2012
Introduction
This paper explains the key components in the therapeutic relationship and how they can facilitate or hinder the therapeutic process and demonstrates the importance the relationship has for the therapeutic work.
Psychoanalysis and humanistic theories will inform, among other approaches, this essay, whilst an intercultural frame will provide it with specific values and guidance that are in accordance with the British Association for Counselling and Psychotherapy Code of Ethics.
Theoretical Background
Carl Rogers developed the person-centred theory and conceptualised the therapeutic relationship as founded on unconditional positive regard, genuineness and empathy whereas Sigmund Freud, the creator of psychoanalysis, discovered the phenomenon of the transference in his therapeutic work. They worked and theorised in different ways, but undoubtedly they both focused on the relevance of the relationship between counsellor and client if therapeutic goals are to be achieved.
Although all these concepts are essential elements of the therapeutic relationship, the idea is not complete until trust, boundaries and suspension of judgements are brought into the scene. Furthermore, the scene is fully understood only when observed as bound to an ethical frame and subject to policies that guide the therapeutic work.
To shed light into the way the therapeutic relationship works, the barriers that it may face will be explored as well as the means to overcome them. Empathy and its development throughout the process will be observed and the concepts of transference and counter-transference explained as they unfold in the work with clients.
The Therapeutic Relationship
The beginning of a therapeutic process is a vital moment characterised by the establishment of a safe environment that will allow clients to open up and explore the issues they bring. If counsellors are to ensure that clients understand what confidentiality, boundaries and their responsibilities are, it is important that they provide them with a contract that clarifies the process of counselling and sets out the guidelines and nature of the work. Failing in doing so may result in a weak beginning that does not create a safe atmosphere and prevents clients trusting their counsellor and therefore building up a meaningful relationship. Following the protocols helps counsellors place the basis for their work although it does not guarantee counsellors’ personal attributes.
Therapy’s beginning is also crucial to set that unique connection between counsellor and client which could be harmed if the counsellor is unable to empathise. To Rogers, empathy is the ability to understand client’s world and feelings from their own point of view, but without getting lost in it. When counsellors do not empathise they may judge their clients according to their values and ideas, but will not recognise and communicate clients’ own perceptions of themselves, which is where the value for the clients lays, as they can increase in that way their understanding of their own feelings and thoughts. When clients perceive their own world in their therapist’s words they are given an exceptional chance to observe themselves from another perspective and with the prospect to look for change.
It is important for counsellors to ask for and receive feedback from their clients with the aim of verifying that client feels she has been understood. Defensiveness may arise when receiving feedback, jeopardising a relationship that is sustained in acceptance and trust. The risk that counsellors face is the difficulty to listen and empathise while clients may feel rejected or judged. For instance, positive unconditional regard refers to the idea that clients are accepted and valued as they are, and when counsellors deny their clients’ point of view they also deny the chance to explore the feelings and ideas attached to it. Creating a safe environment that allows personal discovery and growth requires that counsellors ensure they are genuine and show unconditional positive regard to their clients. Their transparency will let clients to be transparent to themselves. If counsellors conceal, for example, information from their clients, that attitude will influence their relationship and the way the client perceives her therapist, as possibly showing incongruence. Once these conditions are met counsellors are to ensure that they are kept during the whole process and that they adapt to it and its changes.
Counsellors need to be aware of their own prejudices and attitudes and the way they may activate in session. Prejudices may block the therapeutic process when showing, for example, inability to listen, or even harm a client with a judgemental statement that discriminates or disempowers. To avoid those results, counsellors are required to undergo their own therapy and embark in a journey of personal growth so to increase their understanding of themselves. A counsellor that recognises their own weaknesses and strengths is capable of guiding their clients to explore those same paths, accepting them as they are and encouraging self-discovery.
Power dynamics operate in every relationship, consequently counsellors have to be aware of them whilst minimising the damage that power imbalance may cause. A counsellor who belongs to the majority group in the community has to understand the impact it might have on a client from a minority group. How will an African refugee woman perceive her European counsellor? If client’s community has been colonised by Europeans then historic oppression may recreate in the consulting room, preventing client to explore issues related to her identity as a refugee and her relationship with the host country. How could a client reflect on her anger caused by the problems she is facing in the UK if her counsellor occupies a similar position to that she is angry with? Counsellor’s awareness is a need that must be complemented by an open attitude that adjusts to client’s particular circumstances and is attuned with them, in this case by acknowledging the possible oppression and offering an equal relationship. Even though equality policies try to ensure that all clients receive a fair treatment, counsellors need to review their practice in a critical way in order to avoid oppression or discrimination. Supervision to explore counsellor’s attitudes and feelings towards their clients is key as it will help shed light into the difficulties and look for solutions to them. Counsellors will be able to reflect on their practice and expand their understanding on personal and client’s issues so as to offer a sensitive approach that takes client’s personal and cultural particularities into account.
If the beginning of the therapy was characterised by the setting up of safety and the basic conditions to establish a relationship, the middle part of the therapy will deal with a deep presentation and exploration of client’s issues. Although transference and counter-transference were present in the relationship even before client and counsellor met, it is at this stage that client’s life begins to unfold to the therapist. Transference was first observed by Freud, who described it as the redirection of client’s past feelings into the person of the therapist. In this way, the relationship between client and counsellor becomes the perfect scenario for the exploration of client’s patterns that are here and now present in the consulting room. When client and counsellor meet, client’s world, feelings and attitudes are all directed to the counsellor, and if the client feels safe, then looking at what is happening now will shed light on client’s issues. At the same time, the counsellor must be aware of the counter-transference, meaning what they feel towards their client, and the way they communicate or not those feelings back. It is important that counsellors have an awareness on client’s process of change and that they support them through all the journey, maintaining empathy and providing a safe place that lets client immerse in their concerns and deal with all the emotions and feelings that otherwise would overwhelm them. During the first stages, a client may need support in disentangling her feelings, naming and acknowledging them. In response, the therapist can offer acceptance for all those arising feelings whilst reflecting on what the transference evokes. If anger arises in session but was not acknowledged yet, the therapist can reflect on the anger that the client is communicating in the transference and give her the opportunity to approach it. The safety of the relationship allows client to experience her anger and recognise it as hers. When client is ready to dig into it and the exploration has started, then what the therapist feels may be brought to the session to complement client’s insights. Clients go through different stages during the therapeutic process and it is crucial that the therapist is attuned with those stages and offers the precise support that their client needs.
Lastly, the end of therapy will be significant whichever form it takes. Anxiety or fears may arise and counsellors should anticipate the possible responses. Closing the therapeutic process is key in this moment and it will present client and counsellor with the task of giving and receiving feedback on how the process helped the client or not and to assess if more therapy is needed. It is important that the feedback given reflects on all the goals achieved and empowers the client on continuing engaging in their wellbeing. The end of therapy will provide clients with an insight on how they approach endings, what they mean for them and the best way to cope with the issues they bring. It is the moment when clients stop receiving support and help and confront themselves with managing their lives without that support.
The idea of the wounded healer is always present in psychotherapy, as the therapist is a person who has gone through their own wounds and takes their healing energies from their pain. This pain allows therapists to empathise with their clients and understand their pains, thus facilitating clients’ own healing, however, it may have its risks. If client and counsellor share the same hurting, counsellor’s wounds may activate and take over, leaving client’s pain unexplored. If counsellors are aware of this process, they can use it to assist themselves in empathising and to encourage clients to embark in their healing, empowering them to direct its route. Counsellors may share or not their experiences with their clients according to their approaches, but the warmth of the relationship will show them that both are human beings who have been wounded and hold the potential to change and heal. So, it is an intrinsic part of the therapy and a necessary one too. Counsellors will feel closer to their wounds in some specific moments with their clients, while for example exploring touching issues, encouraging empathy and also they will find themselves far as well, thus providing a balanced distance to challenge or confront, for example. In this way, clients experience that they can become their own wounded healer which empowers healing reciprocally.
The pain of the therapist is then an important component in the therapeutic relationship that facilitates empathy and engagement but may as well undermine it if the therapist gets lost in their own suffering.
Conclusion
The therapeutic relationship is a key element in the therapeutic process and its quality and characteristics will shape the therapy itself. Its uniqueness as a relationship provides clients with the opportunity to explore in the here and now of the therapy their issues in a safe and confidential way.
Psychotherapy is a human relationship where two persons engage in one’s healing. Counsellors give their clients the safe and supportive space they need to disclose their stories and, through empathy, positive unconditional regard and genuineness they allow their clients to look at their issues and emotions in a way that lead them to create some changes in their lives. When clients transfer their emotions and attitudes to their counsellors they can observe themselves whilst safely analyse what their issues are with someone who does not behave defensively.
Beginning, middle and end of therapy are different moments characterised by client’s different needs and counsellor’s given support, but throughout the process, the humane encounter will be possible as a result of counsellor’s acceptance and respect towards their client, and the trust that they both can build. Therefore, it is important that counsellors can provide this quality relationship to their clients in order to facilitate their healing in this journey that will try to transform their pain into a new way of living their lives.
Bibliography
British Association for Counselling and Psychotherapy (2002). Ethical Framework for Good Practice in Counselling and Psychotherapy. Leicester, BACP House.
Kahn, Michael (1996). Between therapist and client. The new relationship. New York, Holt Paperbacks.
Rogers, Carl (1997). On becoming a person. A therapist’s view of psychotherapy. London, Constable & Company.
Women and Girls Network (2011). Material for the Advanced Course in Counselling and Supporting Refugee Women. London, Women and Girls Network.
Yalom, Irvin (2010). The gift of therapy. An open letter to a new generation of therapists and their patients. New York, HarperCollins.