How Connections Heal: Stories from Relational-Cultural Therapy

The Relational-Cultural approach makes a robust challenge to the assumptions of much therapeutic, psychological and philosophical theory, by understanding human growth not as a process of separation and individualisation but as a process of making connections.

Rating: 3.5

How Connections Heal: Stories from Relational-Cultural Therapy

Edited by , 2004. ISBN 1593850336. The Guilford Press. 258 pages.

The Relational-Cultural approach makes a robust challenge to the assumptions of much therapeutic, psychological and philosophical theory, by understanding human growth not as a process of separation and individualisation but as a process of making connections. This collection of thirteen separate contributions, by twelve practitioners, all women, covers theory, individual therapy, couples, family and group therapy, and institutional settings, including a women’s prison. It is obviously pitched at a ‘therapeutic’ audience of interested practitioners from any orientation, and possibly clients, and bravely investigates the therapeutic world in detail, both theoretically and at times almost viscerally, although it is written in fairly academic and specialised language.

The Relational-Cultural approach grew out of feminist critique, in particular the work of Jean Baker Miller MD, whose groundbreaking book, Toward a New Psychology of Women (1976)[1] connected women’s mental health and the social-political world and also showed that to lay emphasis on relationships, collaboration, and empathy, allowing emotional vulnerability in the process, was not a weakness but a strength, thereby offering an empowering alternative world view.

The approach shines a strong spotlight onto social context, not only gender but power, class, race, sexuality and all manner of differences which can cause ruptures in our connections with others and feelings of isolation and shame. The major dynamic which is noticed and used is that of connection and disconnection, with distress being located in the times of disconnection.

The relationship is, predictably, conceived as the vital element in therapy, and therapeutic movement arises through mutual empathy, in which the client perceives that the therapist has been touched by their experience, relational authenticity and mutual empowerment. Once these core processes are in play, the gradual process begins of examining and transforming ‘relational images’ — certain patterns that we have internalised about relationships and carry around with us to interpret the world. These are an interplay of cultural and personal images. Therapy is thus seen as a bi-directional process, not one in which the therapist “does something” to the client nor one in which the therapist “provides conditions” for the client. It works both ways.

The essence of an empowering relationship is summed up in Baker Miller’s The Five Good Things (Miller, 1988) [2] — a good relationship includes a feeling of zest, the ability to take action, increased knowledge of self and other, increased sense of worth and a desire for more connections. The therapeutic relationship is meant to be, through the processes of empathy, authenticity and mutuality, an instance of such a good relationship, forming the possibility for more such good relationships in the client’s life.

Most of the pieces collected here recount therapeutic relationships from the therapist’s perspective in great emotional detail, telling the story of the therapy from their point of view with no attempt at “objectivity” — recounting the points and strategies of disconnection and connection that arose between themselves and the clients, their struggles to remain connected with themselves and the clients, to keep communicating, and keep channels open when their own disconnection strategies were triggered by interactions or by similar life experiences (in one case both therapist and client have lost young babies), or by power issues between therapist and client. Sometimes I was on the edge of my seat, while sometimes I found the sections a little too long to hold my attention, with the emotional struggles, as in life, becoming repetitive!

I found the most illuminating sections to be those in which inter-racial therapeutic relationships were examined. The realities of power and privilege burst through the most sensitively conducted therapeutic relationships — in Walker’s chapter entitled Walking a Piece of the Way, she leads us through a relationship with a white client from her perspective as a black therapist just starting out. During the closing session of a seemingly successful therapy, in which race had not seemed relevant in the slightest, the client suddenly said, “and then I saw you walking down the stairs and I saw that you were black! I just wanted to get up and run out of here” (p. 50).

Walker writes inspiringly about what that relationship taught her: “It is, in fact, an abuse of power to pretend to sameness (i.e., avoid conflict) and to pre-empt the growth-inducing possibilities that connecting across difference can bring” (p. 52). “To walk a piece of the way in therapy is to acknowledge that any therapy, irrespective of apparent differences or similarities between client and therapist, is a cross-cultural journey fraught with shifting vulnerabilities” (p. 51).

It is those shifting vulnerabilities, expressed powerfully and clearly so as to dispel shame, which make up the strength of this book.


[1] Miller, J.B. (1976) Toward a new psychology of women. Boston: Beacon Press.

[2] Miller, J.B. (1988). Connections, disconnections, and violations. Work in Progress, No.33. Wellesley, MA: Stone Center Working Paper Series.

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