“ Maybe if I have this client blink his eyes at an improved speed, while exposing him to his past, and add some cognitive behavioral therapy while sitting close to a waterfall, he may be able to perform more effectively in his life! ” Indeed this is rather exaggerated, however it demonstrates the idea that as professionals in the field of treatment, we often seek complex theories, techniques, and strategies to more effectively treat our own consumers. A large amount of our precious time is certainly spent seeking new theories and techniques to treat clients; evidence for this statement is shown by the thousands of theories and techniques that have been created to treat clients seeking therapy.
The fact that theories are being created and the field is growing is absolutely magnificent; however we may be searching for something which has always been right under our nose. Clinicians often enjoy analyzing and making things more intricate they actually are; when in reality what works is quite simple. This basic and uncomplicated ingredient for successful therapy is what will be explored in this article. This ingredient is termed the therapeutic relationship. Some readers may agree plus some may disagree, however the challenge is to be open minded and remember the consequences of “ contempt prior to investigation”.
Any successful therapy is grounded in a continuous strong, genuine restorative relationship or more simply put by Rogers, the “ Helping Relationship”. Without being skilled in this relationship, no techniques are likely to be effective. You are free to understand, study, research and labor more than CBT, DBT, EMDR, RET, and ECT as well as attending infinite exercising on these and many other techniques, although without mastering the art and science of building a therapeutic relationship with your client, therapy will not be efficient. You can even choose to spend thousands of dollars on a PhD, PsyD, Ed. D, and other advanced degrees, which are not getting put down, however if you deny the vital importance of the helping relationship you will again be unsuccessful. Rogers brilliantly articulated this point when he said, “ Intellectual training and the acquiring of information has, I believe several valuable results– but , becoming a therapist is not one of those results (1957). ”
This author will attempt to articulate what the therapeutic relationship involves; questions clinicians can request themselves concerning the therapeutic relationship, along with some empirical literature that facilitates the importance of the therapeutic relationship. Please be aware that therapeutic relationship, therapeutic alliance, and helping relationship will be used interchangeably throughout this article.
Characteristic of the Therapeutic Relationship
The therapeutic relationship has several characteristics; however the most vital will be presented in this article. The characteristics may appear to be simple and basic knowledge, although the constant practice and integration of such characteristic need to be the focus of every client that enters therapy. The restorative relationship forms the foundation for treatment as well as large part of successful end result. Without the helping relationship being the main priority in the treatment process, doctors are doing a great disservice to clients as well as to the field of therapy in general.
The following discussion will be based on the incredible work of Carl Rogers concerning the helping relationship. There is no other psychologist to turn to when discussing this subject, than Dr . Rogers himself. His extensive work gave us a foundation for successful therapy, no matter what theory or theories a clinician practices. With out Dr . Rogers outstanding work, productive therapy would not be possible.
Rogers defines a helping relationship as, ” a relationship in which one of the participants intends there should come about, in one or both parties, more appreciation of, more appearance of, more functional use of the latent inner resources of the individual ( 1961). ” There are three characteristics which will be presented that Rogers states are crucial and sufficient for therapeutic alter as well as being vital aspects of the therapeutic relationship (1957). In addition to these types of three characteristics, this author has added two final characteristic that will appear to be effective in a helping relationship.
1 . Therapist’ t genuineness within the helping relationship. Rogers discussed the vital importance of the clinician to “ freely and deeply” be himself. The clinician needs to be a “ real” person. Not an all knowing, all effective, rigid, and controlling figure. A true human being with real thoughts, actual feelings, and real problems (1957). All facades should be left out from the therapeutic environment. The clinician must be aware and have insight into him or himself. It is important to seek out help from co-workers and appropriate supervision to develop this awareness and insight. This specific characteristic fosters trust in the helping relationship. One of the easiest ways to develop conflict in the relationship is to have a “ better than” attitude when working with a particular client.
2 . Unconditional positive regard. This aspect of the connection involves experiencing a warm acceptance of each aspect of the clients encounter as being a part of the client. There are no conditions put on accepting the client as who they are. The clinician needs to care for the client as who they are as a special individual. One thing often seen in remedies are the treatment of the diagnosis or a particular problem. Clinicians need to treat the person not a diagnostic label. It is essential to accept the client for who they are and where they are at in their life. Remember diagnoses are not real entities, nevertheless individual human beings are.
3. Empathy. This is a basic restorative aspect that has been taught to doctors over and over again, however it is vital to be able to exercise and understand this concept. An accurate empathetic understanding of the client’ s awareness of his own experience is crucial to the helping relationship. It is essential to have the ability to your clients “ private world” and understand their thoughts and feelings without judging these (Rogers, 1957).
4. Shared agreement on objectives in therapy. Galileo once stated, “ You cannot teach a man something, you can just help him to get it within himself. ” In therapy clinicians must develop objectives that the client would like to work on rather than dictate or impose goals to the client. When clinicians have their personal agenda and do not cooperate with the client, this can cause resistance and a splitting up in the helping relationship (Roes, 2002). The fact is that a client that is pushed or mandated to work on something he has no interest in changing, might be compliant for the present time; nevertheless these changes will not be internalized. Just think of yourself in your personal lifestyle. If you are forced or coerced to operate on something you have no desire for, how much passion or energy are you going to put into it and how much respect will you have for the person doing it coercing. You may complete the objective; however you will not remember or internalize much involved in the process.
5. Integrate humor in the relationship. In this authors own clinical encounter throughout the years, one thing that has assisted to establish a strong therapeutic relationship along with clients is the integration of hilarity in the therapy process. It appears to show clients to laugh at themselves without taking life and themselves too serious. It also allows these to see the therapist as a down to earth human being with a sense of humor. Humor is an excellent coping skill and is extremely healthy to the mind, body, and soul. Try laughing with your clients. It provides a profound effect on the relationship along with in your own personal life.
Before delving into the empirical materials concerning this topic, it is important to existing some questions that Rogers suggests (1961) asking yourself as a clinician regarding the development of a helping relationship. These types of questions should be explored often and reflected upon as a normal schedule in your clinical practice. They will help the clinician grow and always work at developing the expertise necessary to create a strong therapeutic relationship also the successful practice of treatment.
1 . Can I take some way which will be perceived by the client as trustworthy, dependable, or consistent in some deep sense?
2 . Can I be real? This involves being aware of thoughts and feelings and being honest with yourself concerning these feelings and thoughts. Can I be who I am? Physicians must accept themselves before they can be real and accepted by clients.
3. Can I let myself experience positive attitudes toward my client – for example warmth, caring, respect) without fearing these types of? Often times clinicians distance themselves and write it off as a “ professional” attitude; however this generates an impersonal relationship. Can I remember that I am treating a human being, just like myself?
4. Can I provide the client the freedom to be who they actually are?
5. Can I be separate from the client and not create a dependent relationship?
6. Can I step into the client’ s private world so seriously that I lose all desire to evaluate or judge it?
7. Can I receive this client as he is? Can I accept him or her completely and communicate this acceptance?
8. Can I end up with a non-judgmental attitude when dealing with this client?
9. Can I meet this individual as a person who is becoming, or will I be bound simply by his past or my previous?
Empirical Literature
There are obviously too many empirical studies in this area to discuss in this or any brief article, however this writer would like to present a summary of the research throughout the years and what has been determined.
Horvath and Symonds (1991) conducted a Meta evaluation of 24 studies which taken care of high design standards, experienced counselors, and clinically valid settings. They found an effect size of. twenty six and concluded that the working alliance was a relatively robust variable linking therapy process to outcomes. The connection and outcomes did not appear to be the function of type of therapy used or length of treatment.
Another review conducted by Lambert and Barley (2001), from Brigham Young University summarized over one hundred studies concerning the therapeutic relationship and psychotherapy outcome. They focused on four areas that influenced client end result; these were extra therapeutic factors, expectancy effects, specific therapy techniques, and common factors/therapeutic relationship factors. Inside these 100 studies they averaged the size of contribution that each predictor made to outcome. They found that 40% of the variance was due to outdoors factors, 15% to expectancy effects, 15% to specific therapy techniques, and 30% of variance was predicted by the therapeutic relationship/common factors. Lambert and Barley (2001) figured, “ Improvement in psychotherapy might best be accomplished by learning to improve ones ability to relate to clients and tailoring that relationship to individual clients. ”
One more important addition to these research is a review of over 2000 process-outcomes studies conducted by Orlinsky, Severe, and Parks (1994), which discovered several therapist variables and actions that consistently demonstrated to have a beneficial impact on treatment outcome. These factors included therapist credibility, skill, empathic understanding, affirmation of the client, as well as the ability to engage the client and concentrate on the client’ s issues and emotions.
Finally, this author would like to mention an interesting declaration made by Schore (1996). Schore indicates “ that experiences in the restorative relationship are encoded as acted memory, often effecting change with the synaptic connections of that memory program with regard to bonding and attachment. Attention to this relationship with some clients can help transform negative implicit memories of relationships by creating a new coding of a positive experience of attachment. ” This suggestion is a topic for a whole other article, however what this suggests is that the therapeutic relationship may create or recreate the capability for clients to bond or develop attachments in future associations. To this author, this is profound and thought provoking. Much more discussion and research is needed in this area, however quickly mentioning it sheds some lighting on another important reason that the restorative relationship is vital to therapy.
Throughout this article the restorative relationship has been discussed in detail, queries to explore as a clinician have been articulated, and empirical support for the importance of the therapeutic relationship have been described. You may question the validity of this article or research, however please take an honest look at this area of the therapy procedure and begin to practice and develop strong therapeutic relationships. You will see the difference in the therapy process as well as client end result. This author experiences the present of the therapeutic relationship each and every day We work with clients. In fact , a client lately told me that I was “ the first therapist he has seen since 9-11 that he trusted and acted like a real person. He continued on to say, “ that’ s why I have the hope that I could possibly get better and actually trust another person. ” That’ s quite a reward of the therapeutic relationship and procedure. What a gift!
Think about, how you would like to be treated in case you were a client? Always remember we are all part of the human race and each human being is unique and important, thus they should be treated this way in therapy. Our purpose as clinicians is to help other human beings enjoy this journey of life and if this field isn’ t the most crucial field on earth I don’ t know what is. We help figure out and create the future of human beings. To conclude, Constaquay, Goldfried, Wiser, Raue, and Hayes (1996) stated, ” It is essential that clinicians remember that decades of research consistently demonstrates that relationship factors correlate more highly along with client outcome than do specific treatment techniques. ”
References
Constaquay, T. G., Goldfried, M. R., Wiser, S., Raue, P. J., Hayes, A. M. (1996). Predicting the result of Cognitive therapy for major depression: A study of unique and typical factors. Journal of Consulting and Clinical Psychology, 65, 497-504.
Horvath, A. O. & Symonds, B., D. (1991). Relationship between a working alliance and end result in psychotherapy: A Meta Evaluation. Journal of Counseling Psychology, 37, 2, 139-149.
Lambert, M., J. & Barley, M., E. (2001). Research Summary to the therapeutic relationship and psychotherapy end result. Psychotherapy, 38, 4, 357-361.
Orlinski, D. E., Severe, K., & Parks, B. Nited kingdom. (1994). Process and outcome in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds. ), Handbook of psychotherapy(pp. 257-310). Ny: Wiley.
Roes, And. A. (2002). Solutions for the treatment resistant addicted client, Haworth Press.
Rogers, C. R. (1957). The Necessary and Sufficient Circumstances of Therapeutic Personality Change. Journal of Consulting Psychology, 21, 95-103.
Rogers, C. R. (1961). On Becoming a Person, Houghton Mifflin company, New York.
Schore, A. (1996). The experience dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, 59-87.