Chapter2.docx

Chapter 2: The Therapeutic Relationship

The Importance of the Therapeutic Relationship in Creating Change

- Therapeutic Relationship

oProfessional relationship involving good working alliance,

trust, honesty, and the promise of confidentiality, which

focuses on the needs of the client and involves compensation

for the helper

oMore predictive of success than the theoretical approach of

the helper

oVital to creating improvement

oMust be established immediately to prevent attrition

- Factors that affect client outcomes:

oTherapist factors

oClient factors

oTechniques the helper uses

Mega-skills

Enhancing Efficacy and self-esteem

Practicing New Behaviors

Lowering and Raising Emotional Arousal

Activating Client Expectations, Hope, and

Motivation

Providing New Learning Experiences

Maintaining a strong Helper/Client Relationship

REPLAN

Provides a way of remembering which general

area to consider and a way of understanding the

intent of the techniques

Relationship

oAt the middle of the circle to emphasize the

other factors reliance on it

Efficacy and Self-Esteem

Practicing New Behaviors

Lowering and Raising Emotional Arousal

Activating Client Expectation, Hope, and

motivation

New Learning Experiences

What Is a Helping Relationship? Is a Professional Helping Relationship the

Same as a Friendship?

- Professional Helping Relationship

oDescribes a contractual relationship between a helper and a

client who agree on compensation for the helper and goals

for the client

oClient’s goals are paramount

oHelper abides by professional ethics

Required to identify and articulate issues not normally

broached in a friendship

- Eric Berne

oFounder of transactional analysis

oInformed consent – clients must know what they are agreeing

to and must participate in the changes that they are about to

make

The Unique Characteristics of a Therapeutic Relationship

- Better Outcomes

oSymptom improvement

- Specific Characteristics of the Therapeutic Relationship

oThere is a mutual liking-or at least respect.

oThe purpose of the relationship is the resolution of the

client’s issues.

oThere is a sense of teamwork as both helper and client work

toward a mutually agreed-upon goal.

Therapeutic Alliance

The degree of collaboration between helper and

client.

Is stronger when the client and helper agree on

treatment goals, techniques, and interventions

oSafety and trust are established, allowing honest disclosure

by the client and feedback from the helper. There is a

contract specifying what will be disclosed to others outside of

the relationship.

oThe relationship includes helper support by also requires

honest feedback.

oThere is an agreement about compensation for the helper.

oThere is an understanding that the relationship is confined to

the sessions and does not overlap into the participants’

personal lives.

oAs a contractual relationship, the relationship can be

terminated at any time.

How can a Helper Create a Therapeutic Relationship?

- Relationship Enhancers

oHelper behaviors that improve the quality of the therapeutic

relationship

oInclude:

Nonverbal skills

Posture

Presence

Empathy

Self-disclosure

- Physical Closeness, Posture, and. Warmth

oInvite the client into a safe relationship and lead to greater

openness

- Adapt to the Client’s Unique Characteristics

oThe relationship grows when the client perceives the helper is

sensitive to religion, ethnicity, family issues, and personality

Keep the focus on the client, avoiding a barrage of

questions, strong confrontation, inappropriate self-

disclosure, being rigid, and being helper-centered

- Create a Collaborative Relationship

oFollowing Suggestions to develop an atmosphere conducive

to developing a joint project (Spencer et al., 2019):

Recognize the client’s expertise

Inquire about preferences

Continua to Use to classify a helping relationship:

The therapist should maintain a profession

distance  offers a warm friendship

The therapist is more about listening  the

therapist is active

The relationship is formal The relationship is

very informal

The therapist steers the direction of the session

 the client directs the session

Recognize that the helper may make mistakes

- Presence

oOften a potent relationship enhancer

- Empathy

oFeeling oneself into another person’s experience

oYou grasp the facts, feelings, and significance of another

person’s story

oInvolves the ability to convey your accurate perceptions to

the other person

oWe soothe the other person’s emotional arousal when we

express empathy

oTaking a tutorial stance

The helper becomes a student and asks the client to

instruct the helper about the culture or specific

situation or illness of the client

Self-Disclosure and the Therapeutic Process

- Occurs when the helper relates personal facts, stories, or feelings

- Self-involving Statements

oWhen a helper shared the helper’s personal feelings with the

client as a way of connecting

oCan be used later in the process to:

Inspire hope in the client

Provide feedback, confrontation, or an alternative

viewpoint

- Self-Disclosure

oEnhance the relationship

oHelp clients realize that they are not alone

oHelp them see another viewpoint

oconvey that their experience is normal

Other Factors That Help or Strain the Therapeutic Relationship

- Ruptures

oBreach in the positive relationship established between the

client and the helper

oMay cause withdraw, drop out or express negative feelings

about the helping process

oCaused by insensitivity by the helper, misunderstandings,

disagreements, or feelings of distrust or disrespect

oOccurs when there is a breakdown in the therapeutic alliance

caused by something that happens in the session

oHow to deal with ruptures:

Developing a surveillance system to identify them

- Facilitative Officer Environment

oShould be quiet, comfortable, orderly, and well lit

oRecommended that the helper face away from the desk so

that there are no obstacles between the client and helper

- Distractions

- Appearing Credible and Taking a Nonhierarchical Stance

oRemember what you do know and use the skills that you have

oDon’t use emotional distance as a way of being professional

oRemember that credibility is enhanced by being organized

and interested and by exhibiting nonverbal behaviors

associated with attentiveness

oNonhierarchical Stance:

When the helper emphasizes equality in the

therapeutic relationship and empowers the client to be

a partner in the helping process

Therapeutic Faux Pas

- Helper responses that may weaken or disrupt the helping

relationship

- The Dirty Half Dozen Roadblocks to a Therapeutic Relationship:

oGiving advice

oUsing logic and the Sermonette

oPraising and Being a Cheerleader

oInterpreting, Analyzing, and Diagnosing

oConsoling, Minimizing, and Reassuring and Emphasizing the

Positive

oProbing and Questioning

Transference and Countertransference

- Transference

oRefers to the client feelings from past relationships or

personal issues that are carried over to the helper or helping

relationship

- Countertransference

oThe helper’s reaction to a client

oOriginate in past relationships or personal issues and are

transferred to the client or on to the helping relationship

Transference as Cognitive Distortions

- Cognitive Distortions

oLearned thinking patterns that are false or irrational

oTransference reactions are cognitive distortions about the

helper

- Major Transference Patterns (client behaviors/attitudes to helper

experience)

oHelper as Ideal

Compliments helper profusely

feels pride, satisfaction, and all competent

Imitates helper

Feels flattered

Wears similar clothing, general idealization

Tension, anxiety, confusion, anger, and

frustration because the focus on the helper

instead of the client

oHelper as Seer

Ascribes omniscience and power to the helper

Experiences “God complex” and self-doubt

Views helper as expert, sees self as incompetent

Feels incompetent and pressured to be right and

live up to the client’s expectation

Seeks answers, solutions, and advice

oHelper as Nurturer

Experiences profuse emotion and sense of fragility

Experiences feelings of sorrow, sympathy,

depression, despair, and depletion

Cries

Has urge to soothe, coddle, touch

Feels dependent, helpless, and indecisive

Desires to be touched and held

oHelper as Frustrater

Feels defensive, cautious, guarded, suspicious, and

distrustful

Feels uneasy, on edge (walking on eggshells)

tense, hostile, and hateful

Tests Helper

Withdraws and becomes unavailable

oHelper as Nonentity

Shifts topics

Feels overwhelmed, subdued, taken aback, used,

and useless

Lacks focus

Feels bored

In voluble and desultory

Experiences resentment, frustration, and lack of

recognition

Meanders aimlessly

Characterizes as a nonperson

Countertransference: Dealing with the Helper’s Feelings

- Common Patterns of Countertransference:

oHelper Emotional Response to client/Helper Behavior/How

Helper Sees Client)

oPaternal/maternal Nurturing

Overprotective, failure to challenge

Fragile

oFear of Client’s Anger

Rejection

Needy

oNeed for reassurance

Socializing

Friend

oNeed for liking

Failure to challenge

oAnxiety

Avoidance of emotionally charged topics

oFeelings of identification

Advice giving, overinvolvement, failure to recognize

client uniqueness

Self

oSexual

Seductive behavior

Sexual object

oRomantic

Inappropriate self-disclosure

Romantic partner

oFrustration

Extreme confrontation

Product

oAnger

Scolding

Success

Dealing with Transference from a Client

- Task of the helper

oTo help the client gain more awareness and to

nondefensively explore the source of these feelings

- How a Helper can React Therapeutically:

oConvey acceptance of the client’s remarks but don’t retaliate

oExplore the client’s feelings

oUtilize self-involving statements to help the client become

more aware of the helper’s genuine thoughts and emotions

about the client and client’s behavior

oUse the experience to help the client to find new and better

ways of expressing feelings and meeting needs

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