chapter 4 - the therapeutic relastionship
TRANSCRIPT
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Chapter 4
The Therapeutic Relationship
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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
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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
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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.
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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
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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
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Features of a Therapeutic Relationship
• 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
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Features of a Therapeutic Relationship
• 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
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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.
All rights reserved.
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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”
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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)
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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
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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
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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”
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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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