Why Study the Relationship?

 

The quality of the relationship between the client and the therapist is critical, this is the strongest predictor of the success of the therapy, regardless of the approach used. This is also referred to as the therapeutic alliance. Apart from this, the perception of the above by the client is also a paramount indicator of how successful the therapy can be.

 

 

To achieve this alliance the therapist and the client has to agree on the therapeutic goals, there has to be some form of collaboration, some mutual engagement during the therapy. Furthermore, the therapist should be genuine and empathic, non-judgemental, there should be some sort of emotional bond between the therapist and the client. They should relate in the here and now, be able to share emotional responses. The ability to share even negative emotions can help the client to form a new kind of attachment, one that might have never been experienced before. As a result the client’s distress can be reduced and old traumas can be resolved.

The psychodynamic approach originates from Freud’s theory. Freud in the early 20th century believed that the therapist should be a blank screen and the patient can project on this. By this tool, unresolved past relationships can be repaired. The therapist is unresponsive, there is no empathy and warmth present. Regarding the therapeutic relationship transference and countertransference occur. Clients may transfer feelings to the counsellor that stem from childhood emotional responses, which means these feelings are not based on any real relationship with the counsellor, this is called transference. (The client projects onto the therapist.) In addition, these feelings operate at an unconscious level. The therapist makes interpretations about the relationship with others to help make the unconscious conscious. Making early developmental relationships explicit along with working with the clients defences such as denial, repression, regression -which are used to protect oneself against extreme discomfort- are seen as central to the therapeutic process, this is also called gaining insight.

Countertransference may occur as well, which is the counsellor’s emotional response to the client by displacing feelings from the past into the present situation with the client. Supervision provides a great opportunity to deal with these countertransferential reactions.

Later, after the 1940s Rogers developed the person-centred approach in the USA, which was based on the core conditions of empathy, unconditional positive regard and congruence. This was the first time when the therapist was more responsive and the therapist showed his genuine self, he entered a relationship with the client based on trust and warmth. The therapist was also emotionally exposed with genuine responses.

Rogers believed that everyone is driven to fulfil their potential, that is everyone has the tendency to self-actualize if the right conditions are provided; just like a plant can grow if enough water, good soil and the right temperature are provided. Similarly, the therapist can facilitate this process and as a result the client can become more congruent. The gap between the real-self and the ideal-self can be reduced, as a result the client can become a fully-functioning person. This approach is client led, non-directive, and the relationship between the client and the therapist has the greatest importance. The therapist is not an expert, he or she is just trying to get into the client’s frame of reference to perceive his or her own reality, and also being present as himself/herself, being genuine and congruent. Accepting the person as he/she is without any judgement or agenda, or any conditions imposed is how the relationship is facilitated by the therapist. This approach was criticised for being too western and based on individualistic values.

The concept of Triangle of Insight, developed by Manninger, which is originally a psychodynamic concept but it can help trainee counsellors to link theory to the actual counselling session. According to the CPCAB website (Study Focus handout) most counselling theories can be mapped onto this triangle. The “in here” refers to the relationship between the therapist and the client in the here and now. The client’s difficulties can be present or mirrored in this relationship too. The “back then” refers to the relationship with significant others in the past. Finally, the “out there” refers to current or recent relationships with others.

Past relationships with significant others can be mirrored in the relationship with our therapist, unhelpful patterns of relating can be identified and dealt with, above all, it affects how we relate to others outside the therapy room. These 3 parts as interacting with each other continuously.

Bibliography:

Counselling Skills and Theory 4th Edition, Margaret Hough, Hodder Education, 2017

https://www.cpcab.co.uk/qualifications/tc-l4, Study Focus handout

Between Therapist and Client, M. Kahn, The New Relationship, St Martin's Press; Rev. Ed Edition 1997