The Therapeutic Relationship

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The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client. Client perception: that the client perceives, to at least a minimal degree, the therapist’s positive regard and empathic understanding.

The Therapeutic Relationship by Clarkson - AbeBooks The Therapeutic Relationship by Clarkson - AbeBooks

Working with real clients is very different from working with peers in college, who are familiar with the concept of counselling, and understand the various boundaries (e.g. to respect time limits, and not to make doorknob disclosures). It is not uncommon for clients in the real world to appear not to fit so well with counselling theory. In the 1950s, Carl Rogers had written a paper entitled ‘ The Necessary and Sufficient Conditions of Therapeutic Personality Change’, published in the Journal of Consulting Psychology. This introduced the idea that the therapeutic relationship is key, and three of the conditions – congruence, unconditional positive regard and empathy, which have subsequently become known as the ‘core conditions’ – have come to be accepted by practitioners of all modalities as vital to establishing this relationship. Our use of self is not something we do to the client. Instead, it emerges within the specific relationship and evolves as we adapt – over time – to the client’s needs and the relational context while they adapt to us. What is beneficial for one client could be problematic, even harmful, for another. Reaching out to comfort someone by holding their hand can be experienced as a lovely, supportive gesture. But in another context, or with another individual, it could be interpreted as patronising, invasive or even threatening. While a forceful challenge may help inspire a client to break with past patterns and behave differently, it could also nudge a client into a freeze or flight response. Our art involves attuning to the needs of both client and the therapeutic relationship towards evaluating when and how to intervene. The concept of therapeutic relationship was described by Freud (1912) as "friendly affectionate feeling" in the form of a positive transference. However, transferences, or more correctly here, the therapist's 'counter-transferences' can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.Horvath, A. O., Greenberg, L. (1986). The development of the Working Alliance Inventory: A research handbook. In L. Greenberg and W. Pinsoff (Eds.) Psychotherapeutic Processes: A Research Handbook, New York: Guilford Press. The person-to-person relationship draws on the work of Martin Buber regarding ‘I–Thou’ (as opposed to ‘I–It’) relationships – i.e. the development of a real emotional connection (which makes counselling a unique profession, differentiating it even from other caring professions). The developmentally needed or reparative relationship is an intentional provision by the psychotherapist of a corrective, reparative, or replenishing relationship or action where the original parenting was deficient, abusive or overprotective”. Therapist unconditional positive regard: The therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied. This is harder to define in absolute terms; it can include an expansion of consciousness, which can be spiritual or healing.

The therapeutic relationship - BibGuru Guides Citation: The therapeutic relationship - BibGuru Guides

The therapeutic alliance, or the working alliance may be defined as the joining of a client's reasonable side with a therapist's working or analyzing side. [6] Bordin [7] conceptualized the working alliance as consisting of three parts: tasks, goals and bond. Tasks are what the therapist and client agree need to be done to reach the client's goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that the tasks will bring the client closer to their goals. This text provides coverage of the uses and abuses of the therapeutic relationship in counselling, psychology, psychotherapy and related fields. It provides a framework for integration, pluralism or deepening singularity with reference to five kinds of therapeutic relationship potentially available in every kind of counselling or psychodynamic work.In 1995, Clarkson wrote a book entitled The Therapeutic Relationship (revised in 2003).Clarkson talked about ‘intersubjective relationships’ (how we connect to others) and ‘intrapsychic relationships’ (how we connect to ourselves). Rory explains the five intersubjective relationships, and provides some real-life examples of these: Counselling and psychotherapy rely, to a great extent on building a human connection with clients, where a deep level of trust is established, this transcends any modality, this is seen to a great extent in the work of Carl Rogers.

The Therapeutic Relationship: In Psychoanalysis, Counselling

Several scales have been developed to assess the patient-professional relationship in therapy, including the Working Alliance Inventory (WAI), [11] the Barrett-Lennard Relationship Inventory, [12] and the California Psychotherapy Alliance Scales (CALPAS). [13] The Scale To Assess Relationships (STAR) was specifically developed to measure the therapeutic relationship in community psychiatry, or within care in the community settings. [14] See also [ edit ]

The Five Phases of a Relationship

The RRP is the suggested or Recommended Retail Price of a product, set by the publisher or manufacturer. The presentation, entitled “A Global Vision: Taking Gestalt Therapy into the 21st Century”, brought together delegates and presenters from across the globe that reviewed and explored views of Gestalt therapy. Clarkson also co-founded two training organisations, the Metonia Institute and Physis.

The Therapeutic Relationship - Petruska Clarkson - Google Books The Therapeutic Relationship - Petruska Clarkson - Google Books

My own perspective is that it is important as a therapist is to have some underlying principles, but to hold them lightly; as Jung said: “learn your theories as well as you can, but put them aside when you touch the miracle of the living soul” . Overall, there are really useful principles of therapeutic practice within Rogers approach that speak to me in my growing and deepening work with clients in psychological coaching

Theory and Practice

Given time the client begins to trust their own judgment and the need to use the therapist as an emotional support lessens, at this point therapy usually comes to an end. Make sure you train on an experiential course (i.e. one that is taught face-to-face, and that includes skills practice). My sense of the two perspectives of Rogers and Clarkson is that they are useful underlying principles to the work of therapy, focusing on the interpersonal aspects of the relationship between the therapist and client. Another interesting approach is that of Katherine Murphy and Maria Gilbert, describing some of their underlying principles, whilst alongside the principles setting out a 5 stage model of therapy ( Murphy and Gilbert 2000). Counselling and psychotherapy relies to a great extent on building a human connection with clients, where a deep level of trust is established, this transcends any modality, this is seen to a great extent in the work of Carl Rogers.