The Therapeutic Relationship
The Therapeutic Relationship
Over the course of the term we have looked at basic aspects of counselling and interpersonal skills, how we understand and relate to them as well as how we have experienced them within our counselling triads. Within the Humanistic schools of theory, we have looked at Person-Centred Counselling, Transactional Analysis and Gestalt, under the heading ‘Integrative learning’. This has allowed me to identify my own preferences and strengths in relation to each theory and apply them in learning triads. I shall also be focussing on interpersonal skills of a more generic nature, and how they can be applied to ease, encourage and explain interactions.
Repeatedly this term I have found myself fascinated with the importance of the ‘Therapeutic Relationship’ and how it is formed and used successfully in order to allow for ‘growth’, ‘change’ or ‘awareness’ within the client. It seems to me a highly unusual type of relationship, intensely intimate but at the same time completely detached from everyday life. With my intrigued stirred this essay will be an exploration of the Therapeutic Relationship within Person-centred and Transactional Analysis primarily but touching on Gestalt, as well as its relation to me and my experiences of use within triads, in order to facilitate an effective and respectful relationship, which is comfortably bound by the BACP Code of Ethics.
“An image of a gossamer thread came into my mind; delicate, shimmering, evanescent and sometimes seeming to disappear completely, but always in the background” (J.Marzillier 2010 p.xvi)
Considering that the focus of this essay my starting point will be point with the BACP and Metanoia Code of Ethics. As expected the code has detailed complaints procedures, a framework for tutors, students, supervisors within the industry and confidentiality clauses among many others that, must be adhered to unless otherwise agreed and ‘contracted’ by both parties before the first session. Other major points in relation to the dynamic of the relationship include (Metanoia Code of Ethics,p2/3); “2. a) Ethical standards comprise such values as integrity, impartiality and respect.
b) Practitioners acknowledge the value and dignity of all humanity, regardless of such differences as gender, race, age, culture, class, sexuality, religion and disability.
6. b) Practitioners shall be aware of their power within the therapeutic relationship, and must not use or exploit their clients..”
Within the Transactional Analysis and Gestalt theories, there is a focus on ‘contracting’ and being responsible for ones own self, if this is adhered to, it should install boundaries of its own. Interestingly within the BACP Code of Ethics there is a focus on ‘Care of self as a Practitioner’ (BACP p.10). I have found that I have needed to be aware of myself within triads, in particular when I have had a client who has detached from the emotion of their story; I have found that, as I am receptive to feeling, it has come at me with full force and as yet I have been unable to let that energy pass through me. This is something I have taken to my therapist to process, and to find methods with which to take care of myself when this occurs.
To summarise, the Codes of Ethics aim is to protect the potentially vulnerable client from being exploited by their practitioner, in addition to highlighting the impact of this work on the counsellor and how continued supervision and personal therapy will help aid the nature of this work. I have understood that when the points above are not adhered to there are major consequences; exploitation will result in the inability to practice and that this would be formally published within a number of publications. In terms of care of the practitioner, when these guidelines are not followed, it seems that often those therapists end up with mental unrest of their own and in some cases suicide. The Code is in place to protect both parties and in addition to personal qualities of the practitioner will allow for an effective and supportive therapeutic relationship.
When thinking about what it is to have successful interpersonal skills, in any context, the ability to build rapport with a relative stranger is a life lesson. By understanding what ‘good rapport’ is it allows us to do certain things to encourage it, using techniques such as ‘mirroring’ (Bandler & Grinder 1979). Mirroring and counter mirroring are not only the embodiment of the other person’s body language but also verbals, such as matching tone, pace and language to that of your client, will ease communication between the two parties. Encouraging your client to talk may seem simple, but to have the right setting and relationship for therapeutic enlightenment is far from straightforward.
It is important to understand when and how to use verbals and non-verbals, and most importantly when silence is key. This has been the case a number of times within triads and I find myself becoming more intuitive to it. Having an awareness of your client from the ‘first session’ and throughout will allow for calibration of that individual, allowing one to identify signals that illuminate what is happening for them and when. Understanding this and how best to achieve it has been our starting block; this skill set has developed and changed throughout my triads and has been reflected upon within my learning journal.
In order to work with the intricacies of the mind we must first understand how we each uniquely see and evaluate the world around us, this is called someone’s ‘frame of reference’ that can be defined as follows: “The structure of associate responses which provide the individual with an overall perceptual, conceptual, affective and action set, which is used to define the self, other people and the world”
(Aaron Schiff and Jacqui Schiff, 1971, p71)
Knowing this allows us to be self-aware of our own frame and that we must not, as the practitioner, allow it to be projected onto the client in session, but instead trying to meet them in theirs. This is a skill, which is embodied in Person-centred theory.
The ‘principle of non-action’ (Carl Rogers 1961 p.8), as the Actualising theory suggests, shows that change happens anyway, given the right conditions to promote growth and understanding. The Person-Centred approach is all about the therapeutic relationship and its importance above all else. The emphasis is that it is the client who ‘knows what hurts, what direction to go.’ (Carl Rogers. Becoming a person p12). Meaning that the practitioner need only embody certain conditions, to promote growth and actualisation within their client. There is a focus on ‘meeting’ the client in their process and facilitating the Actualising Tendency (Carl Rogers. 1961), without appropriating the content to the counsellor. In order for this to be achievable Carl Rogers says the counsellor must embody what he calls the three ‘Core Conditions’.
The first of these is Unconditional Positive Regard (‘UPR’); this is somewhat elusive as it depends on the attitude of the therapist and is somewhat immeasurable but if present has huge therapeutic qualities on its own. The counsellor who embodies UPR, ‘deeply values the humanity of her client’ despite what could be termed as ‘questionable behaviour’. In other words UPR is total acceptance of someone and the belief that an individual is “essentially constructive not destructive, basically social, that self-regard is a human need and that we are in pursuit of the truth” (Bozarth and Temaner Brodley). Alongside UPR are the other conditions, Empathy and Congruence.
Empathy is to enter and experience another persons frame of reference, to be deeply accepting of it, and have an accurate understanding of another person’s world as seen, felt and understood by them. It allows us to be alongside the client as they process and understand their thoughts and feelings; Empathy is in itself therapeutic. “As the client finds the therapist listening acceptantly to her feelings, she becomes able to listen acceptantly to herself” (Rogers 1978, p.11). Last of the core conditions is Congruence, is a state of being where outward responses to the client are in line with inner feelings and sensations. To be truly congruent and for the client to be receptive is no mean feat; one must embody a sense of self-awareness, acceptance and honesty about the limits of ones own ability. Congruence and self-awareness are ever evolving; they will be contested, altered and better understood through experience.
Equipped with an understanding of the core conditions I went into my first triad trying to harness all that I had learnt. Very quickly I became aware of the use of reflection and summary rather than questions in the person-centred approach; this I found a challenge, and a major adjustment from my usual friendly ‘helping’ relationships to that of a person-centred counsellor. I found myself able to reflect emotion; however, this was interrupted by my own curiosity about what was being presented, which in turn led to ill-placed probing questions and a more data focussed conversation. I was aware of my frustration with myself and in quick succession my desire to suppress it, leading me to wonder about my level of congruence and fleetingly, my own unconditional self-regard. Interestingly, both the observer and the client felt that my success at building rapport had prevented my questions from being received uncomfortably. On reflection my frustration had been because I had wanted to learn how to find and then explore the presented emotion. Something to focus on, in future triads.
A quote that to me summarises the role of the therapist within the person-centred relationship is that one should ‘wear her expertise as an invisible garment if she is to become an effective counsellor’ (Person-Centred Counselling in Action, p6).
Whereas Person-centred theories focus on actualisation and awareness, Transactional Analysis (‘TA’) was originally aiming to ‘cure the patient’ (Eric Berne 1965). This has since been adapted to the goal of ‘change’, with ‘cured’ being redefined as successful contract completion. However similar to Roger’s core conditions, Berne has his own set of circumstances needed for a successful therapeutic relationship within the TA model. These are: all people have worth, value and dignity and are therefore OK. The statement of ‘I’m OK and You’re OK’ (Eric Berne 1968) has been identified as one of the basic assumptions in TA theory and philosophy and is part of the ‘Functional’ model.
As with UPR this is not conditional of how you behave, but instead of what you are. To me this helps to prevent what is called a ‘one down’ or ‘one up’ position in the OK Corral (Franklin Earnst 1971), forcing both the therapist and the client to take responsibility for ones self. This leads to; ‘Everybody has the capacity to think’ (TA Today p.6). With exception of the severely brain-damaged we are all responsible for the decisions we make and must live with the consequences. Lastly, TA holds the belief that ‘People decide their own destiny, and these decisions can be changed’ (Eric Berne 1965) this related to what is called a ‘Life Script’ (Eric Berne 1965).
With these in place it allows both parties to enter into a ‘contractual therapeutic relationship’ in equal parts. In terms of BACP it prevents the therapist exploiting their position as counsellor and highlights the responsibilities of each party, within the therapeutic relationship. In both TA and Gestalt, we learnt about Contracts, first defined as ‘a bilateral commitment to a defined course of action’ (Eric Berne 1965) which use the ‘I’m OK and You’re OK’ philosophy to create an ‘adult’ agreement as to their desired outcome and that responsibility is shared. There are two types of contracts ‘administrative’ and ‘treatment’ (Claude Steiner 1974), these differ in their content, administrative tackles; fees, appointment schedule, et cetera. Whereas the treatment contract will be about goal orientation and is more malleable depending on the progress made, it will be referred to within session and requires both the client and the counselor to make an effort towards change.
Unlike in Person-Centered counseling, TA is focused on a result or ‘change’; the therapeutic contract will have a direction. Questions have their place in TA, however although there is an end goal each meeting will still be an exploration of self rather than surface level behavioral changes. With this in mind I took my role as counselor with a little more ease than I had done previously, I was still aware that the situation itself raised my anxiety. I spent the first little while really trying to tune in to my client, mirroring body language, hearing what was said and moreover really feeling the words of the client come at me, before summarizing and clarifying what I had heard.
My summary was greeted with relief from the client that I had understood and they had felt listened to; I was still trying to maintain my composure. Whilst feeling pleased that I had really given the clients story its place to be heard and that I had successfully ‘met’ the client within their frame of reference. Unfortunately, once I had the ease in rapport with my client, I began once again to try and problem solve; whilst there is more emphasis on change in TA, being overtly suggestive and solutions focused was still not the aim of the triad. I was struggling to break from the habit of my other relationships to date, on reflection the desire to ‘succeed’ at ‘fixing’ the issue and converting theory into practice was preventing me from being organic and exploring what was happening for the client as their problem was presented.
Many who come into Therapy want to be ‘fixed’ or have something ‘done’ to them, to in some way be altered; this is an unrealistic and but understandable initial viewpoint of many clients before their first session. It is the for the counsellor to work with this and help the client become familiar with the therapeutic process and the shared responsibility of this relationship. When both parties have understood and are truly committed and understood by one another it will encourage growth and change. My learning and experiences to date, has brought the value of the Therapeutic relationship to the forefront of my mind as a constant.
It is something that I want to promote and grow into, in my own practice over the coming months and years. For me, the theories are simply words, if the power of ‘meeting’ your client and allowing them the space to actualise is not understood by the counsellor. Having demonstrated an understanding of the theories, as well my reflections of my own experiences in the practice triads; I hope to concentrate on being congruent and organic in my practice, to allow the clients emotions to appear, be processed and then subside, to make space for a tighter technical understanding in supervision. In time the combination of these three schools of thought will allow me to grow into an effective integrative counsellor.
BACP Code of Ethics – References
Grinder, J & Bandler, R. (1979). Frogs into Princes – References
Houston, G. (1990) The Red Book of Gestalt
Joyce, P & Sills, C. (2001) Skills in Gestalt Counselling and Psychotherapy- Citations and References
Marzillier, J. (2010) The Gossamer Thread – Reference
Metanoia Code of Ethics – References
Mearns, D & Thorne, B (1988) Person-Centred Counselling in Action – References
Rogers, C. (2003) Client-Centred Therapy – References
Rogers, C. (1994) On Becoming a Person – References
Schiff, J. (1971) Passivity and the Four Discounts. “Passivity”. Transactional Analysis Journal 1 – Reference
Stewart, I & Joines, V. (2002) TA Today- A New Introduction to Transactional Analysis – References
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 10 October 2016
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