Objectives

At the end of this topic you will be able to:

• describe the significance of the relationship between the client and the counsellor
• recognise the elements of the relationship which provide its therapeutic quality
• distinguish some of the qualities of excellent counsellors
• describe some factors which can impede the efficacy of the therapeutic relationship
• discuss humanism and human agency
• apply multicultural empathy to the therapeutic relationship.

Introduction

In this topic we look at the relationship between you and your client. It will be shown that many authors agree that the therapeutic relationship is one of the most important factors in counselling effectiveness and, in turn, in the effective incorporation of counselling into professional practice. This relationship has many components, including the core conditions introduced by Carl Rogers, the use of self, ‘counsellor’ qualities and the more problematic issues of dependency, transference and counter-transference. The ‘counsellor’, it will be explained, is responsible for initiating, maintaining and developing this relationship.

The therapeutic relationship

What is the common ingredient in counselling and helping which facilitates change? The basic ingredient of counselling is that special relationship, the therapeutic relationship, which you, as the ‘counsellor’, develop with the client. The therapeutic relationship occurs because the ‘counsellor’ is able to provide an accepting and safe environment where clients can share their world and some deeply personal issues. Through the closeness that you develop, you come to understand the world through the client’s eyes. Clients experience this as being heard and understood, and thus feel safe enough to take risks to disclose more to you and, consequently, feel able to look at their own life in a clearer or different light. One reason why growth and change occur is because of this safe and trusting relationship.

The qualities that you need to develop to enhance this relationship influence how you will use the techniques and tools you have learned, e.g. the microskills; without a good relationship not much will happen! Thus, as you can see, this concept has tremendous significance in the counselling process and is the cornerstone of development of counselling expertise.

The following is a summary of the ‘core conditions’ necessary to create the ‘therapeutic relationship’. This is the foundation of the Humanistic approach to counselling, which you will learn more about in later topics.

The core conditions

Carl Rogers (1961: 46–8) introduced the most basic and important elements or core conditions that are needed to create that supportive environment. You may have heard about the core conditions before, but we need to have a closer look at these now; they are:

• empathy
• unconditional positive regard
• genuineness.

Empathy

Empathy is the single most important quality in the counselling relationship, in fact it can be argued that without this, change and growth would be severely hampered. It involves according to Rogers ‘as if walking in someone shoes’, and note the emphasis on as if. Nothing is worse than hearing ‘I know exactly what you mean’ – because, how could you? It is important to understand the difference between empathy and sympathy, the latter involving being pitied, a feeling that not many people would welcome.

Patterson and Welfel, (1994, pp. 45–46) state that empathy involves two skills: Firstly, of perceiving what is going on for another person. Secondly, of communicating that understanding accurately. Remember reflection of content and feeling? If we disclose to the other person that we understand their pain, feel with them and reflect their feelings back clearly, then we are engaging in empathy.

Unconditional positive regard

Rogers (1961: 47) developed the concept that the counsellor’s caring for the client needs to be unconditional. Unconditional positive regard involves the acceptance of the feelings and perceptions of the client, regardless of society’s norms. It is important to note that positive regard doesn’t mean approving of dysfunctional and maladaptive behaviours. However, it is crucial not to judge and disregard the client in this case (and any other human being for that matter) because of their behaviours. The client needs to be accepted in total before he/she can move in a new direction. Without support and acceptance the client would have difficulties to change and grow, or stay in a relationship with the counsellor.

Unconditional positive regard involves having a non-judgemental attitude and requires that you ‘suspend your own opinions and attitudes and assume a value-neutrality in relation to your client’ (Ivey & Ivey, 2007: 225). This may be very difficult for you, and it is also important to acknowledge our limitations. For some people, especially if you have strong beliefs about right and wrong, it will be very difficult to work with people who display behaviours and values that are very dissimilar to yours, e.g. how would you counsel a client who is exploring an abortion when you are a Pro-Life supporter? Unconditional positive regard is ‘responding to the client as a worthy human being’, no matter what (Ivey & Ivey, 2007: 225). How will you be able to do this if the behaviour of your client confronts your sensibilities or even your core beliefs? The following section may shed some light on this.

Genuineness and congruence

If the counsellor behaves in a consistent genuine manner across time the client will perceive the counsellor as ‘real’. Congruence really means that body language and speech match, and the client gets the impression that the counsellor is not faking empathy or positive regard. This will help the client feel safe and trusting in the relationship that is developing. In order for the counsellor to be fully genuine and congruent then he/she must know himself/herself very well: He/she must be ‘self-aware’.

In the case referred to above, this would mean that you may want to disclose your preference, and see whether the client still wants to work with you. If not, you may have to refer your client on. This is also true if you could not be unbiased. However, genuineness in not a license to indiscriminately self-disclose or provide feedback. Just as in all other situations, the question needs to be asked by the counsellor: ‘Is this going to be helpful for my client?’ (or am I self-serving in my insistence or disclosure?).

Concreteness

This is not a ‘Rogerian’ concept but was in fact developed due to a concern that a counsellor who is empathic, caring, and genuine may still find it hard to focus the client on relevant material. Concrete examples are requested of the client to help clarify certain points and to help the client come to an understanding of what options are available from their own resources to overcome the problem, e.g. ‘what specifically is being said when you quarrel with your daughter?’ Ivey and Ivey (2007: 224) state that asking for concrete examples ‘makes the interview real’ and write extensively on this concept, which is closely linked to their concept of intentionality.

Definition of humanism

The emphasis of this unit is on humanistic counselling and by the end of your study here you will have a good understanding of some of the basic concepts inherent in this approach. The ‘founder’ of humanistic counselling was Carl Rogers, who emphasised the importance of the relationship between the counsellor and the client as the change agent in counselling. Do be aware that there are many other theoretical approaches to counselling, which we consider in later units in the major, however, this unit cannot cover all the theories of counselling, and all the other healing modalities used in the wide range of the helping professions – humanistic counselling is one modality which has stood the test of time and is constantly growing and developing to meet the needs of its clients, its practitioners and its profession.

In order to appreciate the importance of this relationship let us first look in some detail at what is meant by ‘humanism’.

The status of the individual in the world, and the myriad possible directions of a human life, also leads us to think about some other vital philosophical concepts such as freedom and determinism. These are encompassing issues, and again, although we will very briefly consider freedom and determinism in this topic, we do not have scope in this unit to consider how the history of philosophy has influenced the path of humanism and humanistic counselling. We can, however, keep in mind that our daily work is inextricably linked to the philosophies of the ancient thinkers. In working with humans, we are interfacing with the foundational concerns of thousands of years of striving humanity – what a privilege, and what a responsibility.

Before considering what humanistic means, it is worthwhile to consider the basic philosophy of humanism. Humanism is concerned with humanity, specifically, the worth of humans as individuals (Gladding, 2006). ‘Worth’ is an important word in this definition as all humanistic counselling, regardless of the theoretical perspective of the counsellor and the processes and interventions used, respects the intrinsic worth of each individual as they are, right now. One of Carl Rogers’ (1951) core conditions of the therapeutic relationship is ‘unconditional positive regard’. This core condition is built upon the concept of worth. A significant percentage of people who seek counselling will be working on issues which have arisen from perceptions of their own self-worth, and the counsellor’s attitude towards his or her own self-worth is also a component of the therapeutic relationship.

When we are working from a ‘humanistic’ counselling framework we are concerned with the values, interests, and welfare of human beings (Gladding, 2006). The therapeutic relationship is also closely linked to the concept of human agency. Human beings are ‘agents’ of their own destiny, and whilst they have been heavily influenced by their physical, psychological and social environments, they contain within themselves the ability to transform these environments. With the capacity to produce changes in existing states of affairs, humans are able to transform themselves (Bhaskar, 2002 cited in Sullivan, 2008). Even if we are unable to change a particular state of affairs, we as free agents, can choose our response to that situation.

This does not mean that there are not boundaries, limits and constraints in real life, just that humans have the capacity to rise above circumstances. It is a common phenomenon that humans exceed expectations – for example, a child with learning difficulties who has been told by a person in authority that he/she will never amount to anything, becomes a revered scholar who writes a significant text in his/her chosen field of enquiry. There are many examples of how humans have conquered great adversity and it is possible that each of us can contribute an example from our own family or community.

The concept of human agency links well to Carl Rogers’ (1951) explanation of the inherent self-actualising tendency in all humans. The support of a non-judgmental therapeutic relationship allows a person to achieve his or her true potential.

Freedom and determinism

Our discussion of these important philosophical concepts is limited to a brief overview of how they affect the therapeutic relationship and the process of counselling. These are foundational and wide ranging concepts about which many books have been written over a long period. You will also be able to find many sources discussing cause and effect. In trying to link these broad philosophical concepts to humanistic counselling we can perhaps look at the way clients construct their reality. For example, we may construct a reality which tells us that:

• the world is an unpredictable place and the future is waiting to be shaped by me (Freedom)
  

  or

• the world is in God’s hands (Determinism)
  

  or

• even though I have made many mistakes, I still have the chance to improve my life (Freedom)
  

  or

• I am stuck in dysfunctional patterns of relating to others because of the way my mother treated me (Determinism).

The humanistic counsellor can help the client to identify unnecessary restraints (past causes) and leave them behind to exercise freedom in the present and future (Feltham, 1995, p. 123).

Philosophers may argue that we are determined and free at the same time – this is known as compatibilism – we have free choices no matter what has happened in the past or what events have made us the people we are today. This philosophy links well to Rogers’ concept of self-determination and self-actualisation – as humanistic counsellors we can assist people to discard negative cognitions and behaviours from the past and harness their innate resources to become free, self-determining individuals. Then there is the argument that we can never be free in an environment full of constraints … philosophers (and counsellors) continue to ponder.

Choice, responsibility and authenticity

One of the tasks of the therapeutic relationship is to assist in the process of the client’s journey towards authenticity (van Deurzen-Smith, 1994). This requires the recognition that it is not the goal of therapy to eliminate anxiety. The existence of anxiety in humans is a pointer to life itself, it is only when it becomes unmanageable to the particular person that it is a problem for them. Humanistic/existential counsellors suggest that we need to actively take part in existence, not deny the anxiety which will naturally arise if we embrace life. Sartre (1943, cited in Van Deurzen-Smith, 1994) states that all trouble for humans arises from choice or responsibility. We can therefore eliminate anxiety and deceive ourselves by pretending that choice and responsibility do not exist.

There are many ways that this occurs – for example substance abuse, disengagement from life, deciding that we are ‘ill’ and need to be looked after, adopting a concept of living which is made up of completion of a tedious ritual of habits and fulfilling the expectations of ourselves and others (van Deurzen-Smith, 1994). Striving towards authenticity does not mean the expression of free will without limitations. There are always limitations arising from our own locus of control and external factors in the world around us. The existential/humanistic therapeutic relationship helps the client to discover their own unique direction and builds strength to follow their own path with confidence amidst the ‘unknowingness’.

Determinants of excellent therapeutic outcomes

As we have seen above, the therapeutic relationship requires the expression of the core conditions, the application of skills and attention to process. However, research has found that the most dependable indicator of a successful therapeutic outcome is the person of the therapist. After analysing multiple variables which impact upon counselling, research determined that clients identified successful outcomes when:

• they had the opportunity to talk with a trusted professional in a structured setting
• they were heard accurately by their counsellor
• they were talking in a structured way, and being heard by counsellors who were perceived as human beings, engaging with them as one concerned though imperfect person to another (Howe, 1993, cited by Spinelli, 2001 in Sullivan 2008, p. 75).

This research is supported by Sullivan, Skovolt and Jennings (2005) who explored how identified ‘master therapists’ constructed the therapy relationship. Again, regardless of theoretical framework utilised, the personal characteristics of the therapist and their ability to build the therapeutic relationship were found to be the overall best indicators of success.

The ten characteristics most essential for effective counsellors were ranked by Pope (1996, cited in Sullivan, 2008, p. 77) as:

• acceptance
• emotional stability
• open-mindedness
• empathy
• genuineness
• flexibility
• interest in people
• confidence
• sensitivity
• fairness.

Counsellor qualities

Many authors have commented on the qualities that effective counsellors display. Carl Rogers (1961) introduced the core conditions of empathy, unconditional positive regard and genuineness. The role of empathy cannot be overestimated; in fact, all other qualities counsellors display are based on this single most important quality, empathy. We have touched upon this before and Carl Rogers’ core conditions will be explained in more depth in the following topic.

When we start looking at counsellor qualities it is important to ask ourselves: Are counsellors born or made? The following section may not give an answer to this, but will help to clarify which characteristics are needed to create an effective therapeutic relationship.

Corey’s (2009) personal characteristics of effective counsellors

Corey (2009: 17) poses that an effective counsellor models ‘awareness and growth for their clients’. He agrees that this may be a lifelong process of learning to embody those qualities, but that the emphasis is on ‘the willingness to struggle to become a more therapeutic person’ and not on being perfect already.

Corey’s list shows a well-rounded person, who loves life and lives it fully. This of course is an ideal, and at times we will be able to show some of those qualities, at other times we may ‘struggle’ to even be genuine and accepting of ourselves. Especially the last quality, maintaining healthy boundaries, may provide a challenge for counsellors who are willing to be helpful and supportive. We will discuss this issue in more depth in the next topic, when we look at burn-out. ‘Leaking’ boundaries almost always result in feeling stressed and burned out, which seems to be an issue for most human service workers. If you suspect that you are susceptible to this, make sure you read that section carefully as it gives important clues about how to look after yourself.

So, do counsellors have to be perfect? What do you think? Consider your own responses whilst you are reading these sections. No one is suggesting that every counsellor should possess all of these qualities but I am sure the discussion will raise questions for you about which areas you may need to look at developing for yourself. The following exercises may help you to come to an understanding of your own qualities and skills.

Your head is probably spinning! What seemed to be a simple case of helping another human being to ‘sort out’ his or her life, has now become a complicated interplay of qualities, skills and self-awareness. Some of these concepts may sound like common sense, however the constant attention to the role of the counsellor and how this influences the therapeutic relationship may seem a lot more difficult now! Please, don’t be discouraged; in fact, this learning may have enormous benefits for all your relationships!

Impediments to the therapeutic relationship

Reluctance

Clients who have conscious reservations about being in counselling are said to be reluctant. These clients are aware of the reasons why they do not wish to engage with counselling, but may not be able to put these into words, or choose not to. Some of these reasons are:

• embarrassment and the wish for privacy
• unfamiliarity with counselling
• lack of faith that talking can help
• belief that one does not need help or ought to be able to ‘stand-alone’
• fear that one will lose autonomy over life issues and that the counsellor will take control
• belief that only crazy people need counsellors
• discomfort with the setting (the setting may seem too exposed, may be associated with a disliked entity such as the justice system, or may simply be physically uncomfortable)
• discomfort with the personal characteristics or counselling style of the assigned counsellor
• history of a negative experience with a helping professional
• concern with fees and expenses of counselling (Welfel & Patterson, 2005, p. 188).

Resistance

Resistance consists of unconscious defensive reactions to the counselling situation (Welfel & Patterson, 2005, p. 185). Resistance occurs when clients feel:

• it is a sign of weakness to seek help
• disclosure is difficult (e.g. due to cultural differences)
• counsellors have been ineffective or insensitive.

Some theorists suggest that resistance is just a normal consequence of the counselling process. It is:

a phenomenon that emerges between client and therapist in the unfolding interaction between differently organised subjective worlds.

Transference and counter transference

We look at these concepts later in this unit but they are included here in summary as an important element in this section.

Transference occurs when the repetition of past relationships with significant others are projected onto the therapist. With these projections come all the feelings, behaviours and attitudes that belonged to the earlier relationship (Brammer, Abrego & Shostrom, 1993, cited in Welfel & Patterson, 2005, p. 189).

For example, clients attending counselling may have built up patterns of negative and self-defeating responses to authority over an extended period of time. This begins with the parents and then is continued at school. It is suggested that the child perceives that the parents make arbitrary demands and the child feels that their love is conditional on the child doing their bidding. The child experiences hurt, deprivation, frustration and anger when parents perceive the child’s behaviours as unsatisfactory. Love from the parents is conditional and not dependable. We can see how these ingrained patterns can cross over into adult relationships.

Counter-transference then follows as the counsellor reacts emotionally (with their own past patterns of relating) to the client’s transference. These emotional reactions are a pointer to the counsellor of triggers within their own psyche and can help the counsellor to pinpoint the real issue of the client. The process then continues – transference, counter transference, responses, negative interjects, defence mechanisms, analysis, insight. Much of this interaction occurs on a subconscious level. Although transference and counter transference can be challenging to manage in the therapeutic relationship, they are also powerful tools of transformation – some would say the most powerful tools we have.

Involuntary or oppositional clients

It is quite likely that as we take our practice out into the world, we may work with involuntary or oppositional clients. Indeed, much of the work which is done in human services agencies is directly or indirectly working with this client group, although it is in their own interests to present a façade of cooperation.

Working with angry, involuntary or oppositional clients presents challenges for the counsellor, and this is where we need to remember our commitment to the core conditions. Can we treat each of these individuals with unconditional positive regard? Can we help them turn their anger into a positive tool for change?

Welfel and Patterson (2005, p. 197) provide the following responses to help the counsellor maintain commitment to these clients and to prevent the perpetuation of patterns of dysfunction and failure:

• explore the discrepancy between the client’s deeply held values and his or her current behaviours that led to the referral for counselling (the behaviours that have been labelled problematic are frequently inconsistent with the client’s values, but the client has not recognised this. When counsellors help clients to identify their values, positive change can occur).
• roll with the resistance rather than directly confronting it, just as a canoeist in whitewater rafting goes with the power of the water and uses the power of the water to go forward rather than directly opposing it (directly confronting resistance with a reluctant client will always make things worse)
• support the clients self-efficacy by building confidence that change is possible (focus on the clients strengths and the instances, however infrequent, when the client has found some measure of control over the problem).

Summary

In this topic we have considered some interesting aspects of the therapeutic relationship, and ascertained that it is the vehicle for change in humanistic counselling. We have understood that the personal qualities of the counsellor are a vital part of the success of the healing relationship. We have learned how to work with involuntary or oppositional clients. We now need to consider the importance of understanding ourselves within the counselling role.