The Therapeutic Relationship

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Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology, 2. DOI:10.3389/fpsyg.2011.00270. Perhaps one way of describing it is the feeling you have after going to a concert you enjoyed or a really special evening with friends. A feeling of spiritual connection which was described by Clarkson herself as; More specifically, therapeutic use of self is the self-aware intertwining of both our professional self (the one that uses knowledge, skills and techniques) and our personal self (which arises from our history, beliefs/values, personality and embodied lived experience). It involves our therapeutic practices that we’ve learned and our particular way of maintaining a caring, attuned, holding presence. In other words, therapeutic use of self involves the totality of our being and doing; it is present in our every intervention. Rogers describes the core conditions of empathy, congruence and unconditional positive regard, as the foundations of building an interpersonal alliance between two people. In terms of “The 5 relationship model’ the therapist would use these conditions to facilitate the ongoing encounter with the client. Perhaps one way of describing it is the feeling you have after going to a concert you enjoyed or a really special evening with friends.

The Therapeutic Relationship - Petruska Clarkson - Google Books

What do our therapeutic relationships with clients involve? How do we create a safe space for clients to go exploring? What are we doing when we show clients respect and caring, attuned attention or when we challenge them to grow? How is our way of being with clients therapeutic? These questions around ‘doing’ and ‘being’ all relate to the idea of therapeutic use of self which can be defined as: "A therapist’s thoughtful, deliberate effort to use their self as a tool, one which embodies a self-aware therapeutic way of being in the service of clients and the client-therapist relationship" (Finlay, 2022, p. 1). I have become interested in Petruska Clarkson due to her body of work on human relationships, including the 5 relationship model. When I look at the five aspects of a therapeutic relationship I feel a strong degree of resonance with these principles, and will focus on a couple of particular ones, the working alliance and the reparative/development need aspects. I like the metaphor Clarkson uses in relation to a piano, that some aspects are played more frequently or loudly than others, but they are always potentially there. Many clients come to see therapists as the ‘good enough other’ the idea that at some level they emotionally take on the therapist as a ‘parent figure’ to support them during the personal growth that hopefully takes place during therapy, Clarkson described this as ; 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. Gaston L., Marmar, C. R. (1991). Manual for the California Psychotherapy Alliance Scales - CALPAS Unpublished manuscript. Department of Psychiatry McGill University, Montreal, Canada.The following video clips have been taken from seminars hosted by Prof Robert Schweitzer in 2021 at the School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia. My thanks to Robert Schweitzer, and his students Jeremy Vernon and Dymphna van der Leij, for the opportunity to dialogue on the topic of therapeutic use of self and reproduce clips of the video here: 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. Therapists need to be vigilant of this, if they feel irritated by a client they need to explore in supervision where this comes from, as there is a possibility that reacting to the client as they would a person from their past , this is known as ‘counter transference’, it is unfair and possibly emotionally damaging for the client .

The Therapeutic Relationship: In Psychoanalysis, Counselling

Qualitative research collects data that describes the quality of experience, while quantitative research gathers data relating to quantity (i.e. facts and figures). Each type of research has its pros and cons, and often the two can be combined for strong research results; a balance is important.Integrative Psychotherapy: The Art and Science of Relationship,by Janet Moursund & Richard Erskine.

Therapeutic Relationships - Artemis S. Antoniou The Five Therapeutic Relationships - Artemis S. Antoniou

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. Make sure you train on an experiential course (i.e. one that is taught face-to-face, and that includes skills practice). 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. As I understand it the working alliance is the basis of the client–therapist relationship that enables both the client and the therapist to work together and would include such things as the contract, the presenting issues and maybe a realisation of both people that in other circumstances they may not be kindred spirits, or even necessarily like each other. There are some synergies here with Coaching practice with a contracting process, and examination of presenting versus underlying issues; it leads to my sense that Coaching has beg, stole and borrowed from therapeutic theory!

Client perception: that the client perceives, to at least a minimal degree, the therapist’s positive regard and empathic understanding. 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). Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260. The reparative/developmentally needed relationship is based on the client viewing the therapist as a parent figure to support them during the personal growth that takes place in therapy. This may be especially so for clients who experienced poor parenting as youngsters. In time, the client begins to trust their own judgement and so needs the therapist less (at which point therapy comes to an end). Forgotten the title or the author of a book? Our BookSleuth is specially designed for you. Visit BookSleuth