Major Themes in the Therapeutic Relationship

 

The beginning stage in therapy can be considered similar to the Infancy stage when trust and attachment develop. The middle stage has similar themes to the Authority and Autonomy stage, when the child is a toddler. The ending stage can be viewed as the stage of internalisation and Oedipal love, which shows similarities to the genital stage.

Before the client contacts a counsellor or an agency, they make a decision to seek help and make some arrangements to meet. They might be anxious and they have some sort of expectations about the counsellor’s personality and competence. This can be shaped by previous experience with significant others, who were authority figures. This phenomenon is called pre-transference.

In an agency setting, someone else may assess the client first. Based on the assessment, referral and other available information, the counsellor also forms some picture about the client, this is called pre-countertransference. (just like in a pregnancy we have a fantasy baby)

Then during the first session, a mutual assessment of each other occurs. It needs to be established if we can work together. The client is encouraged to talk about their difficulties, the nature of these and the triggers, too. However, some problems might be masked. Also, the psychodynamic counsellor will try to piece the client’s identity together, linking presenting issues with past experience. Interestingly enough, the client’s capacity to make sense of these links is also tested. As Jacobs puts it “the way how the past is presenting itself in the here and now in the therapeutic relationship has crucial importance”.

Trust develops throughout this stage, the client may just wish to offload, the counsellor can be like a container. The capacity to communicate effectively is important, if a client is under the influence of drugs or seriously distressed it may not be possible. The contract is also drawn at this stage, they negotiate the practicalities such as time, frequency, length of the sessions, boundaries, risk of harm to self or others, confidentiality, supervision, referral process, fees, method of payment, contact between sessions, etc. Therapy can be open-ended or they can have a fixed number of sessions. This can be reviewed later. One session a week seems to provide a balance between intimacy and separateness and between dependency and independence. As the trust develops the client will share more and more negative feelings and thoughts.

Gradually, the shift in therapy moves from problems in the past with significant others to the present relationship between the client and the therapist. Links are also made between the “out there” and “in here” relationships. (Triangle of Insight) The client’s willingness to look at underlying factors is crucial. The client’s perception of the therapist has also great importance. Idealisation may occur or the opposite, clients may perceive the therapist as someone who can’t help or understand them. These are usually transferential feelings and not based on the actual relationship. Some clients may turn up late or miss sessions or they can have difficulties dealing with breaks. (due to resistance, fear of rejection or abandonment)

During the middle stage the client tests the authority of the counsellor and boundaries. The client is testing how much the counsellor can hold. Projection and transference occur as a defence to protect the client from painful feelings. The therapist has to fail the client’s desire to become the parent or the partner he desires. This is also parallel to the concept of disillusion (optimal failure) in attachment theory, when the mother lets the baby down and allows the baby to experience reality without her being present at all times.

Similarly, in counselling if the relationship survives this period the client will realise the permanence of the relationship and will feel safe in the relationship with secure boundaries. (just like the concept of secure base) Defences then can be worked through with the therapist being non-defensive. By exploring defences, patterns can be identified and loosened up and change can be enabled. Immediacy is a useful challenging skill. The middle stage is usually the longest stage in counselling and the client is moving from needing authority to autonomy.

During the last stage internalisation of the therapist occurs which is similar to the genital stage when the child moves from Oedipal love towards being able to form romantic relationships with potential partners but also internalising the parental figure.

Similarly, in counselling transference is dissolved and a more realistic perception of the counsellor is formulated. A new attachment is formed as a result of re-experiencing the relationship with significant others. Providing a safe ending is very important both for the client and the counsellor. There can be strong countertransferential feelings of loss and grief or feeling like a proud parent. Supervision can help to process these.

Bibliography:

Jacobs, M. (2012) The Presenting Past: The Core Of Psychodynamic Counselling And Therapy, Open University Press