Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study

Merve Tatarhan; Ahmet Erdem; Şefika Erdem

doi:10.46778/goputeb.1909888

Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study

Abstract

This study aimed to adapt the Real Relationship Inventory–Therapist Form (RRI-T) into Turkish and to examine its psychometric properties. The real relationship is widely regarded as the most fundamental component of the therapeutic relationship, yet no Turkish instrument previously existed to assess it. The study group consisted of 420 mental health professionals working across Türkiye. The scale was adapted following the recommended cross-cultural adaptation steps, including translation, back-translation, expert committee review, and a pilot application. Exploratory and confirmatory factor analyses were conducted to examine construct validity. Exploratory factor analysis indicated that five items should be removed from the original 24-item structure; the remaining 19 items loaded onto two factors labeled Realism and Genuineness, consistent with the original theoretical framework. Confirmatory factor analysis using the DWLS estimation method yielded acceptable to good fit indices. Reliability analyses demonstrated internal consistency coefficients ranging from acceptable to high across both subscales and the total scale. Criterion validity analyses showed that RRI-T total scores were significantly and positively correlated with the Therapeutic Presence Inventory–Therapist Form, with a stronger association observed for the Genuineness subscale. Overall, the findings indicate that the Turkish form of the RRI-T is a valid and reliable measurement instrument for use with Turkish mental health professionals.

Keywords

Real Relationship, Therapeutic Relationship, Scale Adaptation, Confirmatory Factor Analysis, Mental Health Professionals

Ethical Statement

This study was approved by the Ethics Committee of Tokat Gaziosmanpaşa University Social and Human Sciences Ethics Committee. The ethics approval was granted on 26.11.2024 under the protocol number 01-52. All procedures involving human participants were conducted in accordance with institutional and national ethical standards, the Helsinki Declaration, and applicable regulations. Informed consent was obtained from all participants.

References

Ain, S. C. (2012). The real relationship, therapist self-disclosure, and treatment progress: A study of psychotherapy dyads. Dissertation Abstracts International: Section B: The Sciences and Engineering, 73(2-B), 1237.
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
Békés, V., Aafjes-van Doorn, K., Luo, X., Balarajan, S., & Hopwood, C. J. (2023). Mastery of teletherapy is related to better therapeutic relationship and presence in teletherapy: The development of the teletherapy intervention scale. Frontiers in Psychology, 14, 1206960. https://doi.org/10.3389/fpsyg.2023.1206960
Békés, V., Spina, D. S., Aafjes-van Doorn, K., Gorman, B. S., Stukenberg, K., & Waldron, S. (2024). Development of a new observer-rated measure to assess the real relationship in psychotherapy sessions. Psychotherapy Research, 1–11. https://doi.org/10.1080/10503307.2024.2360459
Bhatia, A., & Gelso, C. J. (2017). The termination phase: Therapists' perspective on the therapeutic relationship and outcome. Psychotherapy, 54(1), 76–87. https://doi.org/10.1037/pst0000100
Boateng, G. O., Neilands, T. B., Frongillo, E. A., Melgar-Quinonez, H. R., & Young, S. L. (2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6, Article 149. https://doi.org/10.3389/fpubh.2018.00149
Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). Guilford Press.
Byrne, B. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming (3rd ed.). Routledge.
Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309–319. https://doi.org/10.1037/1040-3590.7.3.309
Dabanlı, A. B., & Kandemir, M. (2021). Psikolojik danışman adaylarının terapötik ittifak düzeylerinin bir modelle incelenmesi: Beş faktör kişilik özellikleri ve sosyal problem çözme becerileri [Analysis of the therapeutic alliance levels of psychological advisor candidates witha model: Five factor personality characteristics and social problem-solving skills]. International Social Sciences Studies Journal, 7(79), 982–992. http://dx.doi.org/10.26449/sssj.2987

Doğanavşargil, Ö., & Vahip, I. (2003). Terapötik işbirliği neden önemli? Psikiyatrik yakınması 'olmayan' bir aile içi şiddet olgusu [Why is therapeutic alliance vital? A case study of domestic violence who does not complain]. Klinik Psikiyatri Dergisi, 6(3), 165–169.
Erus, S. M., & Zeren, Ş. G. (2020). Danışan ve psikolojik danışmanın penceresinden terapötik işbirliği: Çevrimiçi, yüz yüze ve plasebo gruplarının karşılaştırılması [Client’s and psychological counselors’ perspective on therapeuticalliance: Comparison of online, face to face, and plasebo groups]. Jass Studies, 13(81), 139–152. http://dx.doi.org/10.29228/JASSS.40292
Esen Danacı, A. (2009). Aktarım ve karşı-aktarım [Transference and countertransference]. ADÜ Tıp Fakültesi Dergisi, 10(3), 55–58.
Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9(4), 466–491. https://doi.org/10.1037/1082-989X.9.4.466
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.2307/3151312
Fuertes, J. N., Mislowack, A., Brown, S., Gur-Arie, S., Wilkinson, S., & Gelso, C. J. (2007). Correlates of the real relationship in psychotherapy: A study of dyads. Psychotherapy Research, 17(4), 423–430. https://doi.org/10.1080/10503300600789189
Fuertes, J. N., Gelso, C. J., Owen, J. J., & Cheng, D. (2013). Real relationship, working alliance, transference/countertransference and outcome in time-limited counseling and psychotherapy. Counselling Psychology Quarterly, 26(3–4), 294–312. https://doi.org/10.1080/09515070.2013.845548
Fuertes, J. N., Moore, M., & Ganley, J. (2018). Therapists' and clients' ratings of real relationship, attachment, therapist self-disclosure, and treatment progress. Psychotherapy Research, 29(5), 594–606. https://doi.org/10.1080/10503307.2018.1425929
Geller, S. M., & Greenberg, L. S. (2002). Therapeutic presence: Therapists’ experience of presence in the psychotherapy encounter. Person-Centered and Experiential Psychotherapies, 1(1–2), 71–86. https://doi.org/10.1080/14779757.2002.9688280
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association. https://doi.org/10.1037/13786-000
Geller, S. M., Greenberg, L. S., & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599–610. https://doi.org/10.1080/10503307.2010.495957
Gelso, C. J. (2002). Real relationship: The "something more" of psychotherapy. Journal of Contemporary Psychotherapy, 32, 35–40. https://doi.org/10.1023/A:1015531228504
Gelso, C. J., Kelley, F. A., Fuertes, J. N., Marmarosh, C., Holmes, S. E., Costa, C., & Hancock, G. R. (2005). Measuring the real relationship in psychotherapy: Initial validation of the therapist form. Journal of Counseling Psychology, 52(4), 640–649. https://doi.org/10.1037/0022-0167.52.4.640
Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy: Components, consequences, and theoretical antecedents. The Counseling Psychologist, 13(2), 155–243. https://doi.org/10.1177/0011000085132001
Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their interaction and unfolding during treatment. Journal of Counseling Psychology, 41(3), 296–306. https://doi.org/10.1037/0022-0167.41.3.296
Gelso, C. J., & Samstag, L. W. (2008). A tripartite model of the therapeutic relationship. In S. Brown & R. Lent (Eds.), Handbook of counseling psychology (pp. 267–283). Wiley.
Gelso, C. J. (2011). The real relationship in psychotherapy: The hidden foundation of change. American Psychological Association.
Gelso, C. J., Kivlighan, D. M., Jr., Busa-Knepp, J., Spiegel, E. B., Ain, S., Hummel, A. M., Ma, Y. E., & Markin, R. D. (2012). The unfolding of the real relationship and the outcome of brief psychotherapy. Journal of Counseling Psychology, 59(4), 495–506. https://doi.org/10.1037/a0029838
Gelso, C. J., Kivlighan, D. M., & Markin, R. D. (2018). The real relationship and its role in psychotherapy outcome: A meta-analysis. Psychotherapy, 55(4), 434–444. https://doi.org/10.1037/pst0000183
Gelso, C. J., & Kline, K. V. (2019). The sister concepts of the working alliance and the real relationship: On their development, rupture, and repair. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(2). https://doi.org/10.4081/ripppo.2019.373
Greenson, R. R. (1967). The technique and practice of psycho-analysis (Vol. 1). International Universities Press.
Gullo, S., Lo Coco, G., & Gelso, C. (2012). Early and later predictors of outcome in brief therapy: The role of real relationship. Journal of Clinical Psychology, 68(6), 614–619. https://doi.org/10.1002/jclp.21860
Gülüm, V. İ., Uluç, S., & Soygüt, G. (2018). Terapötik İttifak Ölçeği-Kısa Formun psikometrik özelliklerinin incelenmesi [Psychometric properties of the Turkish working alliance ınventory- short form]. Türk Psikiyatri Dergisi, 29, 47–53. https://doi.org/10.5080/u18260
Gülüm, İ. V., Dilekler Aldemir, İ., İkizer, G., & Karancı, A. N. (2025). Terapötik Mevcudiyet Envanteri’nin Türkçe uyarlamasının geçerlik ve güvenilirlik çalışması [Reliability and validity study of the Turkish form of the Therapist Presence Inventory]. Klinik Psikoloji Dergisi, 9(1), 27–40. https://doi.org/10.57127/kpd.26024438.1470442
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Prentice Hall.
Hambleton, R. K., & Patsula, L. (1999). Increasing the validity of adapted tests: Myths to be avoided and guidelines for improving test adaptation practices. Journal of Applied Testing Technology, 1(1), 1–30.
Hart, C. L., Barnett, M., & Curtis, D. A. (2024). Client deception in therapy is associated with worse therapeutic relationships and perceived therapeutic outcomes. Counselling and Psychotherapy Research, 24, 1014–1020. https://doi.org/10.1002/capr.12767
Hayes, A. F., & Coutts, J. J. (2020). Use omega rather than Cronbach's alpha for estimating reliability. Communication Methods and Measures, 14(1), 1–24. https://doi.org/10.1080/19312458.2020.1718629
Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115–135. https://doi.org/10.1007/s11747-014-0403-8
Hill, E. M., An, M., Kivlighan, D. M., Jr., & Gelso, C. J. (2024). A tripartite model of the psychotherapy relationship: Interrelations among its components and their unfolding across sessions. Psychotherapy, 61(2), 151–160. https://doi.org/10.1037/pst0000521
Hopwood, C. J., Békés, V., Aafjes-van Doorn, K., & Luo, X. (2024). Being real in therapy. The Humanistic Psychologist, 52(3), 274–288. https://doi.org/10.1037/hum0000333
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
ITC Guidelines for Translating and Adapting Tests (Second Edition). (2018). International Journal of Testing, 18(2), 101–134. https://doi.org/10.1080/15305058.2017.1398166
Johanson, G. A., & Brooks, G. P. (2010). Initial scale development: Sample size for pilot studies. Educational and Psychological Measurement, 70(3), 394–400. https://doi.org/10.1177/0013164409355692
Kandemir, M., & İlhan, T. (2019, April). Terapötik İttifak Ölçeğinin geçerlik ve güvenirlik çalışması: Psikolojik danışman formu [Validity and reliability study of the Therapeutic Alliance Scale: Counselor form] [Conference presentation]. 28. Uluslararası Eğitim Bilimleri Kongresi, Ankara, Türkiye.
Karasar, N. (2023). Bilimsel araştırma yöntemi: Kavramlar ilkeler teknikler [Scientific research method: Concepts principles techniques] (38th ed.). Nobel Akademik Yayıncılık.
Kelley, F. A., Gelso, C. J., Fuertes, J. N., Marmarosh, C., & Lanier, S. H. (2010). The Real Relationship Inventory: Development and psychometric investigation of the client form. Psychotherapy: Theory, Research, Practice, Training, 47(4), 540–553. https://doi.org/10.1037/a0022082
Kivlighan, D. M., Jr., Hill, C. E., Gelso, C. J., & Baumann, E. (2016). Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model. Journal of Counseling Psychology, 63(2), 149–161. https://doi.org/10.1037/cou0000134
Kivlighan, D. M., Jr., Kline, K., Gelso, C. J., & Hill, C. E. (2017). Congruence and discrepancy between working alliance and real relationship: Variance decomposition and response surface analyses. Journal of Counseling Psychology, 64(4), 394–409. https://doi.org/10.1037/cou0000216
Kolden, G. G., Wang, C.-C., Austin, S. B., Chang, Y., & Klein, M. H. (2018). Congruence/genuineness: A meta-analysis. Psychotherapy, 55(4), 424–433. https://doi.org/10.1037/pst0000162
Lavik, K. O., McAleavey, A. A., Kvendseth, E. K., & Moltu, C. (2022). Relationship and alliance formation processes in psychotherapy: A dual-perspective qualitative study. Frontiers in Psychology, 13, 915932. https://doi.org/10.3389/fpsyg.2022.915932
Leavy, P. (2023). Research design: Quantitative, qualitative, mixed methods, arts-based, and community-based participatory research approaches (2nd ed.). Guilford Publications.
Lo Coco, G., Gullo, S., Prestano, C., & Gelso, C. J. (2011). Relation of the real relationship and the working alliance to the outcome of brief psychotherapy. Psychotherapy, 48(4), 359–367. https://doi.org/10.1037/a0022426
Markin, R. D., Kivlighan, D. M., Jr., Gelso, C. J., Hummel, A. M., & Spiegel, E. B. (2014). Clients' and therapists' real relationship and session quality in brief therapy: An actor partner interdependence analysis. Psychotherapy, 51(3), 413–423. https://doi.org/10.1037/a0036069
Marmarosh, C. L., Gelso, C. J., Markin, R. D., Majors, R., Mallery, C., & Choi, J. (2009). The real relationship in psychotherapy: Relationships to adult attachments, working alliance, transference, and therapy outcome. Journal of Counseling Psychology, 56(3), 337–350. https://doi.org/10.1037/a0015169
Marziali, E., & Alexander, L. (1991). The power of the therapeutic relationship. American Journal of Orthopsychiatry, 61(3), 383–391. https://doi.org/10.1037/h0079268
McDonald, R. P. (1999). Test theory: A unified treatment. Lawrence Erlbaum Associates.
Moore, S. R., & Gelso, C. J. (2011). Recollections of a secure base in psychotherapy: Considerations of the real relationship. Psychotherapy, 48(4), 368–373. https://doi.org/10.1037/a0022421
Muthén, B., & Kaplan, D. (1992). A comparison of some methodologies for the factor analysis of non-normal Likert variables: A note on the size of the model. British Journal of Mathematical and Statistical Psychology, 45(1), 19–30. https://doi.org/10.1111/j.2044-8317.1992.tb00975.x
Norcross, J. C., & Lambert, M. J. (2019). Psychotherapy relationships that work: Volume 1: Evidence-based therapist contributions (3rd ed.). Oxford University Press.
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.
O'Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer's MAP test. Behavior Research Methods, Instruments, & Computers, 32(3), 396–402. https://doi.org/10.3758/BF03200807
Öztürk, H. (2024). Süpervizyona psikanalitik bir bakış: Süpervizörlerin ve terapistlerin karşı aktarım deneyimlerinin incelenmesi [A psychoanalytic view of supervision: An investigation of the countertransference experiences of supervisors and therapists] [Unpublished master's thesis]. Bahçeşehir Üniversitesi.
R Core Team. (2024). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/
Reise, S. P. (2012). The rediscovery of bifactor measurement models. Multivariate Behavioral Research, 47(5), 667–696. https://doi.org/10.1080/00273171.2012.715555
Rodrigues Ribeiro, P., & Dias Neto, D. (2023). The real relationship: The Portuguese version of the Real Relationship Inventory-Client form. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(2), 678. https://doi.org/10.4081/ripppo.2023.678
Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/h0045357
Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
Saraç, H. (2021). Terapötik süreçte aktarım ve karşı-aktarım [Transference and countertransference in the therapeutic process]. Journal of Sustainable Education Studies, 2(3), 28–40.
Shepherd, B. F., & Brochu, P. M. (2024). Let's get real: Identity concealment, burnout, and therapeutic relationship quality among psychology trainees with concealable stigmatized identities. Psychotherapy, 61(2), 125–136. https://doi.org/10.1037/pst0000522
Soygüt, G. (1999). Bilişsel psikoterapide kişilerarası süreçler: Terapötik ittifak ve terapötik ittifakta bozulma olguları [Interpersonal processes in cognitive psychotherapy: Therapeutic alliance and therapeutic alliance rupture]. Türk Psikoloji Yazıları, 2(4), 1–14.
Soygüt, G., & Işıklı, S. (2008). Terapötik İttifakın Değerlendirilmesi: Terapötik İttifak Ölçeği'nin güvenilirlik ve geçerlik çalışması [Assessment of the therapeutic alliance: Reliability and validity of the working alliance ınventory]. Türk Psikiyatri Dergisi, 19(4), 398–408.
Stefana, A., Fusar-Poli, P., Vieta, E., & Youngstrom, E. A. (2024). Evaluating the psychometric properties of the 24-item and 12-item real relationship inventory-client forms. PLOS ONE, 19(10), e0311411. https://doi.org/10.1371/journal.pone.0311411
Stefana, A., Fusar-Poli, P., Vieta, E., Gelso, C. J., & Youngstrom, E. A. (2025). Development and validation of an 8-item version of the real relationship inventory-client form. Psychotherapy Research, 35(3), 395–411. https://doi.org/10.1080/10503307.2024.2320331
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson Education.
Vaz, A. M., Ferreira, L. I., Gelso, C., & Janeiro, L. (2023). The sister concepts of working alliance and real relationship: A meta-analysis. Counselling Psychology Quarterly, 37(2), 247–268. https://doi.org/10.1080/09515070.2023.2205103
West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with nonnormal variables: Problems and remedies. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Sage Publications.
Wirth, R. J., & Edwards, M. C. (2007). Item factor analysis: Current approaches and future directions. Psychological Methods, 12(1), 58–79. https://doi.org/10.1037/1082-989X.12.1.58
Zeren, G., Erus, S. M., Amanvermez, Y., Buyruk Genç, A., & Duy, B. (2022). Client's experiences of online counseling: Satisfaction and therapeutic alliance. Cukurova University Faculty of Education Journal, 51(1), 634–658. https://doi.org/10.14812/cuefd.843542
Zwick, W. R., & Velicer, W. F. (1986). Comparison of five rules for determining the number of components to retain. Psychological Bulletin, 99(3), 432–442. https://doi.org/10.1037/0033-2909.99.3.432

Details

Primary Language

English

Subjects

Psychological Counseling and Guidance (Other)

Journal Section

Research Article

Authors

Merve Tatarhan
0000-0001-7005-2859
Türkiye

Ahmet Erdem
0000-0002-7151-4100
Türkiye

Şefika Erdem ^*
0000-0001-6308-5169
Türkiye

Early Pub Date

June 9, 2026

Publication Date

-

Submission Date

March 14, 2026

Acceptance Date

June 1, 2026

Published in Issue

Year 2026 Number: Advanced Online Publication

DOI

https://doi.org/10.46778/goputeb.1909888

IZ

https://izlik.org/JA68ZN78TJ

APA

Tatarhan, M., Erdem, A., & Erdem, Ş. (2026). Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study. International Journal of Turkish Education Sciences, Advanced Online Publication. https://doi.org/10.46778/goputeb.1909888

AMA

1.Tatarhan M, Erdem A, Erdem Ş. Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study. IJTES. 2026;(Advanced Online Publication). doi:10.46778/goputeb.1909888

Chicago

Tatarhan, Merve, Ahmet Erdem, and Şefika Erdem. 2026. “Turkish Adaptation of the Real Relationship Inventory–Therapist Form: A Validity and Reliability Study”. International Journal of Turkish Education Sciences, no. Advanced Online Publication. https://doi.org/10.46778/goputeb.1909888.

EndNote

Tatarhan M, Erdem A, Erdem Ş (June 1, 2026) Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study. International Journal of Turkish Education Sciences Advanced Online Publication

IEEE

[1]M. Tatarhan, A. Erdem, and Ş. Erdem, “Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study”, IJTES, no. Advanced Online Publication, June 2026, doi: 10.46778/goputeb.1909888.

ISNAD

Tatarhan, Merve - Erdem, Ahmet - Erdem, Şefika. “Turkish Adaptation of the Real Relationship Inventory–Therapist Form: A Validity and Reliability Study”. International Journal of Turkish Education Sciences. Advanced Online Publication (June 1, 2026). https://doi.org/10.46778/goputeb.1909888.

JAMA

1.Tatarhan M, Erdem A, Erdem Ş. Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study. IJTES. 2026. doi:10.46778/goputeb.1909888.

MLA

Tatarhan, Merve, et al. “Turkish Adaptation of the Real Relationship Inventory–Therapist Form: A Validity and Reliability Study”. International Journal of Turkish Education Sciences, no. Advanced Online Publication, June 2026, doi:10.46778/goputeb.1909888.

Vancouver

1.Merve Tatarhan, Ahmet Erdem, Şefika Erdem. Turkish adaptation of the Real Relationship Inventory–Therapist Form: A validity and reliability study. IJTES. 2026 Jun. 1;(Advanced Online Publication). doi:10.46778/goputeb.1909888