Psychotherapy and Counselling

Unit 2- THERAPEUTIC RELATIONSHIP

The process of counseling develops in definable stages with recognizable transitions.

The first stage involves building a relationship and focuses on engaging clients to
explore issues that directly affect them.

Two struggles take place at this time.

- One is the battle for structure, which involves issues of administrative control
(e.g., scheduling, fees, participation in sessions).

- The other is the battle for initiative, which concerns the motivation for change
and client responsibility. It is essential that counselors win the first battle and
clients win the second. If there are failures at these points, the counseling effort
will be prematurely terminated, and the counselor and client may feel worse for the
experience.

Other factors that influence the progress and direction of counseling are the physical
setting, the client’s background, the counselor’s skill, and the quality of the
relationship established. They will be examined here as well as the nature of the first
interview and the exploration stage of counseling.

Some counseling responses cut across theoretical and cultural lines in helping build a
counselor–client relationship. These responses are sometimes known as microskills
and include atheoretical and social-learning behaviors such as attending,
encouraging, reflecting, and listening.

FACTORS THAT INFLUENCE THE COUNSELING PROCESS

A number of factors affect the counseling process for better or worse. Those covered
here are the seriousness of the concern presented, structure, initiative, physical
setting, client qualities, and counselor qualities.

1. Seriousness of the Presenting Problem

Counseling is impacted by the seriousness of clients’ presenting problem. Evidence

has suggested a relationship between the initial self-reported disturbance level and the
treatment course. “Thus, clients reporting higher initial distress take more sessions to
reach clinically significant improvement than clients reporting lower levels of
distress” . For instance, clients who come to counseling with unfinished business
(unexpressed feelings—such as resentment, hate, pain, hurt, anxiety, guilt, and grief
—and events and memories that linger in the background and clamor for completion)
will, as a rule, take longer to treat than clients who have just experienced a difficulty.
2. Structure

Clients and counselors sometimes have different perceptions about the purpose and
nature of counseling. Clients often do not know what to expect from the process or
how to act. Seeing a counselor is a last resort for many individuals. They are likely to
have already sought help from more familiar sources, such as friends, family
members, ministers, or teachers. Therefore, many clients enter counseling reluctantly
and hesitantly. This uncertainty can inhibit the counseling process unless some
structure is provided .

Structure in counseling is defined as “a joint understanding between the counselor

and client regarding the characteristics, conditions, procedures, and parameters of
counseling”. Structure helps clarify the counselor–client relationship and give it
direction; protect the rights, roles, and obligations of both counselors and clients; and
ensure the success of counseling .

Practical guidelines are part of building structure. They include time limits (such as a
50-minute session), action limits (for the prevention of destructive behavior), role
limits (what will be expected of each participant), and procedural limits (in which
the client is given the responsibility to work on specific goals or needs). Guidelines
also provide information on fee schedules and other important concerns of clients. In
general, structure promotes the development of counseling by providing a frame-
work in which the process can take place. “It is therapeutic in and of itself”.

clients feel stuck and unable to change their behavior. To help clients gain new
directions in their lives, counselors provide constructive guidelines. Their deci- sions
on how to establish this structure are based on their theoretical orientation to
counseling, the personalities of their clients, and the major problem areas with which
they will deal. Too much structure can be just as detrimental as not enough (Welfel &
Patterson, 2005). Therefore, counselors need to stay flexible and continually
negotiate the nature of the structure with their clients.

One way is for counselors to provide information about the counseling process and
themselves with professional disclosure statements that include details about the
nature of counseling, expectations, responsibilities, methods, and ethics of
counseling.

3. Initiative

Initiative can be thought of as the motivation to change. Most counselors and

counseling theories assume that clients will be cooperative. Indeed, many clients
come to counseling on a voluntary or self-referred basis. They experience tension and
concern about themselves or others, but they are willing to work hard in counseling
sessions. Other clients, however, are more reserved about participating in counseling.

A reluctant client is one who has been referred by a third party and is frequently
“unmoti- vated to seek help” (Ritchie, 1986, p. 516). Many schoolchildren and court-
referred clients are reluctant. They do not wish to be in counseling, let alone talk
about themselves. Many reluctant clients terminate counseling prematurely and report
dissatisfaction with the process.

A resistant client is a person in counseling who is unwilling, unready, or opposed to

change (Otani, 1989; Ritchie, 1986). Such an individual may actively seek counseling
but does not wish to go through the emotional pain, change in perspective, or
enhanced awareness that counseling demands (Cowan & Presbury, 2000). Instead,
the client clings to the certainty of present behavior, even when such action is
counterproductive and dysfunctional.

1. Anticipate the anger, frustration, and defensiveness that some clients display.

2. Show acceptance, patience, and understanding as well as a general

nonjudgmental
attitude.

3. Use persuasion—the foot in the door or the door in the face technique.

4. Use confrontation—point out to the client exactly what the client is doing, such
as being
inconsistent.

5. Use metaphors and similes—comparisons of people or actions in one situation

to another,
for example, “your life has reached a dead end” or “you seem to be like a car
that has
plenty of gas but that is not in drive.”

6. Use “mattering”—the perception that as human beings we are important and

significant to
the world around us and to others in our lives.

7. Use pragmatic techniques, such as silence (or pause), reflection (or empathy),
questioning, describing, assessing, pretending, and sharing the counselor’s
perspective.
— 7 points in detail are discussed below:

Counselors can help clients win the battle for initiative and achieve success in
counseling in several ways. One is to anticipate the anger, frustration, and
defensiveness that some clients display. Counselors who realize that a percentage of
their clients are reluctant or resistant can work with these individuals because they are
not surprised by them or their behaviors.

A second way to deal with a lack of initiative is to show acceptance, patience, and
under- standing as well as a general nonjudgmental attitude. This stance promotes
trust, which is the basis of an interpersonal relationship. Nonjudgmental behavior also
helps clients better under- stand their thoughts and feelings about counseling. Thus,
acceptance opens clients to others, themselves, and the counseling process.

A third way to win the battle for initiative is for counselors to use persuasion (Kerr,
Claiborn, & Dixon, 1982; Senour, 1982). All counselors have some influence on
clients, and vice versa (Dorn, 1984; Strong, 1982). How a counselor responds to the
client, directly or indi- rectly, can make a significant difference in whether clients
take the initiative in working to produce change. Roloff and Miller (1980) mention
two direct persuasion techniques employed in counseling: the “foot in the door” and
the “door in the face.” In the first technique, the counselor asks the client to comply
with a minor request and then later follows with a larger request. In the second
technique, the counselor asks the client to do a seemingly impossible task and then
follows by requesting the client to do a more reasonable task.

A fourth way a counselor can assist clients in gaining initiative is through

confrontation. In this procedure the counselor simply points out to the client exactly
what the client is doing, such as being inconsistent. For example, a parent might be
disciplining children for misbehaving sometimes and then letting them act out at
other times. In such situations, the client must take responsibility for responding to
the confrontation. The three primary ways of responding are denying the behavior,
accepting all or part of the confrontation as true, or developing a middle position that
synthesizes the first two (Young, 2017). Doing something differently or gaining a
new perception on a problem can be a beneficial result of confrontation, especially if
what has previously been tried has not worked.

Counselors can also use language, especially metaphors, to soften resistance or

reluctance (Grothe, 2008). “Metaphors can be used to teach and reduce threat levels
by providing stories, by painting images, by offering fresh insights, by challenging
rigid thinking, by permitting toler- ance for new beliefs, and by overcoming the
tension often present between a counselor and the resistant [or reluctant] client.

The sixth way counselors can help reluctant and resistant clients, indeed all clients,
and strengthen the counseling relationship is through “mattering,” the perception that
as human beings we are important and significant to the world around us and to
others in our lives (Rayle, 2006). Research shows that mattering to others directly
affects individuals’ lives and relationships.

Finally, Sack (1988) recommends the use of pragmatic techniques, such as silence (or
pause), reflection (or empathy), questioning, describing, assessing, pretending, and
sharing the counselor’s perspective, as ways to overcome client resistance.

The reason change has not occurred is that the counselor has yet to find a way to help
stuck clients initiate a sufficient push to escape patterns that have been troubling
them.

4. The Physical Setting

Counseling can occur almost anywhere, but some physical settings promote the
process better than others. Among the most important factors that help or hurt the
process is the place where the counseling occurs. Most counseling occurs in a room,
although Benjamin (1987) tells of counseling in a tent. He says that there is no
universal quality that a room should have “except [that] it should not be
overwhelming, noisy, or distracting”

Certain features of a counseling office will improve its general appearance and
probably facilitate counseling by not distracting the client. These features include soft
lighting; quiet colors; an absence of clutter; harmonious, comfortable furniture; and
diverse cultural artifacts.

Eight common architectural characteristics of space and their potential impact on

counseling sessions. The factors they reviewed and their findings are as follows:

- Accessories (i.e., artwork, objects, plants)—“people prefer texturally complex

images of natural settings, rather than posters of people, urban life, and abstract
compositions”; peo- ple feel “more comfortable in offices that are clean and have
plants and artwork”

- Color (i.e., hue, value, intensity)—“bright colors are associated with positive
emotions and dark colors are linked with negative emotions”

- Furniture and room design (i.e., form, line, color, texture, scale)—“clients prefer
interme- diate distance in counseling and ... more protective furniture layouts ...
than do counselors”

- Lighting (i.e., artificial, natural)—“general communication tends to occur in bright

environments, whereas more intimate conversation tends to occur in softer light”;
“full- spectrum lighting helps to decrease depression symptomatology” (In an
experiment with 80 undergraduates in Japan, Miwa and Hanyu [2006] found that
 dim lighting yields more pleasant and relaxed feelings, more favorable impressions
of the counselor, and more self- disclosure than bright lighting.)

- Smell (i.e., plants, ambient fragrances, general odors)—“unpleasant smells elicit

unhappy memories, whereas pleasant smells trigger happy memories”; “inhaled
food and fruit fragrances have resulted in self-reported depressive symptoms”

- Sound (i.e., loudness, frequency)—“sound may enhance or detract from task

perfor- mance”; “music may enhance the healing process and affect muscle tone,
blood pressure, heart rate, and the experience of pain”

- Texture (i.e., floors, walls, ceilings, furniture)—“counselors should consider using

soft, textured surfaces to absorb sound and to increase clients’ feelings of privacy”

- Thermal conditions (i.e., temperature, relative humidity, air velocity)—“most

individu- als feel comfortable in temperatures ranging from 69 to 80 degrees
[Fahrenheit] and 30% to 60% relative humidity”.

- The arrangement of furniture depends on the counselor. Some counselors prefer to

sit behind a desk during sessions, but most do not. The reason desks are generally
eschewed by counselors is that a desk can be a physical and symbolic barrier against
the development of a close relationship. Benjamin (1987) suggests that counselors
include two chairs and a nearby table in the setting. The chairs should be set at a 90-
degree angle from each other so that clients can look either at their counselors or
straight ahead. The table can be used for many purposes, such as a place to keep a
box of tissues. Benjamin’s ideas are strictly his own; each counselor must find a
physical arrangement that is comfortable for him or her.

- counselors should not be interrupted when conducting sessions. All phone calls,
including cell phone calls, should be held. If necessary, coun- selors should put “do
not disturb” signs on the door to keep others from entering.

5. Client Qualities

Counseling relationships start with first impressions. The way that counselor and
client perceive each other is vital to the establishment of a productive relationship.
Warnath (1977) points out that “clients come in all shapes and sizes, personality
characteristics, and degrees of attractive- ness” (p. 85). Some clients are more likely
to be successful in counseling than others.
counselors are influenced by the appearance and sophistication of the people with
whom they work. Counselors most enjoy working with clients who they think have
the potential to change.

A number of stereotypes have been built around the physical attractiveness of

individu- als, and these stereotypes generalize to clients. The physically attractive
are perceived as healthiest and are responded to more positively than others.
Goldstein (1973), for instance, found that clients who were seen by their counselors
as most attractive talked more and were more spontaneous when compared with other
clients. Most likely, counselors were more encouraging to and engaged with the
attractive clients.

The nonverbal behaviors of clients are also very important. Clients constantly send
coun- selors unspoken messages about how they think or feel.

Thus, a client who reports that all is going well but who looks down at the ground
and frowns while doing so is probably indicating just the opposite. A counselor must
consider a cli- ent’s body gestures, eye contact, facial expression, and vocal quality to
be as important as verbal communication in a counseling relationship. It is also
crucial to consider the cultural background of the person whose body language is
being evaluated and interpret nonverbal messages cautiously.

6. Counselor Qualities

The personal and professional qualities of counselors are very important in

facilitating any helping relationship.

five important characteristics that helpers should possess: self-awareness, honesty,

con- gruence, ability to communicate, and knowledge.

Counselors who continually develop their self-awareness skills are in touch with their
values, thoughts, and feelings. They are likely to have a clear perception of their own
and their clients’ needs and accurately assess both. Such awareness can help them be
honest with themselves and others. They are able to be more congruent and build
trust simultaneously. Counselors who possess this type of knowledge are more likely
to communicate clearly and accurately.

Three other characteristics that make counselors initially more influential are
perceived expertness, attractiveness, and trustworthiness

Expertness is the degree to which counselors are perceived as knowledgeable and

informed about their specialty. Counselors who display evidential cues in their
offices, such as certificates and diplomas, are usually perceived as more credible than
those who do not and, as a result, are likely to be effective
Attractiveness is a function of perceived similarity between clients and counselors as
well as physical features. Counselors can make themselves attractive by speaking in
clear, sim- ple, jargon-free sentences and offering appropriate self-disclosure
(Watkins & Schneider, 1989). The manner in which counselors greet clients and
maintain eye contact can also increase the attractiveness rating. Counselors who use
nonverbal cues in responding to clients, such as head nodding and eye contact, are
seen as more attractive than those who do not (Claiborn, 1979; LaCross, 1975). The
attire of counselors also makes a difference (Hubble & Gelso, 1978). Clothes should
be clean, neat, and professional looking but not attract undue attention. Physical
features make a difference, too, in that under controlled conditions, research suggests
individuals are more willing to self-disclose to an attractive counselor than to an
unattractive one

Trustworthiness is related to the sincerity and consistency of counselors. Those who

are genuinely concerned about their clients show it over time by establishing a close
relationship.

Microskills :

attending, encouraging, reflecting, and listening.

6 Characteristics of a Good Counselor

1. Interpersonal skills

Counselors must be able to express themselves clearly and effectively. It is important

not only to be able to educate clients about therapeutic topics, but also to gauge the
client’s understanding at any given time. /emotional intelligence

2. Trust:Counselors must be able to communicate verbally and nonverbally that they

are trustworthy.

Clients need to feel comfortable sharing private, confidential information and parts of
themselves that are often entirely unknown by others. Having faith in the quality of
the relationship and the confidentiality of what is disclosed leads to a deeper
connection with the therapist.

3. Flexibility

A good counselor will create a meaningful treatment plan that is individualized for
each client. This means the counselor shouldn’t follow a rigid schedule of treatment
or have a “one size fits all” approach.

4. Hope and optimism

Hope is a wonderful motivator. Effective counselors can find a balance between
realism and hope.
A good counselor will set realistic goals that engage the client and inspire a more
optimistic outlook.

5. Multicultural sensitivity
The American Psychological Association recommends that therapists adapt treatment
to a client’s cultural values and show respect for differences, beliefs, and attitudes.
When working with clients, it is important to be educated and sensitive to issues of
race, gender, ethnicity, sexual orientation, religion, and cultural background.

6. Self-awareness

An effective counselor can separate personal issues from those of the client.
Countertransference is a phenomenon described by Freud where issues expressed by
a client lead to an emotional reaction of the therapist.
When counselors can identify and manage responses to their own issues, they will be
less likely to react to them during sessions, and it will eliminate any detrimental
effects on therapy.
Part of self-awareness is the ability to know how much information should be
disclosed to clients. This will vary on a case-by-case basis, but professional
boundaries, personal insight, and the ability to read others are integral parts of this.