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Unit 3 Therapist/Counsellor and Client Relationship

1. Describe the three important therapist characteristics and behaviours proposed by Rogers as part of client-centered therapy. 

Rogers felt that a therapist, in order to be effective, must have three very special qualities; theses are as follows: 

i) Congruence or genuineness: Congruence or genuineness means correspondence between the therapist's thoughts and behaviour. The therapist must be a "real" person without any facades or pretences. 

ii) Empathy: Empathy refers to profound interest and care for the client's perceptions and feelings. The ability to feel what the client feels. 

iii) Unconditional positive regard: Unconditional positive regard states unconditional acceptance of the client. Therapist's regard or attitude remains unaltered regardless of the client's choice. 

These core conditions of client -centered therapy are said to be "necessruy and sufficient" for improvement in therapy. Rogers stated that if the therapist shows these three qualities, the client will improve, even if no other special "techniques" are used. 

2. Describe Joining

Joining as a family therapy technique refers to therapist behaviours aimed at becoming a temporary member of the family for the purpose of treatment. 

3. Describe Tracking

Tracking as a family therapy technique refers to the therapist following the comci   of the family facts to identify the interactive patterns in the family, and to determine which of these patterns may be causing the family's problems or symptoms. 

4. Describe Mimesis

Mimesis is a family therapy technique which refers to the therapist becoming like the family in the manner or content of communications for the purpose of treatment. 

5. Describe Confirmation

Confirmation as a family therapy technique refers to the therapist using a feeling word to reflect an expressed or unexpressed feeling of a family member. 

6. Describe Accommodation

Accommodation as a family therapy technique refers to the therapist making personal adjustments in order to achieve a therapeutic alliance.

7. Briefly discuss the concept of cohesiveness in group therapy as the equivalent of the therapeutic working alliance. 

Cohesiveness has been viewed as the group psychotherapy equivalent of the therapeutic alliance in individual treatment. Cohesion is defmed as the therapeutic relationship in group psychotherapy emergin; from the aggregate of member leader, member-member, and member-grour relationships. It generally refers to the emotional bonds among members for each other and for a shared commitment to the group and its primary task.

Intrapersonal cohesion includes members' sense of belonging, acceptance, commitment and allegiance to their group. Intra-group definitions of cohesion focus on the group-level features such as attractiveness and compatibility felt by group-as-a-whole, mutual liking or trust, support, caring and commitment to "work" as a group. Finally, interpersonal definitions of cohesion focus on positive and engaging behavioural exchanges between members. This group process variable is linked with positive outcome in group therapy. 

8. Discuss the differences between a therapeutic relationship and a personal relationship. 

• Focus: In a therapeutic relationship, the client's well-being and growth are the central focus. Unlike personal relationships, the therapist does not seek to fulfil their own needs or engage in reciprocal self-disclosure.
• Boundaries: The therapeutic relationship is bound by clear professional and ethical guidelines. Confidentiality is paramount, and the therapist avoids dual relationships to maintain objectivity. These boundaries ensure a safe and focused environment for the client, which may not exist in personal relationships.
• Objectivity: While empathy and connection are important, therapists must maintain an objective stance to facilitate the client's self-awareness and decision-making. This objectivity can be challenging in personal relationships where emotional involvement might cloud judgement.
• Power Imbalance: The therapist possesses specialised knowledge and skills, creating a power imbalance in the relationship. This dynamic is acknowledged and managed ethically to empower the client, unlike personal relationships where power dynamics can be more fluid and potentially problematic.
• Termination: Therapeutic relationships are designed to be time-limited and move towards a planned termination. This structured ending allows for reflection and integration of learning, whereas personal relationships may have more ambiguous endings.

9. Describe Bordin's concept of the therapeutic working relationship. 

Bordin's concept of the therapeutic working relationship, also known as the working alliance, emphasises a conscious and collaborative relationship between the client and the therapist. He shifted away from the traditional psychoanalytic view that linked the working alliance solely to transference. Instead, Bordin saw the alliance as a crucial factor that enhances the effectiveness of the therapeutic techniques and processes.

According to Bordin, a successful therapeutic alliance consists of three key aspects:

1. Tasks: A shared agreement on the therapeutic activities undertaken during sessions, such as role-playing or cognitive restructuring. These tasks should be tailored to the client's individual needs and preferences.
2. Goals: A mutual understanding of the desired outcomes of therapy, with both client and therapist agreeing on the specific targets for change.
3. Bond: A strong foundation of mutual trust, respect, and connection between the client and therapist. Clients need to feel that their therapist genuinely cares about their well-being and is invested in helping them achieve their goals.

These three components underscore the active roles and responsibilities of both the client and the therapist in working towards positive change. The working alliance, therefore, facilitates the client's engagement in the therapeutic process and strengthens their commitment to treatment. This collaborative approach, as described by Bordin, is essential for achieving successful therapeutic outcomes.

10. Compare the role of the therapist-client relationship in psychodynamic and client-centered psychotherapy. 

• Psychodynamic Psychotherapy: The therapist-client relationship in psychodynamic psychotherapy is viewed as a recreation of past relationship patterns, particularly those experienced during childhood. Transference, where the client unconsciously projects feelings and expectations from past relationships onto the therapist, is considered a central element. The therapist's role is to analyze and interpret these transference reactions, helping the client gain insight into their unconscious conflicts and maladaptive patterns. The therapeutic relationship is also seen as a space for corrective emotional experiences, where the therapist's behavior can offer a healthier model of relating than the client may have experienced previously.
• Client-Centered Psychotherapy: In contrast, client-centered therapy prioritizes the quality of the present therapeutic relationship as the primary catalyst for change. Carl Rogers, the founder of this approach, believed that the therapist's authenticity, empathy, and unconditional positive regard are both necessary and sufficient for client growth. The therapist's role is to create a safe and accepting environment where the client feels understood and empowered to explore their own experiences and emotions. While techniques may be used, they are secondary to the importance of the therapist's genuine presence and their ability to facilitate the client's self-discovery.

11. Illustrate the conceptualisation of the therapeutic relationship in couples therapy. 

The therapeutic relationship in couples therapy has three distinct alliances, posing unique challenges compared to individual therapy:

1. Individual Alliances: Each partner forms a separate alliance with the therapist, similar to the working alliance described by Bordin. This involves establishing trust, agreeing on goals, and collaborating on tasks for each individual within the therapeutic context. However, these individual alliances must be carefully balanced to avoid creating a "split alliance" where one partner feels favoured by the therapist.
2. Subsystem Alliance: The couple also needs to develop a shared alliance with the therapist as a unit, distinct from their individual perspectives. This involves recognizing their shared responsibility for the relationship's issues and working collaboratively towards common goals. The therapist's neutrality is crucial in fostering this subsystem alliance, ensuring that neither partner feels blamed or marginalized.
3. System Alliance: The most complex aspect involves a system alliance that encompasses the individual alliances, the subsystem alliance, and the overall therapeutic process itself. This requires the therapist to navigate the intricate dynamics between the partners, their individual concerns, and their shared struggles. The therapist must be able to identify and address potential power imbalances within the couple, fostering a sense of equality and mutual respect during therapy.

Maintaining a balanced and collaborative therapeutic relationship is essential for successful couples therapy. 

12. Explain some important client, therapist and therapeutic technique related factors associated with the formation and maintenance of the therapeutic relationship. 

• Client Factors:
• Motivation: Clients who are actively engaged and committed to the process are more likely to form a positive alliance and experience positive outcomes.
• Attachment Style: Clients with secure attachment styles, characterized by trust and comfort in relationships, tend to establish stronger therapeutic relationships. Those with insecure attachment may require more time and attention to develop trust and safety in the therapeutic setting.
• Expectations: Clients who have realistic expectations about the therapeutic process and understand their role in it are better equipped to engage in the collaborative work of therapy.
• Therapist Factors:
• Interpersonal Style: Therapists who demonstrate warmth, empathy, genuineness, and respect create a more welcoming and conducive environment for clients to open up and explore their experiences.
• Self-Awareness: The sources emphasize the importance of the "self of the therapist." Therapists must be aware of their own biases, values, and potential countertransference reactions to avoid imposing their own perspectives onto the client. Reflection and supervision are crucial for maintaining this self-awareness.
• Cultural Sensitivity: Therapists should be aware of and sensitive to the client's cultural background and how it might influence their understanding of the problem and their expectations for therapy.
• Therapeutic Technique Factors:
• Collaboration: The therapeutic relationship should be collaborative, as emphasized by Bordin's working alliance model. The therapist and client should mutually agree on goals, tasks, and the overall direction of therapy.
• Structure: Clear boundaries, such as time limits and confidentiality agreements, are essential for creating a safe and predictable therapeutic environment. This structure enhances the client's sense of trust and security.
• Reflective Listening: Active listening and reflecting the client's feelings and concerns demonstrate understanding and validation, strengthening the therapeutic bond.

13. Explain the importance of resolution of alliance ruptures in psychotherapy. 

The therapeutic relationship is not always smooth sailing. Ruptures, defined as strains or disruptions in the therapist-client alliance, are an expected part of the therapeutic process. These ruptures can stem from various factors, such as misunderstandings, disagreements about treatment goals, or the client feeling invalidated by the therapist. However, these ruptures, if handled effectively, can actually strengthen the therapeutic relationship.

Resolving alliance ruptures is crucial for several reasons:

• Restoring Trust and Collaboration: Ruptures can erode the foundation of trust and collaboration that is essential for therapeutic progress. Repairing these ruptures reaffirms the therapist's commitment to the client and their shared goals, allowing the therapeutic work to continue.
• Deeper Understanding and Growth: Openly addressing a rupture allows the therapist to gain valuable insights into the client's experiences, relational patterns, and potential triggers. This can lead to a deeper understanding of the client's needs and a more tailored therapeutic approach.
• Modeling Healthy Communication: By successfully navigating ruptures, the therapist demonstrates healthy communication skills and conflict resolution strategies. This can be a powerful learning experience for the client, equipping them with tools to manage conflicts in their own relationships.
• Strengthening the Alliance: Successfully repairing ruptures can actually make the therapeutic relationship stronger. By working through challenges together, the therapist and client develop a deeper level of trust, understanding, and mutual respect.

The therapist's ability to recognize, address, and repair alliance ruptures is a key skill in psychotherapy. It requires self-awareness, humility, and a willingness to engage in open and honest dialogue with the client. By embracing ruptures as opportunities for growth and connection, therapists can transform potential setbacks into catalysts for a more authentic and resilient therapeutic relationship.

14. Describe the important ethical issues in the therapist-client relationship.  

• Informed Consent to Therapy 
• Confidentiality and Limits of Confidentiality 
• Dual or Multiple Relationships
• Other Ethical Guidelines 

Important Points

i) Who conceptualised what:

• Freud - Transference
• Bordin - Task, goal, bond alliance components
• Rogers - Unconditional Positive Regard
• Greenson - Working Alliance
• Neki - Guru-chela relationship

ii) In psychoanalysis, transference refers to the feelings expressed by the client toward the therapist which are indicative of the unconscious feelings toward significant people in her or his personal life.

iii) The term corrective emotional experience refers to the emotional experiences between therapist and client, which are contrary to the maladaptive relationship patterns and emotions experienced by the client in the past. 

iv) Three important aspects of the therapist's behaviour in psychoanalysis are neutrality, abstinence, and anonymity.

v) The therapeutic relationship is not viewed as the primary factor contributing to change in cognitive behavioural therapy. 

vi) The therapist-client relationship is defined by collaborative empiricism in cognitive behavioural therapy.

vii) Empathic listening contributes to building the therapeutic relationship in supportive psychotherapy

viii) The alliance between the therapist and each partner during couples therapy is the individual alliance 

ix) The alliance with, among, and between the couple and the therapist is the system alliance 

x) The alliance with the therapy as a couple, and not as individuals, is the subsystem alliance

xi) Split alliance refers to a situation when the perceptions of the therapeutic alliance are significantly more positive for one partner than for the other in couples therapy

xii) Client characteristics associated with the development of positive therapist-client relationship: 

a. Level of motivation 

b. Early attachments and relationships 

c. Social support 

xiii) Therapist factors and techniques linked with positive alliance formation are: 

• Empathy towards the client 
• Encouraging expression of affect

xiv) Therapist's perceptions and ratings of the therapeutic alliance are the strongest predictors of the outcome of therapy. 

xv) The strength of the therapeutic relationship in the first few sessions of therapy is most predictive of outcome. 

xvi) The therapeutic relationship does not remain the same throughout the course of therapy. 

xvii) Ethical and unethical behaviours:

• Greeting your client if you unexpectedly meet the client in a public setting - Unethical 
• Discussing a case with a colleague in a crowded elevator with other staff, clients and families - Unethical 
• Borrowing money from a client - Unethical 
• Breaking confidentiality if a client is suicidal - Ethical
• Agreeing to see your best friend's daughter in psychotherapy - Unethical