (Rogers, 1957). The working alliance is formed as individuals collaborate with one another to develop common goals and as they develop a sense of shared responsibility for working on tasks that are involved in achieving those goals (Bordin, 1979). Elizabeth Gavett and I (Tickle-Degnen & Gavett, in press) recently reviewed two bodies of literature about relationship—one on therapeutic relationship and one on the formation of close intimate relationships— and found that interpersonal relationships of different forms, including that of clientcentered occupational therapy, could be conceptualized as involving the development and maintenance of rapport and the working alliance. This article attempts to answer the following question: How can research evidence be used over the course of a therapeutic relationship in a manner that contributes to the formation and maintenance of rapport and the working alliance? Because interpersonal communication is a primary means by which therapists and clients bond to one another (Crepeau, 1991; Mattingly & Fleming, 1994), my suggestions for the use of evidence during therapy are based on functions of communication that emerge and change over an effective therapeutic relationship.