Relational Depth at a Time of Coronavirus

It is one of the strangest and most unnerving times in our history. We are at the peak of the coronavirus crisis: locked away in our homes, terrorised by a microscopic parasite that destroys lives indiscriminately. We are watching as many of our most treasured social practices—going to work, eating at a restaurant, seeing friends—have been taken away. People are dying.

And yet, relationally, there is much that we might learn from the coronavirus crisis.

First, that we are all so much more connected than we thought. Practices at a wet food market in Wuhan bring London to a standstill; death rates in Italy determine social policies across Europe. We are not isolated, separate communities (however much BREXIT tried to make us be) but intimately tied together as communities and peoples around the world. A sneeze in one country, literally, triggers a tornado of fear and grieving in another. Human interconnectedness, then, is not something we create, but something we are. It is our natural state: to live in this web of human relationships.

Second, that we need social connection. As people become more and more physically isolated, so they find new and innovative means of connecting with others. The evening ‘Zine’ has become popular: a Zoom webchat accompanied by a glass (or two) of wine. A few night ago, I spoke to my eldest sister who I haven’t talked to, properly, for several years. I’ve learnt the name of my neighbour’s dog (‘Zorro’). We stand outside at 8pm each Thursday to the clang of cheering and banging pans to show appreciation for our NHS. The human being, pushed inwards, forces outwards: to new connections, new possibilities, new relationship and ways of relating.

Third, that, at heart, we are not destructive or antisocial beings, but deeply compassionate and caring. Faced with this threat, human beings—almost exclusively—have not turned against each other, but towards each other: with kindness, neighbourliness, and love. The heroism of health staff: working on the frontlines to battle the virus, all the time knowing their own vulnerability to infection. In the UK, we have seen millions of people sign up as volunteers to help and care for others.

The concept of relational depth is intimately tied to each of these three premises. It starts from the assumption that, as human beings, our natural home is with each other. That we do not come into the world as separate, independent organism, but rather as nodes in a complex network of social and community relationships. Here, at the heart of our being, is love: a reaching out and tying in to the other. A need for the other. A being-togetherness that extends and transcends our individual identity.

Yet that deep human need for connectedness can be thwarted. We fall outside of relationships, of community, and become cut off from the love that is needed to feed our bones and our soul. We become, as the great Jewish philosopher Martin Buber puts it, ‘individuals’ rather than ‘persons’. This is the state that many of our clients come to us in. Maybe not explicitly. And certainly not entirely. But for lots of our clients—whether depressed, anxious, or hopeless—it is a cut-offness from others that is at the heart of their difficulties. That does not mean that they are alone and without others. It means that their heart is no longer able to reach out to the hearts of others. Their truth lies inside only. The bonds of human connectedness and embeddedness have become torn away.

Relational depth is a form of human engagement with the capacity to repair those bonds (see the most recent edition of Dave and my book, Working at relational depth in counselling and psychotherapy, Sage 2018). It is not something that counsellors and psychotherapists can, or should, strive for; but it is a state of relating that therapists can open themselves up to. And, in doing so, they can create a space in which clients can both reach out to others and reach in to their own deepest truths. Relational depth is a being-with-self while being-with-others: it is a state in which someone, in their deepest, most authentic being, is in touch with another authentic being. It is, as the research shows, a profoundly healing experiences: and one that can touch clients’ lives for many years to come.

Healthcare systems across the developed world have moved towards the prioritization of cognitive behaviour therapy (CBT) and other psychological approaches that can be delivered in brief, easily measurable packages. Certainly, these therapies can be of great value to many clients. Yet we must never forget the deep human connectedness that is at the heart of so much healing. There is another approach to mechanized and technique-centred interventions which is based on a relational reaching out to clients, and calling them back into connection and community. During the current coronavirus crisis, it is certainly true that people are turning toward technology to address their difficulties (Zoom has never been so popular, and I love it dearly!), but these tools are only a means and not an end. No-one wants technology for technology’s sake: we use it to reach out, to connect, to be back in relationship with others. Similarly, whilst technologies and manualized practices may be useful in psychotherapy, it is often—as the evidence shows—the relatedness running through them, between therapist and client, that is the true agent of healing and change. Buber said that we cannot spend all our lives in ‘I-Thou’ relatedness to others; but if we have none of it at all, if we only live in the world of the ‘I-It’, we will suffer. Developing our capacity, as counsellors and psychotherapists, to relate at depth means that each of our clients, however isolated and cut off they are in their hearts, have the possibility of reaching back into connectedness: to be back, once again, in the loving holding of community. Whatever skills, practices, and manualized practices we have acquired and can deliver, it is this offering of relational depth to our clients that may be of most therapeutic value.

[Image: CC2.0 by DFID - UK Department for International Development at https://www.flickr.com/photos/14214150@N02/15455192817. Thanks to Dr Yukishigie Nakata to reprint the above from the Preface to the Japanese translation of Working at relational depth]

[Spanish translation of this blog post]

Relational Depth in Online Therapy: Can it be Experienced, and What Facilitates and Inhibits It?

With recent developments around the coronavirus, many counsellors and psychotherapists are having — or choosing — to move to online or telephone-based therapy with their clients. But, for relationally-based practitioners, a concern can be that these changes will make it much harder to achieve a depth of connection.

Fortunately, a couple of years ago, Aisling Treanor, a trainee on the Doctorate in Counselling Psychology at the University of Roehampton, asked exactly such a question in her thesis. It was entitled ‘The Extent to Which Relational Depth can be Reached in Online Therapy and the Factors that Facilitate and Inhibit that Experience: A Mixed Methods Study’ and can be downloaded, in full, from here.

There were two parts to Aisling’s study. First, she conducted a small scale quantitative survey with 13 clients, looking at how much they had experienced a depth of relating in online therapy. Then, she conducted qualitative interviews with seven of those participants to explore their experiences in much more depth. All of the interview participants, and most of the survey participants, had received therapy via video conferencing (mainly Skype). Six of the seven interview participants were female, all were white, and their therapy tended to be long term: generally more than two years (though, in some cases, they switched to online part-way through the therapy).

So what did Aisling find?

Do Clients Experience Relational Depth in Online Therapies?

In her survey, Aisling used two quantitative measures to assess the extent to which clients experience relational depth (both of which can be downloaded from my page here).

The first was the Relational Depth Inventory, which asks respondents to identify an important event during a therapy session, and then to rate the extent to which they experienced specific qualities, associated with relational depth, during that event (for instance, ‘I felt a profound connection between my therapist and me’, ‘I felt my therapist trusted me’). The average score for the online therapy clients was approximately 3.7 on a scale of 1= ‘not at all’, 2 = ‘slightly’, 3 = ‘somewhat’, 4 = ‘very much’, 5 = ‘completely’. So that means that, in an important moment of therapy, clients experience relational depth to a considerable extent. That compares with a mean of around 3.3 from clients in face-to-face work, albeit using a different version of the RDI and with a different sample. So we can’t conclude that clients in online therapies have deeper connections in important moments than those in face-to-face therapies, but certainly the results aren’t too bad for online practices.

One of the limitations of the RDI is that it just asks about depth of connection in one moment of therapy, but what about the therapeutic relationship overall? This is the focus for a second measure the Relational Depth Frequency Scale (RDFS). This RDFS (client version) presents respondents with the following stem, ‘Over the course of therapy with my therapist, there were moments where…’ and then asks them to rate items related to relational depth (for instance, ‘It felt like a shared experience,’ ‘We were deeply connected to one another) on a scale of 1 = ‘not at all’, 2 = ‘only occasionally’, 3 = ‘sometimes’, 4 = ‘often’, 5 = ‘most or all of the time’. The average score for the 13 participants was 3.5, so somewhere between ‘sometimes’ and ‘often’. This compares against a mean of 3.5 in a survey of mainly face-to-face. Again, the measure used was slightly different and there’s no way of comparing the samples, but at the least we can say that the participants in online therapies did experience some depth of connection with their therapists.

In addition, five of the seven interview participants said that relational depth was experienced in their online therapy; and their descriptions of these moments of encounter was very similar to clients in face to face therapy (see, for instance, here). This included describing these moments as ‘beyond words’ and ‘liberating’. One client, for instance, said, ‘I think they are life changing moments those moments. They don’t come often, it’s like catching rainbows. You can’t catch a rainbow, it might land near you or something you know and in a sense these moments are I suppose miracles in a way, they are just extraordinary moments.’

So, in summary, Aisling’s research would suggest that clients can experience relational depth in online therapies. Bear in mind that all of the clients were in fairly long term work but that, in itself, would suggest that the level of relating was sufficiently deep for the clients. We also need to be wary because, of course, it’s a very small sample; and clients who were willing to take part in the survey may have been more likely to relate closely with their therapy and their therapists. Nevertheless, the findings strongly challenge the assumptions that relational depth can’t be achieved when working online—clearly it can, and for some clients in quite powerful ways.

What Facilitates Relational Depth in Online Therapy?

In the interview study, participants reported a number of factors facilitating a depth of connection that we’ve also found in face-to-face therapies (see here). First, the longer they were in therapy, the more depth of connection they tended to report. Second, there were personal and professional attributes of the therapist, such as being authentic, ‘holding the boundaries’, and being competent. There were also, however, two factors specific to online therapies.

First, and perhaps most interestingly, some of the participants said that the physical distance between them and their therapists enabled a more honest dialogue, and therefore deeper levels of communication. For instance, one client said, ‘I find it easier to communicate because there is that distance. I find one-to-ones intimidating and therefore that slight distance releases that tension.’ Another client said, ‘I’ve felt quite, like, relaxed and very free to express what I might want to, being on Skype rather than being face-to-face.’ A couple of clients also talked about the intimacy of the video conferencing encounter because participants are, perhaps ironically, more ‘face-to-face’ with a therapist (quite literally) than when they are in a room together. One client said, ‘it can feel more intimate than being in a session, em, in the same room, ’cos you kind of forget- you almost forget the kind of physical, kind of, conditions and you’re just purely focused on the conversation and content of that.’

The second factor that participants said could make for deeper relationships in online therapy, as compared with face-to-face therapy, was the ‘convenience’ of the encounter. Aisling writes, ‘Being at home in a comfortable and relaxing environment may allow clients to talk about distressing or painful experiences more quickly than being face-to-face with a therapist, and therefore enabling a deeper connection to exist.’ After sessions, too, knowing that you can just ‘flop into bed or onto the couch’ helped some clients feel safer to express more in-depth material. Some clients also felt that the offer of online therapy, when face-to-face was no longer possible, was experienced as a caring gesture by the therapist, and taking their specific needs and circumstances into account. The fact that therapy was cheaper (saving on travel costs, in particular) and available at a wider range of times also meant that clients were more likely to engage with therapy in the first place. There was also a vastly wider choice of therapists, thus meaning that clients were more likely to find someone they could connect with.

What Inhibits Relational Depth in Online Therapy?

Not surprisingly, perhaps, the biggest obstacle to experiencing relational depth in online therapies was technical difficulties. Most often, this was simply to do with problems in the online connection, for instance the internet cutting out or a poor signal. One client stated:

The only thing that ever frustrated me was when there were connection problems. It didn’t hinder the relationship as such as I knew it wasn’t anyone’s fault, it was just exasperating when you were mid sentence and spilling your heart’s secrets out and then all of a sudden I couldn’t hear what the therapist was saying or there was a delayed reaction or the camera would freeze.

Participants also spoke about the visual distraction of seeing themselves on screen (usually in a little box). One client said, ‘I find it really difficult, I didn’t like it at all, especially being able to see myself, I don’t even- I never really like it, I find it really impersonal and quite awkward using Skype’.

The second inhibiting factor, mentioned by a couple of participants, was the lack of non-verbal cues. One client described how this meant moments of deep connection could get missed:

The picture’s not terribly good and the sounds not terribly good and, em, I guess that I was a bit slow on picking it up [that the therapist was emotionally connected] because of the lack of body language to go with it. You know she [the therapist] had to say to me, ‘Oh my God, I’m finding this very emotional’, before I really picked it up and saw that she was crying, em, whereas if I’d have been sitting in the same room, I’d have noticed it straight away’.

Then there was the physical distance which, while disinhibiting for some (see above), could also be experienced as a barrier to relational depth. One client, for instance, who had experienced relational depth in face-to-face therapy, felt that he could not experience it online because of the sense of detachment that the physical distance brought. Other clients felt that the lack of physical proximity made it difficult to really feel that ‘the other person is with you’. Similarly, while some participants felt that the home setting was conducive to relational depth, others felt that it could get in the way: distracting, creating a sense of ‘lethargy’, and not bringing about the focus and ‘mindset’ that a specifically therapeutic context could bring.

Conclusion

Overall, what the findings from Aisling’s study show is that it is possible to experience relational depth in online therapy, though there are aspects of this medium that may make it less (as well as more) likely to occur. This is consistent with the broader research on relating in online therapies (see, for instance, here), which suggests that its quality does not plummet when therapy is conducted online, though it may be less than face-to-face in some instance.

What Aisling’s research also shows, however, is that there were large differences between clients. Some were absolutely fine with online therapy and found that they could relate deeply and intensely: perhaps even more so than in face-to-face therapy. Others, however, did find the medium inhibiting, and couldn’t experience the depth of relating that they would if they were in a room with their therapist.

For therapists who need to switch to online work, one obvious implications is that it’s ideal if you can get the technicalities as finessed as possible. Sometimes, there is not much you can do about poor signals and weak connections; but knowing how Skype or Zoom works, and learning how to be confident with them, is critical in being able to deliver therapy remotely. Also, given the lack of non-verbal cues, explicitly communicating to clients what you are experiencing and feeling may be of considerable value.

Developing the competencies to deliver therapy online, and issues of data security and confidentiality, is beyond the scope of this research and this blog. BACP have some good guidelines here; and Ruth Allen has posted some very useful guidance here. There is also a freely available online short course from Kate Anthony here. And the good news coming out of Aisling’s research is that delivering, or switching to, online delivery of therapy doesn’t necessarily mean compromising the depth of therapeutic relating. Clients can still have powerful, intense moments of deepened therapeutic connection via Skype or other video conferencing platforms.

[Spanish translation of this blog post]

The Chronic Strategies of Disconnection Inventory: A Practice Example

Chronic strategies of disconnection (CSoDs) is a concept developed by the feminist psychotherapist Judith Jordan. It refers to patterns of behaviour that we may develop to protect ourselves from hurt or anxiety in close relationships, but which may now be redundant: i.e., we tend to do them automatically when, in fact, it may be more beneficial for us to stay in closer connection with another person. It is a concept I have written about in relation to relational depth: looking at the ways in which people may, consciously or unconsciously, undermine their own ability to relate at depth.

The Chronic Strategies of Disconnection Inventory was a self-reflective checklist of different CSoDs developed by Rosanne Knox and myself. We developed the inventory based on data from workshops with counsellors and psychotherapists, in which they were asked to identify their own CSoDs (see our paper here). The checklist presents various different CSoDs (e.g., ‘Pushing others away,’ ‘Not expressing your wants’) and invites respondents to indicate on a 0 (Not at all) to 3 (A lot) scale, the extent to which they tend to adopt these CSoDs.

Originally, the inventory was designed for counsellors and psychotherapists to use. The aim was to help us identify our own CSoDs, so that we could explore the extent to which these might ‘leak’ into our therapeutic work, attenuating our ability to relate deeply with clients.

However, the inventory can also be used with clients to help them identify their own CSoDs.

Recently, I received an email from Simon Hughes, a trainee on the first year of a person-centred diploma, who also works in a homeless charity and housing trust. He wrote about his experience of using the inventory in a community of seven people who have come from residential rehab or detox units. I found it so interesting how he had used it that, with his permission, I have reprinted his email (with details anonymised). Simon writes…

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As part of the house, we run groups twice a week, and Wednesday's groups are about psycho-social education to build skills for relapse-prevention and help the guys in their recovery. The house are a community who challenge each other and support one another in their recovery—they have strong connections together and this is one of the best things about the project. I have been in this role since September, and decided to use the CSoDs Inventory for a house group on the fourth week I had been in the role. Relationships at this stage were still forming.

First, I spoke to the group for around five to ten minutes to explain what chronic strategies of disconnection were and gave a disclaimer about how they are not diagnostic, but just to raise awareness. I had read the Mearns and Cooper book on relational depth earlier that month, and explained how relationships can help us grow as people, but also how relationships can be risky and that we can develop strategies to protect ourselves from deep ways of relating. I then read out the blurb at the top of the CSoDs Inventory page and we had a discussion about relating deeply to people and how that is helpful (e.g. in the group talking about recovery) but can also be vulnerable and different to how we tend to relate to others outside of the group and places like Narcotics Anonymous. 

I was conscious that reading the CSoDs Inventory was not everyone’s style, so I read through the 40 strategies of disconnection aloud, giving examples of how each one might look. After that, we had the choice to either fill in the form with a pen and tick what seemed like a strategy we employed, or else to sit and think if any of them had resonated with us. We discussed what we had said and then had a cigarettes break.

After the break the group said they would like to look at the inventory again, and challenge each other on what strategies they believe the others used. I spoke briefly about how just being aware of them won't change things, but that these things tend to decrease in therapy because of an accepting relationship where people feel able to be themselves truly. I said for example, that my wife and I had been watching too much TV and not relating, and being aware of this helped us relate deeper by doing things like going for walks—but it needed to be followed by more than just being aware of it. We discussed framing how we would challenge each other and its usefulness, then the group decided they would like to proceed. People went round saying what CSoDs they felt others used, and I was surprised that the challenges were empathic and encouraging the others to become more part of the community—no one seemed upset, surprised, or offended.

At the end, the group said they felt that this had been the best ‘house group’ yet. I felt a real sense of depth in the group, which I haven't felt to that extent in a house meeting and the majority of the house seemed really able to use the inventory. I also felt a benefit in taking part in this exercise with them.

Feedback

I feel that the CSoDs Inventory was a hugely useful tool to promote conversation and deepen relationships in the context of a therapeutic group. It provided a space for residents to talk about each other’s behaviour (e.g. isolating in rooms) in a constructive way, in order to promote connection. The inventory worked for people from various educational backgrounds, literacy skills (originally said literally abilities), and at different stages of recovery. The group were able to use the inventory and engage with it, with only a small introduction, and I was able to facilitate the group whilst still being in counselling training. Honest discussion promoted relational depth in the group and the group liked this inventory more than any other Wednesday group I have since co-facilitated.

The CSoDs Inventory might be used by professionals and trainees as a therapeutic tool or outcome measure—it is reasonably accessible in how it is written and works well in a group setting, as well as for individual reflection. The inventory was applied to a group focused on recovery from substances, and provided a format to discuss tensions in the house in easy accessible language without members feeling accused or insulted.

I find the weakness in the inventory is that, while it is graded, there is no interpretation or use for the grading (e.g., no interpretation of what a total score might mean).

It may be that the inventory could be used like other outcome or process forms (e.g. CORE-OM, PHQ-9). For instance, a CSoDs Inventory could be completed at sessions 1 and 10, and the results compared. The assumption would be that people would let go of disconnection strategies within therapeutic relationships, and their score would likely decrease.

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Simon’s experiences identify some very interesting possibilities for use of the CSoDs Inventory, and the concept more broadly. As with any therapeutic method, however, the inventory should only be used following consultation with supervisors/trainers, and in-depth discussion of its appropriateness to the particular therapeutic context. It is essential, too, that clients are invited to consider whether or not they would like to use the CSoDs form prior to its use.

Relational depth: Some frequently asked questions

Over the years--across workshops, lectures and informal discussions--a number of common questions have been asked about relational depth. In the second edition of Working at relational depth in counselling and psychotherapy, due out later this month, I've tried to provide some answers to them.

What is relational depth?

It’s a state of profound contact and engagement between people. 

So is that something that happens at specific moments, or an ongoing quality of a relationship?

Both.  ‘Relational depth’ can refer to particular moments of in-depth encounter (e.g., ‘There was a real instance of relational depth with my client today’); and it can also refer to a relationship in which there is an ongoing depth of connection (e.g., ‘There’s a relational depth between my client and I’).  This is like the distinction between an ‘intimate interaction’ and an ongoing ‘intimate relationship’.  Of course, moments of relational depth can be considered the ‘essential building blocks’ of a deep relationship, but they are not the whole thing.  For instance, you may feel deeply connected to someone even though you hardly ever see them.  Likewise, it’s possible to have very intense moments of connection with someone without ever forming a deep, ongoing closeness. 

Are moments of relational depth distinctive from ‘everyday experiencing’, or is there a continuum from shallower to deeper relating? 

The question here is whether experiences of relational depth are a threshold phenomenon (like being pregnant, where there is only ‘yes’ or ‘no’), or a gradient phenomenon (like hunger, where you can have more or less of it on a continuum).  We tend to talk about moments of relational depth as discrete, threshold phenomenon.  However, what research there is suggests that it is probably closer to a gradient phenomenon.  When people are asked, for instance, to rate the depth of relating at particular moments, there is a smooth continuum from deeper to shallower rating, rather than a discrete cut-off between in-depth moments and all the others.  What we term moments of ‘relational depth’, then, could probably be more accurately described as moments when the strength of relating is particularly deep.  However, these moments of very deep relating seem to be so powerful and memorable that people often remember them as discrete, threshold-like events.

Is relational depth only relevant to therapy?

No.  It can probably be experienced in all walks of life: and particularly with partners and friends. 

And what about in groups?  Can you have ‘group relational depth’?

Yes, and Wyatt has researched and written about this.  However, in this book we focus primarily on relational depth in the one-to-one therapeutic encounter.

Can relational depth happen in short term therapy?

As the client study of Dominic (Chapter 5 of the book) suggests, yes.  However, research also shows that, the longer the therapeutic relationship, the more likely it is that there will be moments of in-depth connection. 

Does relational depth only happen in person-centred therapy?

No.  Research shows, for instance, that clients in cognitive analytic therapy also experience relational depth; as do therapists and clients in many other orientations.  Relational depth, then, can be considered a ‘common factor’ across a range of therapies.

Ok, but does ‘relational depth’ really say anything new?  Isn’t it all there is Rogers’s writings anyway?

Yes and no.  As Steve Cox rightly puts it, the concept of relational depth is inherent in Rogers, but what we have tried to do is to offer a language and a foundation that ‘firms up previously held ideas about relational interactions’. 

So is a ‘relational depth’ therapy any different from ‘usual’ person-centred therapy?

It depends what you mean by ’usual’.  These days, as we said above, most people would agree that there isn’t any one, standard person-centred therapy: it’s a diverse nation with many different ‘tribes’. 

However, if what you mean by ‘usual’ is a classical, non-directive approach, then a ‘relational depth-informed’ approach is a bit different.  With the latter, there’s a particular emphasis on meeting clients in a two-way, interpersonal dialogue; as opposed to primarily providing for clients a more one-way, reflective space.  So, for instance, therapists might be more likely to draw on their own experiences and perceptions: becoming a distinctive ‘other’ to their clients.  Similarly, rather than wholly focusing the work around a non-directive, ‘empathic understanding response process’ , therapists might engage with their clients in a variety of different ways.  For instance, they might ask questions, probe, suggest exercises, and maybe even offer advice: whatever is seen as having the potential to deepen the level of relational engagement.  In addition, because of its focus on genuine human interaction and affirmation, a relational depth-informed therapy might move beyond a ‘non-judgemental “acceptance” of the client to a more active, intentional prizing of their being-in-the-world: not just a “however they experience the world is fine,” but a deliberate affirmation of their being in all its uniqueness’.  In Chapter 1 of the new edition of Working at relational depth, we will see how these differences can be traced back to subtly different assumptions about human beings’ relational needs. 

But you can’t make relational depth happen, can you?

No, you can’t.  Partly because it requires two people to make it happen; partly because you can’t relate deeply to someone if you’re trying to do something to them; and partly because clients are likely to ‘push back’ if they feel pressurised or manipulated.  But, as a therapist, you may be able to create the conditions when relational depth is more likely to be reached, and that is the focus of our book.

Does relational depth need words?

No.  As you will see in Working at relational depth, some of the most powerful experiences of relational depth can happen non-verbally.

Just because one person is experiencing relational depth, does that mean the other one is too?

Research suggests that experiences of relational depth can be shared, but that is not always the case.  In fact, Rooney found that only about one in three moments of deep connection, as identified by clients, were also identified as such by the therapist.  On the other hand, I found about 45% overlap between clients’ and therapists’ ratings of the depth of connection.  What this suggests is that, when therapists are experiencing relational depth with their clients, it is more likely that clients will be experiencing this too, but there is no guarantee that this will be the case.

Surely it would be too much if people were relating at depth all the time?

Yes--agreed.  Buber, the existential philosopher, says that we will always move in and out of deep relating (what he calls the ‘I-Thou’ stance), and that we need to have that distance in our lives as well as the closeness.  But if we do not have any experiences of relational depth, that is where problems can start. 

But isn’t there a downside to relational depth?  For instance, couldn’t it make clients overly-dependent? 

Findings here are mixed.  Therapists and clients nearly always describe experiences of relational depth in positive terms.  However, there are some studies which suggest that feelings of vulnerability, anxiety or pain can be associated with that depth of connection.  In addition, one study found that, in about a third of clients, an in-depth therapeutic relationship had some negative consequences.  In particular, clients were left wanting more from their therapists, and perceived their therapists as being withholding .  This is consistent with evidence that, in unhelpful therapeutic relationship, clients can feel ‘relationally abandoned’ by their therapists .  However, the findings of McMillan and McLeod have not been replicated; and it may be that such experiences are more the consequence of relational depth not being fully realised, or potential precursors to this experiencing, rather than aspects of relational depth, per se.  Nevertheless, more research and scholarship is needed here to understand this ‘shadow side’ of deep encounter.