 Mae'r gwahau sydd yn ystod o'r cyffredinidau, mae'n amlwg am y gwahau, ond rydyn ni'n dweud y ffordd yw'r gwahau. Mae'r gwahau sydd wedi bod yn ei wneud, ac mae'n dweud yw'r gwahau sydd yn ymddangos, ond yw'r cyffredinidau. Ond oeddwn ni'n dweud ar y gwahau sydd yn y cyffredinidau sydd yn y gwahau, yn y sylfaenwyr sydd yn y gwahau. Ond rydyn ni'n dweud yw'r cyffredinidau, ond rydyn ni'n dweud ar gweithiwn yn y gwahau, ac mae'r gweithio ar dafod hwn efallai ynghylch llythau ac mae'r gweithio ar y gweithio arall, yn ystod roedd gydig yn unig o'r cyflonddau ynddyn ni'n gwneud hynna i'r peth. Wrth gwasanaeth, mae'r gwneud y cael bod, mae'n meddwl o'r cyflwp hwn i'n cyflwp hwn. Roedd eich cyllid gyda'r cyflwp hwn, a mewn yw'r cyflwp hwn. Oherwydd yna'r gwneud hynny yw'r clynyddon yw'r cyflwp hwn. o'r lleolau, ychydig o'r lleolau o'r llai a'r llai'r clain o'r rhai gan y llwyb i'r arbennig. A'r lleolauau ar gyfer sydd wedi'i ddigonu ar ei ystyried yn ei gwybod, dyna'r llai yn eithaf? Ieithaf mae'r lleolau o'r llai yn ei ddigonu? Mae'r cwestiynau o'r cwestiynau ar gyfer sy'n cymdeithasol i gael i'r cyfle, ac mae'r ceisio i gael i gael ei gael i'r cyffredin iawn. Gweld genneud y cwestiynau ei gael ar roi ymwneud, sy'n gallu hynny, cael ei gael y dyfodol, ei angenogaeth, ei angenogaeth, ei angenogaeth, ei angenogaeth gwneud, ei angenogaeth gwneud, yr ydych yn gynweddyn, mae'r gennym o'r eu cynnig ar yr haemnig iawn o'i ddialog, mae'n bywys gwybod ddechrau, yn gyfnodd ryn ni'n ddych chi ar hyn yn eich gwneud. mae費 diton yn oed yn bwysig. Yn mynd cael y cwestiynau'r haemnig iawn, ac mae'r gwybod yn unig those of us who are interested in perhaps more humanistic, more integrative elements of the therapeutic field because, on the one hand, we can say that these things are beyond research. We don't want to cheapen it with research. Remember, somebody once saying that relational depth is like this butterfly, and if you try and capture it, you kind of kill it by grasping it, and we can say, you know, let's just let it be, and not try and bring it together in some way while it's quiteール οποSI prevention of that, ond we live in an evidence-based culture, we live in a world where therapies are commissioned and funded on the basis of evidence and these days it's not enough for me to go to the government and say, look I know relational debt is really important, I've experienced it or I've written about it, you should be funding therapies that are relational. The reality is today that the therapies get funded are the therapies where the policy makers and the commissioners can say, there is an evidence base for this and I can kind of understand that, they've got their daily mail on their back, they're not going to want to be saying, we put this therapy in because Colrodd has said in 1959 this was the thing to do. So there's an ongoing tension and I guess for me the compromises that research takes has been worth it for the kind of policy impact that we've had in areas like for instance where now hundreds of thousands of kids are getting school-based counseling based on some of the work that we've done or that we've contributed to and the others have contributed to. And I guess there's also something for me more than that though which is about research and the ability, you know relational debt as I'll talk about in a minute is about openness, it's about being allowing the world in and what I love about research and what I've always loved about research is the way that it challenges us to think about things to be open and I'm not talking about a perspective that is research driven but one is that research informed. One way we can use research and findings from research as a way of thinking about things mixed in with our clinical experience, our theories and our expertise so some of the research that we've done on relational debt in many ways it raises more questions than answers but I think it's a way that has felt very fruitful and productive and creative as a way of further understanding what it means to relate deeply and of course that doesn't take away from other areas like theory, poetry, art as other ways of understanding what it means to relate to debt but there's one contribution I think it has a lot of value. So let me tell you a bit about relational debt to begin with. The term was coined by a colleague of mine Dave Minns who many of you may know came from the personal centre field and he wrote personal centre accounting in action and we worked together on a book called Working at Relational Debt in Counseling and Psychotherapy. Now Dave, coming from a personal centre field, I think there were two things that drove him to develop this concept of relational debt. One was that in the personal centre field we talk about training is often based around these three core conditions of empathy, congruence and unconditional positive regard and students often learn about in their training to be empathic and they learn to identify moments of empathy, moments of congruence, moments of UPR. What Dave wanted to say is that it's great to learn all these skills but there was a lot of people, particularly in the states, were kind of codifying into different techniques, these core conditions and what Dave I think wanted to say is that really these core conditions are a winner. They're a unified, integrated way of being with another person and they're not separate things. You can't do empathy now and then do congruence and then do a little bit of UPR and sprinkle a bit of UPR on. It's a way of being and that's what he referred to as relational debt. I think the other thing that Dave was concerned about is that as Counseling was becoming more and more professionalised, he was feeling that the focus is becoming more and more on the dangers of over-involvellment. What Dave wanted to say is that there is another side of the coin and that's the dangers of under-involvellment. That's not to say we shouldn't be professional, we shouldn't have boundaries but if the focus of our work is so much on boundaries and contracts and formalities and being professional, there's a danger that we can lose the essence of what can be really healing in the work that we do which is our humanity and our ability to be in a deepened connection with another human being. He wanted to bring to the fore this depth of relating and remind us really that that is so important to so much of the work we do. We worked on that first book and we worked on a book in 2018 and I did a revision of it. My own trainings in existential psychotherapy are trained at Regent's College. I was very interested in the work of Buba and I guess for me this question of what does it mean to connect with another person? I was always one that in my personal life had been really important to me and I was really aware for myself of just how fundamental, how healing, how valuable those moments of connection I'd had with friends or family members, they were the kind of nuggets of gold in an otherwise kind of sometimes flat, sometimes fairly low shoulder that felt really important and valuable to me. I was really aware that when I started doing therapy that again I was experiencing something about these moments of connection. I couldn't quite put words onto it but somehow those moments of connection seemed to be the important part of what I was doing in therapy. I was very taken by Buba's work of the existential philosopher Martin Buba. He talks about dialogue and Buba differentiates between dialogue and what he calls monologue disguised as dialogue where it looks like people are talking but actually they're really talking to themselves or monologue per se. It raised for me again those questions about what's the difference between monologue and dialogue, how do we define dialogue, how do we understand what it means to be truly in dialogue with another person? Because I can feel it, I have a bodied sense when I'm in dialogue with someone as opposed to for instance someone talking at me or someone not listening. But what does it actually mean? As I said we've had a lot of work and research around relational depth so a book came out recently called Research in Relational depth which was new perspectives on it. That has a number of chapters for instance relational depth with children and some of the criticisms of relational depth. We define relational depth as a state of profound contacts and engagement between two people where each person is fully real with the other and able to understand and value the other's experience at a high level. So relational depth as I was saying was something about being real and was also something about valuing the other and was also something about understanding the other. So we brought in all those core conditions. But one of the questions we had is like is relational depth, is it something about a quality of a relationship? Do you have like a deep relationship or is relational depth more of a moment? And actually Dave and I when we were working on this book did come at this from slightly different perspectives. Those was particularly interesting in the kind of deep relationship. I think from my phenomenological background I've been particularly interested in these moments of deep connection and what happened at these very deep moments. I guess one way we conceptualized it, can you see this screen alright by the way? It's a bit bright, it's okay. So one of the ways that we conceptualized it was to think that the level of connection in any relationship can kind of go up and down and that there's moments of deeper connection and there's moments of perhaps less deep connection. And that when we're talking about relational depth what we're talking about is we're talking about those moments when the connection really deepens. And those particular moments where it feels like a really profound strong low down connection with the other. But that raises questions in itself for instance are those moments are they qualitatively different from the other moments? Is it like we kind of quantitatively go up and down it's like a smooth transition we can have more or less contact? Or is it that there's something about those moments that are really profound and that are different from other experiences in everyday life? But we can kind of differentiate between maybe deep relationships where there is more of that depth of connection and then more surface level relationships where we don't have so much deepened connections. So a deepened relationship is one where there's more moments of relational depth compared with a surface level relationship. But again it throws up some interesting questions. Can you have a relationship at depth with someone where maybe there's only been one moment of deep connection or perhaps no moments at all? Could you have a deep, you think about the people in your life that you feel a deep relationship with? How much those moments of deep connection happen? Maybe they're in a different country. I have friends that I haven't seen for many years and yet I feel a deep connection to them based on perhaps one or two or more moments of deep connection earlier in our friendship. Of course relational depth doesn't just come from the person's inner field. There's people in other areas that have talked about it. As I was saying there's boobers, talked about the eye of our stance. Daniel Stern from the more psychodynamic field has talked about moments of meeting. Judith Jordan, the feminist cultural therapist has talked about mutual intersubjectivity. Ronnie Lang talks about co-presidents. John Rowan, who unfortunately died last year, talked about linking from a kind of transpersonal perspective and the idea that when we kind of link at a soul to soul level, that we're talking about something very similar. Actually, a boober, who also comes from a spiritual background, talks about these moments of relational depth or moments of eye-thou meeting or dialogue as the way towards spirituality for him that we actualise our spirituality, not away from other people, not from doing things necessarily like mindfulness or being separate. But that it's in those moments of deep connections with others that we find our way towards something transcendent. That to be in spiritual connection is to be through bonds with others and through bonds with our community. So, what do we learn about relational depth? One of the first things that we've looked at is this question of what is the experience of relational depth actually like? What's the phenomenological experience of deep connection? Just to say these slides will be available from the middle of next week on the conference website. So, what does it feel like phenomenologically to connect deeply with another person? We've done studies with clients, we started off doing studies with therapists and there's been a number of these studies now, several studies looking at this question. And we tend to find that this experience of relational depth falls into four areas. So, one is the kind of interpersonal feelings, what I feel inside. And then there's the experience of the other, so how I experience the other at those times. There's something about the relational, what goes on between us and then a fourth thing about the atmosphere. In terms of the interpersonal, people talk about feeling very authentic. There's something about a moment of deep connection, you feel very real, you just feel like you're being yourself. There's an energy about it, there's a kind of exhilaration and empowerment and aliveness at these moments. People often describe it as a very physical thing. They kind of feel it in their body and very importantly what we've learnt is that relational depth is not just the kind of cognitive head-to-head connection. It's a very much embodied physical, people talk about feeling electrified or tingly like something goes on in their bodies that mean that they're in resonance. We know now from some of the neuroscientific evidence that this indeed can happen, that we can resonate through mirror neurons with others. So that for instance with our clients, we can pick up in an embodied level what goes on with them in a way that is sometimes deeper and more holistic than what we might know at a cognitive level. People talk about it as being very spontaneous in the moment. There's a sense of immersion, a lot of people talk about feeling very immersed in these moments, like they're very focused. One councillor I remember saying that she works in this very noisy room, but when she was in a deep connection with her client, she wasn't aware of the noise anymore. It was just like her and that client there in the room together, free of distractions. People talk about feeling very safe and okay with themselves, there's a sense of kind of self-worth. Although also people often say that coming in or associated with these moments of relation depth is a vulnerability. It's like you kind of open yourselves up and that's the vulnerable bit. When you're in there it doesn't feel so vulnerable but the opening up can be feelings of vulnerability. And often clients talk about these moments as moments of kind of insight and in fact it's often difficult to disentangle, particularly when we look at the effects. What is the effects of that moment of connection and what is the effect of the moments of insight? It's like in gennalling terms, in focusing terms, it's like where people are right at the edges of their awareness and that they're bringing something new into experiencing into awareness in connection with others. Relational depth seems to be very much about being in connection with myself but in connection with another person. It's not just an internal experience, it's a kind of shared experience of internal and external. As something new emerges that you don't tend to get these moments when people are talking about rehearsed things that they're very familiar with. It's something new at the edges of people's being. And then people talk about how they experience the other. They feel at these moments that the other is very genuine. They've used to say that at the moments of relational depth that there's no transference, that clients just experience us as we are, not as a projected figure. I had somebody ask me recently actually whether if you had projected, if there was transference, could you have a relational depth if the client was transferring onto the therapist say a parent figure or not? It's quite an interesting question that I don't really know the answer to but I think there's something about if the therapist is holding that projection but also is feeding themselves and is engaging in a way that is authentic. I think you can have a lot of depth. I think if the therapist was just neutral and was just holding the projection without being themselves present, I don't think that would be so much relational depth. And it does also then raise the question about can you have relational depth one way? Can one person experience relational depth with another but the other not experience it back and I'll come on to that. We've done some research around that. So people feel that the other is very understanding at these moments and trustworthy comes up a lot. There's a real sense of deep trust for the other and being valued and acknowledged. And then people talk about the connection in different ways. They talk about a kind of closeness and intimacy, a togetherness. They talk about an encounter and meeting of minds. They talk about how they're kind of flowing together as synchronicity often comes up and a mutuality and equality. Clients often say that at these moments they know that the psychotherapist is still other and still a professional but they don't experience them as a kind of white coated professional who's the one who knows. It's just them and that person in the room together. And they really at those moments talk about this humanity of the psychotherapist rather than them in their professional role. There's a sense of bidirectionality and a kind of interconnectedness. Like it's not just that the therapist feels that they know the client but they feel that they know the client knows them and clients talk about something similar. Some of these people talk about love and the way that you know in the same way that in therapy we can have that experience is not obviously not romantic love but a kind of filial what we might call love. That relational depth seems to have some connection with that. Sometimes people also talk about a kind of blending and at oneness and that's another area of discussion. Is relational depth where we're one together because Buba would say that to have dialogue you have to have difference. It can't be if you're the same as somebody and this kind of brings up differences with Rogers in some way because Rogers talks about standing in the shoes of the other. But Buba and Buba is in dialogue with Rogers says that when we're in dialogue with another there needs to be another. If we're just in the shoes of another person we can't really talk to them. The relational depth is maybe more talking across differences. And then there's something about the atmosphere. People often talk about a kind of sense of timelessness at these moments. It's like short periods feel very long or long periods feel very short particularly in therapy. But it's stillness so there's a kind of energy but also stillness. People talk about it as altered or a kind of magical state and again spirituality comes up a lot. For me the best way of understanding these moments of relational depth is what I call a kind of co-presence. So James Bougantol the existential humanistic therapist talks about presence as having two aspects. He talks about it as having a receptivity that to be present to another means to really take that unique person in. So we're working for instance with someone who's depressed. Not just saying okay here's a depressive or here's a borderline I know all about borderline people. But to really listen and to take in to breathe in the uniqueness of that person. And then out of that comes an expressivity that we share from that understanding of the other from that taking in at that embodied again level that we express something of who we are. But relational depth is not just what one person does. And of course you know as therapists we can't make relational depth happen. We can at best perhaps facilitate its emergence. And one of the reasons for that is because as we saw before people said that relational depth is something spontaneous. You can't construct it. But another reason is that relational depth is not just about us. The client is a key part of that and to have relational depth. The client also needs to be receptive of us and expressive of us. And often that's the key challenge. We can work on our own receptivity, our listening, our ability to listen, our ability to resonate deeply and embodied level. We can work on our own self-awareness so that we can be more expressive. But we can't work on the client's receptivity or expressivity. And often if we're working with clients who've been maybe traumatised, abused, deeply hurt. Then being receptive to another is an incredibly challenging thing to do. And I'm sure we've all worked with clients where we feel that it's really difficult for that other person to take us in. And probably for very good reasons. But without that person taking us in, being able to hear us, being able to take in some of the things we may be sharing. And often positive things. I've worked with clients where the things that they were most close to was the positive feedback that I was giving them. That they weren't a bad person or that they weren't useless at everything. But there was something really shut there in terms of that receptivity and we talked about that. And of course it was because their experience has been that when people have been positive to them they then manipulated and then used that. And clients also need to be expressive in terms of being able to talk about what's going on for them at a deep level. And again I'm sure you've had experience working with clients where the talk very much seems to come from the outside. What they did over the day or what their partners did but rather than something deeply felt. So as psychotherapists the challenge for us in some ways to meet clients of depth is four different doors that need to be open. We need to be receptive to clients. We need to be able to express ourselves. But also clients need to be receptive and expressive. And often that's something that just simply takes time in a relationship to emerge. So what else have we learnt about relational depth? Well in terms of understanding more about relational depth we found different ways of measuring it. And as I said before you know this challenge is around measuring relational depth and kind of cheapening it if you like. But at the same time it does allow us to explore it, understand more, be able to talk about it and ultimately be able to see whether it is related to therapeutic outcomes. One of the measures we developed is something called the relational depth inventory. And this invites clients to think about a specific moment in therapy. And then to rate it on qualities that we know are associated with relational depth. Like I felt a sense of freedom or I felt my therapist respected me. Something that we've been doing more recently and we've been doing a lot of work on it. Something called the relational depth frequency scale. The relational depth inventory has been really interesting but it does focus on just one specific moment in therapy. So it doesn't kind of capture relational depth in the relationship as a whole. So the relational depth frequency scale, what that does is that that asks clients or therapists to think back on the relationship and then think how frequently they experience things like I felt we were deeply connected to one another and they can mark that from not at all to most of all of the time. And then we can look at how much clients are experiencing relational depth in therapy and how much therapists are experiencing. But then we can also look at is that experiencing a relational depth related to therapeutic outcomes. Is it that clients who are experiencing more depth then have better outcomes. And I'll tell you some of the things we're finding later on in the talk. But the first question we looked at really was do therapists experience relational depth for their clients? And I did an interview study with a number of person sensitive therapists and there's been surveys in other studies since. What our quantitative evidence shows is that most therapists do recognise experiences of relational depth. So on our relational depth frequency scale, the frequency is somewhere between sometimes and often. So they're not saying that they always experience in the client but to a certain extent. Where we've done interview studies we also find that most person sensitive therapists for instance that I talked to could identify moments where they felt very deeply connected to their clients. Other interesting studies for instance Eleanor McLeod looked at therapists working with clients with learning disabilities and found that also there most of the therapists could identify times of deep connection which was interesting because the literature has often said that people with learning disabilities can't really connect. You want to work in more cognitive behavioural ways. But she found that the therapists could really talk about powerful moments of deep connection with their clients. And we've seen studies with other therapists working with young people for instance. And again there seems to be that experience of connection. Some of the moderators we found that more experienced therapists seem to experience more relational depth. And also that therapists talk about more relational depth in longer episodes of therapy. So relational depth it does seem to happen where it's short for episodes. But it doesn't happen as much and the longer the therapy goes on the more frequently people seem to experience these moments of relational depth. But we didn't find any gender orientation or age differences. Another question though and perhaps a more important question is do clients experience relational depth. Is relational depth just something that therapists feel? And actually for clients it's not really so relevant or experienced. So again we've got both quantitative and some qualitative evidence of this. Quantitatively we found that around four-fifths of clients could identify moments of deep connection in their therapy. Although interestingly a lot said that they'd met therapists and didn't feel any connection and eventually found someone that they could connect with. In terms of frequency it's a bit less than the therapist. So therapists were somewhere between... What was that? That is not feeling a relational depth is it? I know what's wrong. Power cable came out. Let's see what's going to happen here. This is where spiritual deep connection with my computer. Let's have a look. Suddenly this is where relational depth doesn't matter at all. I just need a technical intervention. No, I think it's okay. It's going to come back on. Yeah, it's just the power. That's fine. So just on this question, sorry to impress that. Come on, come on, come on. So I'll just carry on without the slides. So I was trying to get the slides just because I don't want to eat into your time. So just on... I can see it here. I might turn my laptop around so you can see it as well. We got it? No. So just in terms of what clients are saying about their experiences of relational depth. Around four fifths of clients say that they have had some experience of deep connection with their therapist. Although they do report it a bit less than the therapist. In terms of qualitative findings, again what we found when we've done interviews with clients, and that's been some of the most interesting studies is talking to clients about their own experiences of deep connection and what that means to them. But we found that most participants could identify moments of deep connection. For instance, participants in cognitive analytic therapy could identify moments of deep connection. And I was saying many clients found that they had had these relationships where they hadn't had so much of a deep connection. Now one of the interesting things that we looked at was looking at what happens when you do video conference-based therapies. Do clients experience deep connections in online therapies? And actually what we found is that most clients could identify these moments of deep connection. Around five out of seven, I mean it was just a small scale study. But around five out of seven clients talked about having had these experiences of deep connection. And what was interesting is that they talked about what you might imagine as kind of inhibiting factors like a sense of physical detachment, and a lack of non-verbal cues, technical difficulties, feeling distracted. But feeling distracted. But also what they talked about was that they talked about that there were some positive things around web-based therapies. So actually what they said is that the kind of physical distance from their therapist meant that they felt more anonymised and then they felt that they could talk about more things that maybe they wouldn't have been able to talk about otherwise. Because there was that kind of freeing up because it was based on the web. For instance, one client said, I felt quite relaxed and very free to express what I might want to be being on Skype rather than being face-to-face. So it seemed like it worked both ways. And I think on email therapies, even therapies based on emails, I wouldn't be surprised if clients were saying that actually that they could experience quite a depth of connection. Even though it wasn't the kind of face-to-face, they lost the face-to-face but they had some other things. Sorry. Is that brilliant? Apologies for that. Okay, so on the web-based therapies, people also talked about experiences. I was just going to stand here and bang this. So now another one we looked at was about young people's experiences. And we'd had a paper in the book that I showed you before which was around a therapist who worked with young people saying about how she'd experienced the very deep connections of the young people. But another question that was to see it the other way around, what about young people? Did they experience connection with therapists? And what we found interestingly is that the young people really struggled to identify moments of deep connection. And of course we didn't ask them, you know, tell us about a time of relational depth for your therapist who's defined in this. We said, you know, can you tell us about a time of closeness or connection with your therapist? And what seemed to happen is that they really didn't, they just didn't get the question really about closeness and connection. We thought about, you know, is that that they just don't experience it and maybe it's just therapists imagining it. Is it that young people don't have the language to talk about closeness and connection in a way that adults do and maybe it's not kind of how they conceptualise things. Is it that they don't see the therapist as someone that they would connect with? Like it's a bit of a weird question to say, you know, do you connect with this person when you see a councillor in a school who's kind of miss and not someone you connect with? So that they were quite thrown by that question. So it'd be interesting, you know, it doesn't necessarily mean they didn't experience it, but it would be interesting to look more into that. In terms of moderators, what we found is that we looked across different orientations. In humanistic person centre therapies tends to be quite a lot of connection as clients rate it. In some of our studies we found that there was less in psychodynamic approaches. Others have kind of shown mixed findings. We haven't found massive differences. Although some people might think that in CBT you would have less of a connection, actually that hasn't come up. And some studies actually, there was a very interesting study about factors that have caused a deepening or strengthening of the alliance. And interestingly when clients were rating these different factors, one of the ones that they highlighted most strongly were things like being asked to do homework, setting goals with the therapist, doing exercises. It was a technical factor that actually rather than things like self-disclosure, the counselor really understood me. And there might be something about where you're doing these quite technical things that are kind of working together, can actually feel very connecting. And equally, and I think this is particularly pertinent to person centre therapy, that sometimes sitting opposite someone who's not really saying much, even if that therapist is trying for themselves to really deeply connect, can actually for clients feel very disconnecting. And we see that a lot in the research we've done around counselling in schools where kids again and again and again and again say, I can't stand it when the counselor doesn't say anything. I feel really awkward. It's like I'm sitting there and she's just looking at me one young person. I was looking at her recently and she looked at me for three minutes and just didn't say anything. Like what is this weirdness going on? And I think that's something really important to take a moment. I'm sure the counselor was thinking, I'm really trying to understand you. I want to create a space for you, but for the client it felt really disconnecting. We've done some work around gender. One study we found that the connections were generally deeper with female therapists as compared with male therapists. But what was particularly interesting was that the difference was bigger with male clients. So when you had a male client working with a female therapist, that's where we got the deepest connection. And then a male client working with male therapists, you had the least connection and the differences were a bit smaller when the client was a female. Another interesting question we've been looking at is around whether client and therapist actually experienced the connections at the same time. So is it that, for instance, as I said before, is it that the therapist experience might be this kind of up and down of connection? But is the client's one similar? Is it a similar journey? Or could it actually be that at times when the therapist isn't feeling much connection, the client is really feeling connection and when the therapist is feeling the deepest connection, the client is thinking about what they're going to have for their supper or what bus they're going to get home. So we did a study around this and what we did is that we asked, we did like counselling pairs and we gave people a little grid and every minute we asked them to just mark down separately so they couldn't see what the other one was doing, how deeply connected they feel. So you might look at anything, that is just the worst kind of research, like how is anybody going to experience relational depth when they're having to write down on a little grid, I feel seven out of ten relational depth, but it wasn't too bad actually, people felt that they got used to it and it was interesting to then see what the matching. And what we found actually, I was quite surprised by this, but what we found is actually the matching wasn't too bad, it was about 50% overlap and we found a number of instances where the therapist and the client really kind of followed the same track in terms of how deeply connected they were as one went up, the other went up and one went down and the other went down. But we did find other examples for instance here where what you've got is a therapist who starts off feeling pretty deeply connected to the client and that carries on at about the same level all the way through therapy. And in the meantime you've got a client who's starting off the same therapy so they're sitting opposite each other but the client is starting off feeling really just not connected to this person who actually does feel a connection back to them. And then they go on this journey of deepening and deepening and deepening connection whereas the therapist pretty much stays at the same level. Interestingly we found that when the therapist was a qualified counsellor psychotherapist as compared with a trainee that there wasn't higher matching with the client but again we found that the women were more matched with as well as having deeper overall that the women were more matched than the men. So another question that this kind of brings us on to then is what about the impact, does any of this matter, does relational depth actually have any influence on what happens in therapy and therapeutic outcomes? And we've looked at that now in a couple of ways. One of the things we've done is that we've used this relational depth inventory which asks clients to identify a particular helpful moment in therapy and then we can rate that and we can look at how deep the connection was in that particular moment and then we can look at whether it correlates with the therapeutic outcomes. And what we found is actually that there is a pretty strong correlation. And bear in mind that that's just one moment in therapy. So what that means is that clients, when you ask them to think about a helpful moment the clients who identify moments when there was a deeper connection seem to have better outcomes overall and of course it's correlation, it doesn't prove that one leads to the other and it's quite striking because we're just talking about one moment and you can see here that's the degree of relational depth and that's the outcomes, higher up being better and that you find a general correlation. Just on the train up I was looking at some data from our, we have a research clinic at the University of Rohampton and I was looking at our data there. Now this is slightly different because one of the problems with looking at just the quality of the relationship and outcomes is that you don't really know which one is causing which. It might be that you get a better relationship on moments of relational depth and then that leads to better outcomes. Or it might be that clients have good outcomes, they're feeling good about the therapy and then you ask them how they feel about the therapies and they go, yeah what a great therapist, I really like them. So there's always this thing about which way random does it go and we have to be very cautious in terms of the findings. One of the things that people do then is that rather than looking at therapy from the beginning to the end what you can do is you can measure say the depth of relating at session four and then rather than looking at the change overall, you can look at the change after that point and if you're getting a correlation between the depth of relating at session four and then change after that, that does start to suggest more that one is proceeding and perhaps causing the other. And this is just some data I looked at last night and that shows that very much but this is the ratings on that relational depth frequency scale which goes from 6 to 30 and this is the client's outcomes on the PHQ9 which is a measure of depression. And again what you can see is a correlation, it's only a small number of clients but it's quite a strong correlation. I mean it's not 100% overlap, it's about 13% overlap but that's still quite a strong figure for psychotherapy research showing that as clients rate more depth in the relationship so the outcomes become better and in fact when I looked at the therapist it's something similar sometimes the therapist's ratings don't correlate with much but actually the therapist's ratings also predicted better outcomes. That's similar to what we've seen also in quality of interviews that when we talk to clients what they say is that these moments of connection do have a highly significant and enduring positive effect both on the therapeutic process and long after and in terms of the immediate effects what they talk about is these moments being facilitative, healing, changing and they talk particularly about the way that it deepens trust with their therapist that although they're not always at those moments of deep connection they feel that they can go back to them and it allows them to feel that they can have deep connections with their therapist in future. In terms of long term effect the main thing that clients talk about is about an increased connection to their own selves and they say that these moments of deep connection allow them to connect back to themselves and they also talk about feeling more powerful, enabled and improved relationships with others. So in some ways what we can say is that this relational connection this meeting between the client and the therapist allows the client to transform how they relate to themselves that maybe from a place of shame, a place of vulnerability that the therapist connecting with that in a way that is empathic, accepting, real but all those things together in a way that is deeply supportive and loving allows the client to transform and internalize and transform that relationship to themselves. So I'm just going to skip a few things because I wanted to come on to just about a final very important question which is about what is it that therapists can do then to deepen their connection with clients? What facilitates a relationship? Oh, sorry. I'm not doing very well on PowerPoint today. It's death by PowerPoint. They say I'm dying. They normally talk about the audience dying. This is me dying. Self death by PowerPoint. If you can have that. So one of the things and I think again what I love about research is that it helps you talk to clients and I do one of the things I bang on about, sorry about this but often when people do research in psychotherapy particularly in masters or doctorate they look at what therapists think about this what therapists think about that and I just feel we're missing such a trick by not talking to clients and hearing from the horse's mouth so to speak and hearing and how the clients find things. So one of the things we've done is to talk to clients and Roseanne Knox particularly did this about what do clients feel led to those moments of deep connection and the thing that comes up I think the most interesting thing that comes up is that clients talk about genuine care what they say is that what really mattered is that I felt the therapist cared about me and in a way that's more than just acceptance or non-judgmental somebody saying you can be however you are it doesn't matter how you are it's feeling like someone is on your side and clients talked about this in the kind of little things it was like one that comes up a lot is clients saying I was in hospital and a therapist came to visit me in hospital and we did some work there or the client saying it was raining and the therapist offered me an umbrella or that they shook my hand or that they were warm and welcoming and that they gave me a few more minutes in the session because I was really upset it was where the therapist conveyed that they weren't just doing a job but they actually felt it mattered to them what happened to the client and I think that goes right back to what I was saying at the beginning about where Dave was coming from about the dangers of under-involvement clients didn't want unprofessionalism they didn't want you know therapists ringing them up at 8 o'clock in the night and inviting them out for a drink but it was feeling that that they mattered and I think what that means for us as therapists is not you know you can't make mattering but I know that most of the all the clients I've worked with that there is a deep sense of care that I have towards them and what I've learned from this research is the value of being able to express that and through expressing that five minutes is that okay? that it's okay and often very helpful to express that it doesn't always have to be held back and obviously you know there's professional issues all these things are very important but there is also an important space for care in the relationship and being on the client's side was about feeling like that the therapist had your back that they wanted the best for you that you know it wasn't about somebody saying yeah God your husband what a bastard you know you really should have left him but it wasn't about collusion but it was about feeling again somebody it mattered and that you really wanted your best for the client there's been some interest in working on super shrinks and I think again that comes up in that literature that the super shrinks who do seem to have better results than others that they have this real passion for the work and for the client in terms of doing what they can to make things better rather than a more neutral detached disinterested not that they are disinterested but coming across sometimes as disinterested compassion is another way perhaps of expressing that linking to compassion focus therapy so clients talk about the warmth of the therapist about being really real not playing the role of a psychotherapist but being just themselves was important for clients open safe one client said it felt as though my counselor without breaching boundaries went beyond a professional level interest and gave me such a shum and compassionate response something I couldn't put a price on I think I'd only expected to receive from her professional self it felt like she was giving from her core clients also said it was also about them and it was about them knowing what they wanted from therapy that they talked about having thought about what kind of therapist they want being ready to engage and then clients talked about making a leap and that relates to that thing I was saying about the client's own receptivity and expressivity that for therapists it often felt spontaneous clients were saying right I open those doors and that's really what allowed that relational depth to be happen one client said it was a very definite thing within myself that happened I allowed myself to be so open and let my defenses down enough it was almost as if I got to the point of no return and I thought I'm going to go for it just the last thing I want to say and then I'm sorry about eating into your break time but I think another way of looking at this is how might we as therapists be more open to meeting clients of relational depth and that means inviting ourselves at a level of self reflexivity to really think what are the ways in which I stop connecting with other people Judith Jordan the feminist therapist has talked about this idea of strategies of disconnection the idea that we all have ways that we have learnt to break away from connection from others because we feel vulnerable because we feel scared and you know if we're ourselves with our clients then that's something that will inevitably come into our client work maybe we sometimes deal with fears of disconnection by becoming detached or we have ways of disconnecting which are about intellectualising you know and by looking at our own relationships and our own relationship to intimacy and connection and thinking about how do I break connection with people in my lives when I know that actually I could be more connected do I put on a kind of facade do I go very quiet do I withdraw do I talk about theory and by thinking about that in our own lives in our own therapy and in supervision we can maybe then think does that ever come into our therapy or if not what comes into our therapy that means that sometimes we don't allow ourselves to connect with our clients as much as we could and of course it's not that those things are bad or wrong but by reflecting on it and becoming more aware of it we can maybe learn to put it more to one side and more fully meet our clients and allow that connection to be there with clients when they can I know for myself that I'm quite a conflict avoidant person and I know sometimes with clients that where they're maybe a bit angry or a bit irritated a bit annoyed I can tend to just deflect it a little bit rather than actually staying there and meeting it and encountering it and sometimes that actually although things are nicer it can sometimes make the work a little bit more superficial so something to think about and I hope that's introduced you to some of the work we've done and as I say you know I think what I love about this work is that it's raised so many questions and I think so many interesting questions and even though they're on easy answers even though it's murky and unclear and lost I think in a way when we're talking about relationships and connection we probably wouldn't want anything else and it's really a lifetime inspiration so thank you very much for this thing