The Working Alliance 2.

 

Petruska Clarkson worked out a comprehensive integrative model which can be applied to the therapeutic process regardless of the modality or approach used. She believed that the systematic use of the relationship between the therapist and client can be the key to achieve changes in clients’ feelings, thoughts and behaviour. According to her model, there are five forms of therapeutic relationship and they are all valid. The first one is the working alliance, the client and the counsellor enters a contracted relationship, which is the foundation of the work done together. Both parties strive to work together and achieve positive change for the client.

 

 

 

According to Horvath, working alliance refers to a collaborative relationship between the helper and the client, meaning that there is a consensus and willingness on the part of both parties to engage in and do the work that leads to improvement.

This collaborative engagement involves consensus over the goals, a sense of confidence and commitment to the kinds of activities that the counsellor and client engage in as part of the helping journey. In addition, there’s mutual trust, confidence in the work together and liking of one another. It is dynamic in time and content. In order to achieve change, goals must be agreed, there must be agreement on the tasks. A personal bond between the two parties is crucial, which is based on trust and confidence. There are some sufficient conditions that are needed from the counsellor’s side: accurate empathy, unconditional positive regard and genuineness. In managing and maintaining the working alliance the counsellor’s personality and their grasp of problems seem to be significant factors.

When clients come to counselling they have some expectations. These are influenced by their beliefs, their ability to trust another person and their attachment style. According to Petruska’s client experience during the early stages it may be easier to form the working alliance if the client and the counsellor have similar cultural background but later it can be more difficult to achieve profound change.

Ruptures can be seen as opportunities for breakthrough according to Clarkson. Ruptures can have different forms, for example clients can express negative feelings, can be hostile or avoidant or there can be disagreement about goals and tasks. Clients may not respond to therapeutic intervention. By working through these ruptures the therapeutic alliance will be stronger. This can be done by reviewing and renegotiating the work together.

Evaluating the working alliance is quite challenging, it can be done intuitively by looking at how one feels about it, how lively the encounter is or how spontaneous the experience feels. There is a tool called working alliance inventory. It’s a questionnaire by which the WA can be measured.

During the first session we can check with the client how they wish to be called, then we can start negotiating a contract, which includes telling the client about our qualification, that we work bound to the BACP ethical framework and explaining what this means. It is also important to inform the client about supervision, which enables our personal and professional development. Sometimes client’s issues are discussed during supervision sessions and we have to inform clients about the possibility of this, making sure they understand that their identity will not be revealed. Telling the clients about confidentiality is also important, including limits of confidentiality in case of harm to self or others, or in case of criminal activity such as money laundering, terrorism or drug trafficking.

The possibility of referral can also be mentioned at this stage in case talking therapy is not the appropriate intervention for the client’s presenting problem. In some cases clients might benefit from a more active intervention or it can be a crisis situation when referral is needed. Exploring who referred them to us is also important, we might need permission to seek more information about the client from their GP or other professionals. Informing the client about the approach we use is also a good practice but we should use simple terms.

Informing the client and negotiating about the following are also crucial: number, timing, length and frequency of the sessions and payment method, cancellation and discharge policy. We also need to consider how we can keep records about clients that complies with GDPR.

In addition, the contract needs to be reviewed and renegotiated throughout the counselling relationship, e.g. the number of sessions can change especially if there is a shift in focus. All these factors are also ethical considerations. The aim is to provide a safe, boundaried relationship.

Bibliography:

Petruska Clarkson, The Therapeutic Relationship, Wiley, 2003

Working Allianceinventory:

https://help.greenspacehealth.com/article/74-therapeutic-alliance-br-wai