Chapter 4 - The Therapeutic Relastionship

Chapter 4

The Therapeutic Relationship

© 2015. Cengage Learning.All rights reserved.

Qualities of a Counseling Relationship

• Contract in which both parties agree to abide by certain rules: – Client to show up on time, and to make an effort

to be as open as possible– Counselor to be trustworthy, to protect the

welfare of the client, to do everything possible to help the client reach identified goals in the most efficient period of time


Qualities of a Counseling Relationship

• Contract in which both parties agree to abide by certain rules: – Client is primarily responsible for the content of

the relationship– Counselor has much of the responsibility for

directing its style and structure– Uneven distribution of status and power remains• Counselor has more of a natural power


Benefits of Power Imbalance

• Power imbalance conceived as critical to the success of treatment

• When clients perceive the counselor as a person of authority and expertise, they are more likely to experience hope that the process will help them– Strengthens commitment to counseling process– For some, it provides immediate relief from some

emotional distress© 2015. Cengage Learning.

All rights reserved.

Non-Power Approach Benefits

• Many practitioners try to minimize the power dimensions of the relationship, believing that equality is crucial to change– Feminist and narrative approaches to counseling

conceive of relationships that are especially sensitive to those who have been oppressed by the dominant culture


Features of a Therapeutic Relationship

• Relationships are the forum for change to take place

• Relationship has an explicit goal and purpose• There is an understanding that one person

(counselor) has more control, responsibility• Relationship is essentially one of interpersonal

influence



• Counseling relationships exist in a cultural context

• Interactions are structured to make the most efficient use of time

• Helping relationship can deal with a variety of human behaviors, thoughts, attitudes, and actions



• Fluid, adaptable, and ever changing• Important to encourage, motivate, structure,

and support constructive action• Client and counselor must agree as to the

causes and etiology of the presenting complaints and what must be done to make things better

• The relationship is multidimensional


Emphasis Should Be…

• Structure vs. flexibility• Warmth and authenticity vs. objective

detachment• Consistency and predictability vs. novelty• Focus on content (what the client says) vs.

process (underlying meaning of interactions in session)

• Exploring issues vs. focus on problem solving© 2015. Cengage Learning.


History of the Relationship

• Relationship structured around remembering the past is often not enough– Re-experiencing and reliving prior feelings and

impulses lead to constructive work– Takes place through a relationship that helps

clients access intense, unresolved feelings, express them, and discuss matters nondefensively and objectively


History of the Relationship

• Winnicott (1958): The “holding relationship”– Provides a safe setting with clear boundaries so

clients feel secure enough to experience their deepest feelings

– The counselor–client relationship as analogous to how a parent holds an upset child in his or her arms, soothing the child with comforting words.

– Session boundaries provide a supportive structure, while the counselor’s empathy soothes an emotionally overwhelmed client


Rogers on the Helping Relationship

• Congruence– The most important ingredient in the helping

relationship– Encourages counselors to work toward developing

more congruence between what they are feeling on the inside and what they are communicating on the outside


Rogers on the Helping Relationship

• Positive regard– The counselor does not evaluate and judge

clients’ actions or statements– Behavior is viewed neutrally and all people are

worthy of respect• Empathy– Denotes the process of attempting to understand,

from the client’s frame of reference, the thoughts and feelings underlying behavior


Working Alliance factors

• Practitioner creates a businesslike contract with client to meet certain specific goals and an action plan for reaching them

• Relationship becomes an encounter between teacher and student– Ensures compliance with agreed-upon treatment

plan– Clients more likely to follow through when they

feel a degree of commitment to the relationship© 2015. Cengage Learning.


Multiple Models

• Social interactions are co-constructed by participants based on their interpretations of their experiences– Internal “narratives” are altered by the dialogues

that take place• Conversations aimed at helping clients change the ways

they interpret their realities

– Often evolves into active collaboration in which both client and counselor try to educate each other about their respective views


Feminist Model

• Feminist theory speaks of the distinctly female way that relationships can be constructed

• Greater commitment to caring and connection rather than distinctly “male” values of competition and autonomy


Corrective Emotional Experience

• Corrective emotional experience repairs clients’ childhood wounds stemming from problematic or hurtful relational interactions with their parents– As counseling progresses, the client is increasingly

aware these fears will never be realized– Counselor will be a nonjudgmental, consistently

available, compassionate listener regardless of what the client does or says


Empirically Supported Treatments

• The counselor’s strategies produce improvement

• Middle ground is to take the common factors approach– Suggests although the relationship is one of the

curative or growth-enhancing components of effective counseling, specific interventions also play a role


Relational Approach

• The therapeutic relationship helps client work through feelings of isolation

• Only cure is communication with someone who is sensitive, receptive, neutral, interested, and psychologically healthy

• Yalom also said the single most important lesson for a beginning counselor to learn is that “it is the relationship that heals”


Trust and Empathy

• Trust:– Respect for the client’s intrinsic right to be his or

her own person– Warm regard for the client as a unique being– Genuineness (being honest and real)


Trust and Empathy

• Empathy:– Ability of the counselor to truly understand the

client from within the client’s perspective– Often involves communicating accurately the

feelings and meanings of clients’ statements, thereby demonstrating an active understanding of clients’ concerns


Trust and Empathy

• Empathy is not sympathy– The empathic counselor is trying to make

objective sense of the client’s experience, not demonstrate concern, pity, or sorrow for his or her pain


Primary and Advanced Empathy

• Egan distinguishes between two levels of empathy– Primary level• Refers to the interchangeability between the client’s

statements and the counselor’s responses• Counselor communicates a basic understanding of the

thoughts, feelings, and behavior of the client – “You are feeling sad”


Primary and Advanced Empathy

• Egan distinguishes between two levels of empathy– Advanced level• Built on the primary-level base and emphasizes the

counselor’s responding in a way that facilitates the deeper exploration of relevant issues– “You are feeling sad because you can’t get back the time you

wasted drinking.”

• Captures the leading edge of a client’s experience, what is just beyond the client’s own awareness


Failure to Empathize

• When the counselor tries to communicate an understanding of a client’s feelings or thoughts and gets it wrong, the client may feel hurt or disconnected– If the counselor recognizes the client’s discomfort

and apologizes, the bond is strengthened– Repeated episodes assist the client in better

tolerating the empathic failures that are inevitable in all intimate relationships


Confidentiality

• Just as an attorney, clergy member, or physician must be able to guarantee that whatever is revealed will be considered privileged communication, trust and openness in counseling hinge on a similar promise– Since clients feel safe and know whatever they

share will remain private, they are more inclined to talk about things they may not be willing to otherwise


Influences by the Counselor

• Lazarus believes the most important function of the initial interview is to inspire hope and help the client believe in the process and expertise of the counselor as an influencer


Influences by the Counselor

• Placebo effects in counseling– Structuring the expectations of the client to

maximize favorable results– Examples: evidence of expertise (diplomas on the

wall), attractiveness (dress, surroundings), and power (control of the interview)• Each of these parameters can be used and

communicated in a manner likely to result in the development of a constructive relationship and to lead to productive change


Reciprocal Benefits

• Clients bring issues to sessions that you have not fully resolved yourself– This is both a burden and a gift• Take what you have taught to others and apply these

lessons to your own life


Reciprocal Benefits

• Many counselors report that one of the most familiar experiences is an increased respect for the power of being human– Learned to infuse personality, sense of self into

therapeutic style without being self-indulgent– Report being transformed or healed by their efforts

to help others• With this sense of trust and confidence also comes a

certain humility — no matter how long they do this work, they will still never feel like an expert


Emerging Themes

• Anger/frustration– “I’m not sure where to go with this client”

• Disappointment/regret– No matter what you say or do in any session with

a client, you will be flooded with ideas about other things you could have initiated instead


Emerging Themes

• Anxiety/fear– You will fail in your efforts to be helpful

• Elation/excitement– Therapeutic relationships are not only educational

encounters but spiritually transcendent ones in which both parties are moved by the experience


Attending Skills

• Have a reason for listening– Know what to listen for and how it will be

important to the client’s exploration, understanding, and action

• Be nonjudgmental– To listen effectively, you must suspend

temporarily the things you say to yourself


Attending Skills

• Resist distractions– Resist internal and external distractions so your

attention and listening focus will not be disturbed• Wait to respond– Give yourself time to respond fully and deeply to

the client’s statements


Attending Skills

• Reflect content– Reflecting back to the client what you hear him or

her saying communicates understanding and provides an opportunity to check out the accuracy of your perceptions

• Look for themes– Be selective about all the stimuli presented and

attend only to the content that is relevant and meaningful


Listening Skills

• Passive listening– Use of verbal encouragement and nonverbal

attending in order to acknowledge messages communicated by the client

• Parroting– Repetition of the client’s words to indicate

interest, demonstrate accuracy of listening, or stall for time until a more elegant response can be formulated


Listening Skills

• Paraphrasing– Restatement of a message’s content to clarify or to

focus the client’s attention• Clarification– Confirmation of a message’s accuracy to encourage

elaboration• Summary– The linking of several ideas together in a condensed

way© 2015. Cengage Learning.


Exploration Skills

• Probe– Questioning in an open-ended manner to gather

relevant information• Immediacy– Attempting to bring focus to the present, to

comment on the style of interaction in the session, or to give feedback


Exploration Skills

• Self-disclosure– Sharing personal examples from your life to build

trust, model personal effectiveness, or capitalize on identification processes (with boundaries)

• Interpretation– Promoting insight by pointing out the underlying

meaning of a behavior or pattern


Exploration Skills

• Confrontation– Diplomatically identifying discrepancies among

what a client has said in the past and is saying now, what she or he does, what a client describes about herself or himself, and what you actually observe


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Chapter 4 - The Therapeutic Relastionship

Education