What is relational psychotherapy?

Scroll through Psychology Today, and you’ll see a slew of acronyms and specialized language about various therapy modalities. I’m guilty of it, myself. What can be a helpful shorthand in the profession (and even that’s arguable) becomes esoteric alphabet soup to people who are suffering and looking for a way out.

A word you’ll likely see repeated, even on my own website, is relational. In the context of psychotherapy, ‘relational’ refers to approaches that focus specifically on the relationships between people as central to understanding and healing. It might seem redundant - isn’t all therapy technically relational? In a sense, yes. The heart of therapy is a relationship. Relational therapy, specifically relational psychoanalytic therapy, my life’s passion and most-studied modality, places the relationship at the center of the work.

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With that in mind, my hope is to help demystify what relational therapy means - how it works and how it might actually feel. In other words: what are we doing here, and why is it helpful?

Being mystified - and Becoming Less So

Part of the intention behind terms like ‘relational’ is to name something important about the type of therapy a clinician offers, but without context, they can come across as vague and create confusion.

Before further explaining relational therapy, it’s worth touching on why searching for a therapist can be confusing in the first place. The field is full of different approaches, each with its own language and framework. Sometimes it’s clarifying, but often it creates distance between therapists and the people they’re trying to help.

In psychoanalysis, there’s a concept called mystification, in which our reality becomes obscured within relationships without our realizing it. Over time, this can make it incredibly difficult to trust our own inner experience. A child who is repeatedly criticized and treated with contempt may come to believe they are a “bad kid” and act out accordingly. Recognizing that a parent is emotionally abusive is far too threatening because attaching to their caregiver is critical to that child’s survival. The truth becomes harder to access.

This confusion can also be created by larger systems. In mental health, pressure from insurance companies to limit or block patient care and pressure on researchers to publish-or-perish both create “demand” for short-term, easily replicable therapies. Pressures that therapists feel to carve out a professional identity, demonstrate expertise, and create steadier sources of income contribute to the proliferation of new therapy modalities and trainings on how to use them. All of this runs counter to the

The end result can look like a sea of (usually) well-meaning therapists trying to differentiate themselves, while patients are wading through the alphabet soup, simply trying to find someone they can trust with their pain.

What does it mean to work relationally?

Relational therapy, as the name suggests, centers the relationships in our lives. It’s based on the idea that we come to know ourselves through relationships. How do we stay in relation to others? What is a meaningful relationship? What relationships have molded us and how? Relational psychoanalytic therapy focuses on how relationships shape who we are and, in turn, how those internalized relationships continue to impact our lives. Through the lens of relational therapy, both people are responsible for co-creating therapy, and intentional, real-time exploration of the therapist-patient relationship drives change. Therapy, then, is a collaborative process in which we use your history and what unfolds in the therapeutic relationship to bring the thoughts, feelings, behaviors, and beliefs that typically occur outside of conscious awareness into your awareness.

Which, to be blunt, can be bizarre to imagine without first experiencing it. The first time a therapist asked me some version of a question about what it would be like to be mad at them, my brain may as well have spit out an error code. It can feel completely foreign to express annoyance or dislike towards someone one sees as an expert or someone trying to help you (others might feel the opposite!). It also might stir up questions about the therapist’s intentions - are they seeking validation? Is this a test? Obviously, I can’t speak for all relational therapists, but I can say that a skilled therapist aims to welcome all parts of you into the relationship. It also might feel strange to be asked questions about your experience with the therapist because it may have never even entered your mind.

Relational psychoanalytic therapy isn’t a monolith, mainly because no two therapists or patients are the same. A truth about therapy is that the relationship is the best predictor of outcomes. However, this reality isn’t always acknowledged in other approaches. Relational psychoanalysis names and grapples with this truth - we are two humans connecting and creating meaning together. Working with a competent relational therapist means becoming more aware of what gets acted out in the safety of a relationship where we can ideally talk about anything. Ultimately, this process invites you to cultivate curiosity about yourself and the world, have more agency in your life, and live more freely.

What Relational Therapy Looks Like in Practice

Part of what makes “relational” a helpful catch-all is the difficulty in explaining what happens in session, because it is so unique to each person’s psychology and each therapist-patient relationship.

Oftentimes, people come to therapy and recount the events of their week. To work relationally means to inquire about the relationships in your life, past and present, while also paying close attention to what happens between us in the room (and to the thoughts and feelings you have during the time that passes between sessions). It’s not that you don’t get to talk about your week; I welcome everyone to bring anything they’d like to discuss and to let their mind wander, as it’s all important. It does mean that relational therapy usually prioritizes lines of inquiry into aspects of your story related to relationships, including the one you have with yourself or the process of sharing it with me.

A first session is typically focused on laying the foundation for a genuine, collaborative relationship in which you’re welcome to express things that might otherwise feel “wrong” or taboo. You might be invited to share what brings you in, your hopes or concerns, anxieties, and ambivalence about starting therapy. There is no pressure to have everything figured out or to share your story perfectly; the goal is to get a sense of who you are, start building trust, and gently explore what it’s like to talk together.

To ground this in more specific circumstances, someone I’ve been working with might come in and tell me that their boss is a jerk and doesn’t notice them. I’m trained to pay close attention to listen to a variety of things - your complaints, the way you’re telling me the complaints, what you’re not saying about your boss, shifts in body, possible feelings or motivations left out of the conversation, etc.

I might ask more detailed questions about their relationship with their boss, which might eventually lead us to understanding ways they’ve been criticized by loved ones in the past. That could lead me to think about how this person might be understanding their relationship to me (consciously or not). They might lump me in with the vast majority of people as a critical figure, or perhaps the opposite, that I’m “safe” and therefore would never intentionally criticize them. Whatever it might be, working from a relational perspective means I’ll invite curiosity about what’s happening between us. We’ll take stock of what’s coming up - do they imagine I’m judging them? Are they feeling embarrassed? Maybe they don’t seem to feel anything at all. All of these things could be important for understanding the processes underlying the pain points in someone’s life that they wish to change.

Spending time being curious together helps us consider thoughts, feelings, behaviors, and dynamics we engage in automatically. Automatic strategies aren’t inherently bad, but increasing awareness of these parts and developing a relationship with them gives us the ability to change and reduces barriers to emotional intimacy with others. Relational therapy isn’t about getting you to change. By wondering together about what’s getting in your way, you have agency to reflect and make different decisions of your own accord. With trust built over time, it feels safe to try new things and share in ways that previously felt off limits.

This is in contrast to other ways of working that might prioritize coping strategies, “correcting” cognitive distortions, or even approaches that seek to understand how history impacts your reactions, but don’t utilize the immediacy of what’s happening in the therapeutic relationship much, if at all. It’s not to say relational therapy can’t include those things, and vice versa, but the focuses are different.

What Makes Relational Psychotherapy Different From Talking with a Friend

Something that might seem confusing about forming a genuine relationship with your therapist is what that actually looks like. Relational psychotherapy is not like talking with a friend. We are both meeting with the intention of understanding you and helping you make the changes you want in your life. The relationship is no less real, but will always have some level of asymmetry, which may, in and of itself, bring up feelings that are important to share.

Another difference is that therapy has boundaries, or what professionals call ‘the frame,’ that are different from those in a friendship. Things like confidentiality and meeting at a regular time create a reliable structure that helps build trust and allows for meaningful work. Having an agreed-upon, predictable setup is a big part of what makes therapy feel safe enough for deep work.

What about talking with an AI chatbot?

Potentially the most important difference between working with a skilled relational therapist and interacting with an AI is how a relational therapist is trained to use their inner experience. Relational psychoanalytic therapists are trained to attend not only to what you say and do, but also to their own emotional responses, reactions, and associations as useful tools in the therapeutic process. This involves an ongoing commitment to self-reflection and to using oneself thoughtfully in the work. AI, by contrast, responds to the content it’s given and does not have an inner subjective experience in the same way.

Who Relational Therapy Helps

What I wish more people understood is that nearly everything we do is in a relational context, and our relationship with ourselves touches everything in our lives. Speaking for myself in a professional capacity, the pressure to “niche down”, which I recognize exists in nearly every industry now, is in opposition to my belief that most people could benefit from exploration about who they are and how they relate to themselves and others, especially given the ever-increasing sense of isolation, dread, and terror in the world.

With that in mind, someone might look for relational therapy if they notice the same patterns repeating in their relationships. For example, people who see themselves as ‘people pleasers’ might feel frustrated by always choosing emotionally unavailable partners, or they might struggle with small but ongoing issues like replying to messages. People who are stuck in painful patterns with themselves, such as pervasive self-criticism, can also benefit greatly from relational therapy.

Anecdotally, I’ve also seen this approach resonate with people who have previously done more structured or skills-based therapies. Those experiences may have been helpful, but many are left with a deeper curiosity about why they feel and act the way they do. They also might continue to wish for greater intimacy in their relationships.

So…What Are We Doing Here?

Returning to the question - what are we doing, and why is it helpful - relational therapy is focused on creating change through the very thing that makes us human. We’re working towards putting words to experiences that happen in relationships that we often don’t, and sometimes can’t, notice. What once felt automatic, confusing, or inevitable becomes something known that you have more agency over. The goal of relational psychoanalytic therapy is to help people become better attuned to their own feelings and needs, navigate conflict with more self-confidence, become more curious about themselves, feel more self-compassion, and improve their ability to communicate in healthy ways, ultimately leading to a more authentic, unburdened way of living.

*A parting note that this is inevitably an imperfect and incomplete picture, as this question is one psychotherapists and writers have been grappling with for decades, and there’s no 100% clear answer. There are numerous books and articles exploring the subject - some of which have greatly contributed to my understanding, which will undoubtedly continue to evolve over time.

cross-posted on Substack 5/11/26