THE COUNSELLING COUNSELL ING RELATIONSHIP RELATIONSHIP Introduction
The actual contact between a counselor and a person who is seeking help lies at the heart of what counseling is about. Although a counselor may be able to use theory to make sense of the client’s difficulties, and may have a range of techniques at his or her disposal for revealing and overcoming these difficulties, the fact remains that theory and technique are delivered through the presence and being of the counselor as a person: the basic tool of counseling is the person of the counselor. An interest in the nature of the therapeutic relationship represents a common concern of all therapy practitioners and theorists. Even if different approaches to counseling make sense of the client therapist relationship in different ways, they all agree that effective counseling depends on how this kind of relationship operates, operates, what happens when it goes wrong and how to fi! it. The relationshi relationship p between a client and and pati patient ent and and thei theirr ther therapi apist st is prob probabl ably y unique unique for for the the ma"o ma"ori rity ty of peopl peoplee who who ente enterr counseling. Even in short#term counseling, the person is e!posed to a situation in which another person will listen to him or her for several hours, will make every effort to see issues and dilemmas from the speaker’s perspective, will treat what is said with e!treme respect and confidentiality and will abstain from seeking to gratify any of their own needs during this time. There is a deep caring, and sense of being $special’, that is unusual or even absent from the e!perience of most people in %estern industrial societies. &f course, such an e!perience may be hard to accept: can the counselor really be trusted' (s he or she genuinely interested in what ( am saying' )ow can ( take so much without giving something back' The intensity with which many therapy clients e!perience their relationship with their therapist is captured well in a study by *ott +---, who interviewed women around their feelings about their therapists, and by %achhol/ and 0tuhr +---, who found that, 1 years after the end of therapy, clients still held vivid memories of their therapist and the qualities of their relationship with him or her. The importance of the counselor client relationship has been reflected in the findings of many research studies. 2esearch that has invited clients to describe what has been help helpfu full or unhel unhelpf pful ul for for them them in coun counse seli ling ng has has consi consist sten entl tly y found found that that clie client ntss ident identif ify y relationship factors as being more important than the use of therapist techniques. (n the eyes of the client, it is the quality of their relationship with their therapist that has made the largest contribution to the value of therapy for them. 3c*eod +--4 has reviewed this research literature. Another line of research has involved measuring the strength of the client therapist relationship early in therapy, and looking at whether a strong therapeutic alliance predicts a subsequent good outcome. This research, which has been reviewed by &rlinsky et al. +--5, repeatedly demonstrates a high positive correlation between the quality of the therapeutic relationship and the amount the client gains from therapy therap y. These research findings findings have been interpreted interpreted as providing support for the role of non#specific non#specific
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factors in therapy, which were discussed in 6hapter 7: the relationship between client and therapist is a core non#specific factor e!isting in all forms of therapy +)ubble et al. ---. %hy is the therapeutic relationship so important' There are several ways of making sense of what happens in the relationship between a counselor and a client. There are some counselors, often influenced by the cognitive behavioural tradition, or by ideas about professional client relationships in occupations such as medicine, teaching or social work, who regard the building of $rapport’ to be an initial step in counseling, of significance mainly as a platform from which structured therapeutic interventions can be made. (n contrast, there are other counselors, working within the psychoanalytic tradition, who see the relationship as an arena in which the client acts out dysfunctional relationship patterns, thus enabling the therapist to observe these patterns and set about remediating them. 8inally, there are counselors operating within the humanistic tradition who regard authentic contact or encounter between persons as intrinsically healing. 0ome counselors move between these types of relationship, depending on the client with whom they are working, or the stage of the work. The aim of this chapter is to e!amine the different images of the therapeutic relationship that have been proposed in the counseling and psychotherapy literature, and to e!plore the ways in which these ideas have been applied in practice. IMAGES OF THE THERAPEUTIC RELATIONSHIP
(t is useful to think about the different types or style of therapeutic relationship in terms of images, rather than as lists of attributes or theoretical models. 9y reflecting on images of relationship, it is possible to consider a wide array of cultural images that lie behind, or may fuse with, the approach to the counselor client relationship advocated by different theorists. 8or e!ample, images of the counselor or helper as confessor, priest, healer, shaman or friend are also present in contemporary theory and practice, but are generally referred to in an implicit rather than e!plicit fashion. The notion of $image’ also reminds us that the ideas of 8reud, 2ogers and others arise from their imagination. Any relationship between two people is played out at a number of levels: social, emotional, linguistic, physical etc. Theories of what goes on between counselortherapist and client are inevitably a partial representation of the relationship, one among many possible versions of reality. (t is important to recogni/e that ideas such as transference and empathy are ways of describing some of what is happening in therapy, rather than constituting ob"ective truths. 8inally, the idea of $image’ also reminds us that the intensity and focus of an image can vary. (n short#term counseling, there may not be time for an intense relationship to become established. (n longer#term counseling, the relationship may become stronger and more sharply defined, but may at the same time begin to be overlaid by other images, as counselor and client get to know each other in different ways.
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THE PRACTICALITIES OF RELATIONSHIP COMPETENCE: HOW TO DEVELOP AN EFFECTIVE THERAPEUTIC ALLIANCE
Although the images of the therapeutic relationship that have been reviewed above offer a valuable range of different ways of making sense of what happens between a client and a counselor, they tend to be fairly silent on the question of what a counselor should actually do to establish a robust alliance with a client. 0ome of the more recent theory and research around the topic of the therapeutic relationship have focused on identifying and developing practical strategies that can be applied by counselors to build and maintain constructive relationships with clients (t is helpful to reali/e that, on a moment#to#moment basis, congruence can be e!pressed in the way the counselor talks. 3ost of the time in counseling, both counselor and client talk in a manner that refers to the topic of the client’s $problem’. 9y also including talk that refers to the process and activity of talking, it becomes possible to weave in to the conversation a continual flow of statements about aspects of the relationship between counselor and client. This $talking about the process of talking’ has been discussed by 2ennie +--; as the skill of metacommunication: $the act of communicating about communication . . . stepping outside the flow of communication to appraise it.’ E!amples of therapist#initiated metacommunication would be when the therapist: < talks about his or her own plans, strategies, assumptions= < asks the client to focus on his or her plans, strategies, assumptions= < shares his or her assumptions about what the client thinks and intends= < invites the client to share his or her assumptions or fantasies about what the counselor thinks or intends= < reviews the relationship in all these ways when stuck, or in a therapy $crisis’= < e!plores the impact of the client on counselor +the feelings, action tendencies and fantasies that are evoked by the client’s behaviour= < e!plores the impact of the counselor on the client. Each of these ways of talking opens up a layer of the $unspoken’ or implicit relationship between counselor and client, and makes it possible for both participants in that relationship to reflect on what is happening between them, and if necessary change it. The use of metacommunication represents the application in therapy of the relationship framework developed by *aing et al. +->>. &n the whole, counselors do not engage in metacommunication to any great e!tent within therapy this is a neglected skill. ?iesler +-;; concluded, as a result of his research into
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this topic, that $therapist interventions incorporating metacommunicative feedback have been almost universally overlooked in the individual psychotherapy literature.’ 2epairing ruptures in the alliance it is seldom that a therapist and client meet form a good working relationship and then continue through several sessions of therapy without any challenge or disruption to the bond between them, or their agreed goals and tasks. This kind of $ideal’ relationship +in therapy as in any other area of life is a myth. %hat is more usual is for the relationship, and the therapeutic work, to $hit the buffers’ now and again. @articipants in counseling both clients and counselors may report that they have reached an $impasse’, or that there has been a $rupture’ in the relationship. (n these circumstances it is necessary for the counselor to be able to call on strategies for $repairing’ the relationship. A significant amount of recent theory and research has begun to address the question of how best a therapist or counselor can repair or retrieve the therapeutic relationship when it goes through a bad patch. The work of eremy 0afran +0afran --7a, b= 0afran and 3uran -->, 1444a, b, 144 has been at the forefront of attempts to investigate the processes and implications of $ruptures’ in the therapeutic alliance. 8or 0afran, the single most important strategy for the therapist in such situations is metacommunication it is necessary to stand back from what is happening, name and discuss the problem, and then negotiate around it. 0afran has identified a series of steps or stages that can be observed in the effective repair of a therapeutic alliance. 8irst, the therapist needs to be sensitive to the presence of rupture in the alliance. Typically, a client will e!press confrontation +anger with the therapist or criticism of the progress of therapy, withdrawal +disengagement from the therapist or the therapeutic process or a combination of these two responses. The task of the therapist at this point is to draw attention to what is happening within the here#and#now relationship, for e!ample by asking $%hat are you e!periencing . . . '’ or $( have a sense that you are withdrawing from me. Am ( right'’ The acknowledgement by both the therapist and the client that there is a difficulty moves the repair process on to the ne!t stage, which involves helping the client to describe their negative feelings, or what it is they believe is blocking them or hindering progress. The therapist may need to acknowledge at this point, in an undefensive way, how he or she might be contributing to the rupture. The final stage involves encouraging the client to access their primary feelings +typically anger or sadness, and to e!press to the therapist their underlying needs or wishes. &ne of the tasks of the therapist at this stage is to affirm the importance of these nee ds and wishes. 0uccessfully resolving a rupture in a therapeutic alliance can have a number of benefits for the client. 6learly, it strengthens the relationship, and makes it possible to continue therapy in a productive direction. 9ut it also gives the client an opportunity to learn about how to sort out relationship difficulties in general, and how to askdemand what they need in a relationship. 8inally, for people who may be more familiar with rivalrous conflict#ridden relationships, it provides a model of collaborative, give#and#take relatedness
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The concept of boundary may be an useful way to begin to make sense of the relationship between a therapist and client is to consider the way in which the boundary between the two participants is created and maintained. Although the concep t of boundary was not used by any of the $founders’ of therapy +e.g. 8reud, ung, 2ogers, it has become widely used in recent years as a means of describing important aspects of the therapeutic relationship. (n common#sense terms, a boundary marks the limits of a territory, and the line where one territory or space ends and another one begins. (n counseling and psychotherapy, the concept of $boundary’ is clearly a metaphor there are no actual boundary posts, markers or lines laid out in a therapy room. (n a therapy situation, boundaries can be identified in reference to a range of different dimensions of the relationship. 8or e!ample, boundaries can be defined around: < Time. The beginning and end of a therapy session. < @hysical space. )ow close +or far apart should the client and counselor sit= how e!tensive is each participant’s $personal space’' < (nformation. )ow much should the client know about the counselor' < (ntimacy. )ow emotionally close should the counselor and client be' Boes the level of intimacy within the relationship e!tend to touching, or even to se!ual contact' < 0ocial roles. )ow does the counselor acknowledge the client if they meet in another setting' )ow should the counselor respond to a client’s request to form a relationship outside of the therapy room' The idea of boundary also allows other significant aspects of the therapeutic relationship to be discussed. 9oundaries can be rigid or permeable. 6ounselors differ in the personal style, with some favoring strictly regulated boundaries, and others being more fle!ible. 0ome counselors may $loosen’ their boundary in the later stages of therapy with a client. 3any different forms of behavior +the client being late or $forgetting’ to pay the fee= the counselor touching the client can be interpreted as boundary $violations’ or $transgressions’, and links can be made with other boundary issues reported by the client in his or her everyday life. The concept of boundary has been particularly widely used within contemporary psychodynamic and psychoanalytic thinking. The psychoanalytic psychotherapist 2obert *angs +-;; has been prominent in arguing for the strict imposition of clearly defined boundaries in therapy as a core principle of therapy. *angs believes that definite boundaries create a strong therapeutic frame within which the client will be safe to e!plore painful and threatening personal material. 3any humanistically oriented counselors and psychotherapists have had reservations about the way in which the idea of $boundary’ is used within therapy as a "ustification for a distanced, detached stance in relation to the client. 8or e!ample, )ermansson +--C: 7D has argued that $the very nature of the counseling process demands a measure of boundary crossing . . . counselor
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aloofness, often promoted by boundary rigidity, is in itself potentially abusive.’ ordan +1444:4D acknowledges that she has: $trouble with aF Gboundary languageH . . . anchored in aF view of separation as safety. CONCLUSIONS: THE COMPLEXITY OF THE THERAPEUTIC RELATIONSHIP
The theory and research discussed in this chapter reflects the importance of the client counselor relationship in all approaches to therapy. (t is clear that counselors trained in the use of different theoretical models employ quite different ways of understanding the therapeutic relationship. (t also seems clear, however, that there are fundamental $truths’ about the client counselor relationship, relevant for all approaches to counseling, captured in the ideas of 2ogers +-DC and 9ordin +-C-, and in 8reud’s concepts of transference and counter#transference. (t also seems likely that some clients respond better to some types of relationship than others, depending on their own personal history and needs. The therapeutic relationship makes a difference in counseling the quality of the relationship has been shown to contribute significantly to the eventual outcome of counseling, and to the ability to help distressed people to stay in counseling. (t is essential, therefore, for any counselor to be aware of where his or her strengths lie, in term of making and maintaining helpful ways of relating to clients, and also to keep striving to become more responsive to the endless variety of relationship patterns that may be presented by clients. Therapeutic relationships are comple!, and operate at a number of different levels at the same time. (t is difficult to $decentre’ sufficiently from one’s own viewpoint to develop an accurate understanding of how one behaves in relationships. 8or any counselor, building an understanding of how he or she engages in relationship with clients is greatly facilitated by the use of opportunities, such as training groups, or supervision, which provide feedback and challenge on his or her way of being with others.
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