Articles
2026: Online Advance Publication
Developing relational competence in psychotherapy training: a qualitative study of trainees’ perspectives
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 April 2026
0
Views
0
Downloads
Authors
Relational competence is a key determinant of psychotherapy outcomes, yet its development during training remains insufficiently understood. The present study adopts a qualitative, trainee-centered approach to examine how psychotherapy trainees conceptualize relational competences, evaluate their strengths and limitations, and identify the experiences most influential in their development. Forty-nine trainees from a four-year psychotherapy training program completed a structured interview, and data were analyzed using inductive qualitative content analysis. Findings revealed four main themes: i) the conceptualization of relational competence as a foundational and multidimensional component of clinical practice; ii) a predominantly external, patient-driven locus of validation for perceived strengths; iii) the context-dependent and relationally situated nature of perceived limitations; and iv) the central role of experiential learning contexts in fostering relational development. Overall, relational competence emerged as a dynamic and developmental construct, shaped by the integration of personal dispositions, experiential learning, and evolving professional identity. These findings highlight the need for training models that more effectively integrate experiential and reflective components while supporting the development of more internalized standards of professional competence.
Downloads
Download data is not yet available.
Citations
Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1-33. doi: 10.1016/S0272-7358(02)00146-0
Berne, E. (1961). Transactional analysis in psychotherapy: A systematic individual and social psychiatry. Grove Press. doi: 10.1037/11495-000
Constantino, M. J., Boswell, J. F., & Coyne, A. E. (2021). Patient, therapist, and relational factors. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition (7th ed., pp. 225-262). John Wiley & Sons, Inc.
Dennhag, I., & Ybrandt, H. (2013). Trainee psychotherapists’ development of therapeutic skills during training. Psychotherapy Research, 23(4), 432-444. doi: 10.1080/10503307.2013.789433
Hatcher, R. L. (2015). Interpersonal competencies: Responsiveness, technique, and training in psychotherapy. American Psychologist, 70(8), 747-757. doi: 10.1037/a0039803
Heinonen, E., Lindfors, O., Härkänen, T., Virtala, E., Jääskeläinen, T., & Knekt, P. (2014). Therapists’ professional and personal characteristics as predictors of working alliance in short‐term and long‐term psychotherapies. Clinical Psychology & Psychotherapy, 21(6), 475-494. doi: 10.1002/cpp.1852
Heinonen, E., & Nissen-Lie, H. A. (2020). The professional and personal characteristics of effective psychotherapists: A systematic review. Psychotherapy Research, 30(4), 417-432. doi: 10.1080/10503307.2019.1620366
Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social science & medicine (1982), 292, 114523.
Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52(2), 196-205. doi: 10.1037/0022-0167.52.2.196
Hill, C. E., Lystrup, A., Kline, K., Gebru, N. M., Birchler, J., Palmer, G., & Pinto-Coelho, K. (2013). Aspiring to become a therapist: Personal strengths and challenges, influences, motivations, and expectations of future psychotherapists. Counselling Psychology Quarterly, 26(3-4), 267-293. doi: 10.1080/09515070.2013.825763
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277-1288. doi: 10.1177/1049732305276687
Joo, E., Bae, S. H., & Orlinsky, D. E. (2005). Korean psychotherapists’ self-report on strengths and limitations in practice: An exploratory qualitative study. Korean Social Science Journal, 32(2), 71-89.
Kramer, U., & Stiles, W. B. (2015). The responsiveness problem in psychotherapy: A review of proposed solutions. Clinical Psychology: Science and Practice, 22(3), 277. doi: 10.1111/cpsp.12107
Lorentzen, S., Rønnestad, M. H., & Orlinsky, D. E. (2011). Sources of influence on the professional development of psychologists and psychiatrists in Norway and Germany. European Journal of Psychotherapy & Counselling, 13(2), 141-152. doi: 10.1080/13642537.2011.570016
Mathieson, F. M., Barnfield, T., & Beaumont, G. (2009). Are we as good as we think we are? Self-assessment versus other forms of assessment of competence in psychotherapy. The Cognitive Behaviour Therapist, 2(1), 43-50. doi: 10.1017/S1754470X08000081
Messina, I., Gelo, O. C. G., Sambin, M., Bianco, F., Mosconi, A., Fenelli, A., & Orlinsky, D. E. (2018). Trainees’ self‐evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training. Clinical Psychology & Psychotherapy, 25(2), 338-347. doi: 10.1002/cpp.2165
Messina, I., Gullo, S., Gelo, O. C. G., Giordano, C., & Salcuni, S. (2019). An overview of the Italian contribution to the international multisite SPRISTAD study on psychotherapy training. Research in Psychotherapy (Milano), 22(3), 418. doi: 10.4081/ripppo.2019.418.
Messina, I., & Trimoldi, G. (2024). Shaping psychotherapy trainees’ potential: Insights from training program directors. Research in Psychotherapy (Milano), 27(2), 799. doi: 10.4081/ripppo.2024.799
Nissen-Lie, H. A., Goldberg, S. B., Hoyt, W. T., Falkenström, F., Holmqvist, R., Nielsen, S. L., & Wampold, B. E. (2016). Are therapists uniformly effective across patient outcome domains? A study on therapist effectiveness in two different treatment contexts. Journal of Counseling Psychology, 63(4), 367-378. doi: 10.1037/cou0000151
Nissen-Lie, H. A., Monsen, J. T., & Rønnestad, M. H. (2010). Therapist predictors of early patient-rated working alliance: a multilevel approach. Psychotherapy research: Journal of the Society for Psychotherapy Research, 20(6), 627-646. doi: 10.1080/10503307.2010.497633
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315. doi: 10.1037/pst0000193
Oasi, O., De Salve, F., Rossi, C., Maggio, S., Casabona, I., & Molgora, S. (2024). Rethinking treatment failures. Research on a group of Italian psychotherapists. Frontiers in Psychology, 15, 1403736. doi: 10.3389/fpsyg.2024.1403736
Orlinsky, D. E., Messina, I., Hartmann, A., Willutzki, U., Heinonen, E., Rønnestad, M. H., & Schröder, T. (2024). Ninety psychotherapy training programmes across the globe: Variations and commonalities in an international context. Counselling & Psychotherapy Research, 24(2), 558-571. doi: 10.1002/capr.12690
Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. American Psychological Association. doi: 10.1037/11157-000
Orlinsky, D. E., Rønnestad, M. H., Hartmann, A., Heinonen, E., & Willutzki, U. (2020). The personal self of psychotherapists: Dimensions, correlates, and relations with clients. Journal of Clinical Psychology, 76(3), 461-475. doi: 10.1002/jclp.22886
Orlinsky, D. E., Strauss, B., Rønnestad, M. H., Hill, C., Castonguay, L., Willutzki, U., Hartmann, A., Taubner, S., & Carlsson, J. (2015). A collaborative study of development in psychotherapy trainees. Psychotherapy Bulletin, 50, 21-25.
Rocco, D., Gennaro, A., Filugelli, L., Squarcina, P., & Antonelli, E. (2019). Key factors in psychotherapy training: an analysis of trainers’, trainees’ and psychotherapists’ points of view. Research in Psychotherapy (Milano), 22(3), 415. doi: 10.4081/ripppo.2019.415
Rønnestad, M. H., & Skovholt, T. M. (2013). The developing practitioner: Growth and stagnation of therapists and counselors (2nd ed.). Routledge.
Saxon, D., & Barkham, M. (2012). Patterns of therapist variability: therapist effects and the contribution of patient severity and risk. Journal of Consulting and Clinical Psychology, 80(4), 535-546. doi: 10.1037/a0028898
Tilkidzhieva, E., Gelo, O. C. G., Gullo, S., Orlinsky, D. E., Mörtl, K., & Fiegl, J. (2019). Self‐concept of relational skills in psychotherapy trainees: A pilot study. Counselling & Psychotherapy Research, 19(3), 311-320. doi: 10.1002/capr.12217
Zhang, Y., Shi, L., Wei, J., Hartmann, A., Leonhart, R., Bassler, M., & Fritzsche, K. (2022). Perceived professional development of Chinese psychotherapy trainees: a pilot study. Research in Psychotherapy (Milano), 25(2), 580. doi: 10.4081/ripppo.2022.580
Supporting Agencies
This work was supported by Mercatorum University “Bandi Competitivi di Ateneo” under Grant [43-FIN/RIC].How to Cite
Developing relational competence in psychotherapy training: a qualitative study of trainees’ perspectives. (2026). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2026.890
Copyright (c) 2026 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.