Magoosh GRE

Learning outcomes for the 1st year of the diploma in Humanistic Counselling

| January 16, 2017

1. To demonstrate knowledge of counselling skills and understand their relationship to communicating ‘the necessary and sufficient conditions’ for promoting change in a therapeutic relationship
‘The necessary and sufficient conditions’ for promoting change in therapy in the context of Humanistic Counselling refer to the aspects of the therapeutic situation, background, and the people involved which influence the likelihood that positive change will occur in the process of the ongoing therapy (Dryden, 1989; Hanna and Ritchie, 1995). The goal of counselling is of course to identify issues, examine the prognosis of various options to respond to the issue, and ultimately to create a supportive environment in which the person is free to explore the issues and options for resolution in a productive way, culminating in a change in mental state and outlook towards the issue that had been perceived as unpleasant at the start of the process (Rogers, 1952; Walker and Peiffer, 1957). If this broadly defined goal is achieved it is speculated by Walker and Peiffer (1957) that greater self-satisfaction and social benefits will occur.

If this is to happen, then perhaps the most important part of the process is a positive and encouraging therapeutic relationship with the counsellor, this is like the background or context in which the change will hopefully take place (Gelso and Carter, 1985; Rowan, 1998) and it is therefore pertinent in all aspects of the therapeutic process which is to take place. This is demonstrated well by the fact that the same message conveyed by different external agents will be perceived differently by the same person; it is the contextual information in which this information is presented which colours how it is ultimately interpreted, and evidence for this phenomenon is extensive in psychological literature in many different situations (Mearns and Thorne, 1988; Neimeyer, 1998).

There are several factors involved in the process of building ‘the necessary and sufficient conditions’ and they can vary subtly depending on which article is consulted. Gelso and Carter (1985) define three components of all therapeutic relationships which are present regardless of the counselling perspective that is prescribed; these components are a working alliance, a transference configuration, and a real relationship. A transference configuration must also include therapist countertransference (Lapworth and Sills, 2011). This refers to the juxtaposition of therapist and client, specifically how the client views themselves in relation to the therapist and their perception of the role of the therapist in their lives (Lapworth and Sills, 2011). The notion that this is an important perception is backed up by Strupp (1973) who reviews the necessary ingredients for a successful and productive therapeutic relationship. They include the formation of a helping relationship patterned after the model of the parent-child relationship. When given the proper circumstances to form a secure bond with parents this type of relationship provides the archetypal relationship style for a safe, non-judgmental, open environment, which makes for a perfect situation to assimilate material that has not been properly symbolised (Rogers, 1946; Rogers, 1952) and is therefore change-promoting. Indeed Strupp (1973) also lists the creation of a power base in which the therapist influences the client through common psychological techniques and a client who has the capacity to benefit from such an experience as necessary conditions for this approach to be beneficial.

This sets the scene well for therapy to take place but actually does little to define what the therapeutic relationship actually feels like in practice. It is frequently argued that empathy is a key attribute of a productive therapeutic relationship (Feller and Cottone, 2003; Lapworth and Sills, 2011). This information is arguably more useful because it describes in practice what specifically is needed to create an appropriate atmosphere. According to the humanistic approach, it is also essential that the relationship is transparently and completely absent of threats, real or perceived and that the therapist maintains a non-judgmental and encouraging demeanour. In order to do this it is essential that the therapist views the client as a whole, greater than the sum of its parts, encourages self-awareness and self-realisation and appreciates the individual as a unique entity, working with them in terms of their own personal potential to explore and expand their understanding of themselves (Green, 2010). This is in line with the 19 propositions of Rogers (2008).

The counselling skills which are important in establishing the sufficient and necessary conditions in the therapeutic relationship include empathy, warmth and genuineness (Patterson, 1984; Green, 2010) which helps create the environment described above. There are a number of other techniques such as gestalt therapy (Perls, Hefferline and, Goodman, 1951; Green, 2010), transactional analysis and methods derived from transpersonal psychology. These techniques involve viewing the client as a whole rather than focusing on smaller attributes or episodes or analysing how individuals communicate and how this is affected by the way they see themselves in relation to others (Berne, 1961). The culmination of these techniques is client-centred counselling, which in broad terms assumes that the client is the best authority on interpreting and describing their experiences and feelings, not the counsellor. Therefore, counsellors should not make recommendations, but should rather focus on creating an encouraging and safe environment for the client to explore their own issues, draw conclusions and make choices for themselves (Rogers 1952; Rogers, 1959).
2. To demonstrate awareness of the philosophy and theory of a humanistic approach, and how this underpins practice within the counselling relationship
The philosophy of the humanistic approach in broad terms views the individual as unique not only in composition of experiences and characteristics but also fundamentally in their entirety which is a whole greater than the sum of its parts; as a unique entity with a unique conception of their own self and their own ideas about their relationship with others in their own worldview (Rogers, 1952; Rogers, 1959). The theory behind the practice then is based on a person-centred approach and has incorporated gestalt principles. These notions are derived in turn from the philosophy of Carl Rogers and his 19 propositions (Rogers, 2008) which in short state that the individual exists in a perceived environment of which they are the centre, that they react as an organised whole to stimuli in their perceptual field, that a portion of this perceptual field gradually becomes differentiated as the self which takes on different forms depending on interactions with other selves and that behaviour is goal-directed towards striving to actualise, maintain and enhance the experiencing organism.

From these propositions it can be concluded that the best vantage point for understanding, maintaining and indeed changing the perceptions and behaviours of an individual is from the internal frame of reference for the individual. In other words, this means from the perspective of the individual themselves which is why in humanistic counselling, recommendations, interpretations, and diagnoses are not typically made by the therapist since it is not seen useful to speculate on such things when only the individual can usefully conceptualise their feelings and suffering.

The 19 propositions also cover emotions, values and experiences. Emotion essentially accompanies goal-directed behaviour, and often facilitates its performance; the type of emotion is defined by the significance of the behaviour for maintaining or enhancing the organism. Values are developed by experiences, and in some cases are borrowed and introjected from other individuals, in this case they are perceived in distorted fashion but nonetheless directly. Finally, the propositions discuss the nature of psychological adjustment, maladjustment and distress, and address the possible circumstances in which an individual could become more psychologically well-adjusted and subsequently reduce distress (Rogers, 1952).

Importantly, when experiences occur they are either symbolised then integrated into a framework which is congruent with the self, ignored because there is no perceived relation to the self-framework, or given distorted symbolisation or denied it entirely because they are inconsistent with beliefs about the self. When the latter happens it creates psychological tension, which can result in psychological maladjustment. This can occur when behaviour is necessitated by experiences and needs which have not yet been symbolised, or when an experience occurs which cannot be integrated congruently with the current conception of the self. Any experience which is perceived as inconsistent with the idea of self is seen as a threat, and the more of these there are, the more rigidly the self must be organised in order to maintain itself. Psychological adjustment is just the opposite of this; it is a state in which all experiences are symbolised in a manner which is consistent with the notion of the self with all of its associated attributes (Rogers, 1952).

Under certain conditions, such as when absolutely no threats are perceived, unsymbolised or unintegrated experiences may be re-examined, and the concept of the self can be revised by the client undertaking therapy to make adjustments for the problematic experience (Rogers, 1952). These are the necessary conditions for humanistic therapy; above all the environment must be perceived by the client as completely threat free and safe. There is no universal experience or concept which will always be defined as a threat in humanistic counselling because it is centred on the individual, and as such a threat for one person is not necessarily a threat to another persons’ self-structure (Rowan, 1998). This is related to Roger’s (1959) practice of ‘unconditional positive regard’, which is simply accepting a person without negative judgment or appraisal of their basic worth. This practice sets the scene well for a positive, threat-free and safe environment which encourages open expression.

The humanistic approach holds that it is not necessarily life events that cause problems, or in other words there is no specific life event that will always lead to an individual becoming maladjusted if they experience it (Rowan, 1998). This philosophy leads to therapists treating clients as individuals, and indeed not relying on archetypes, diagnostic criteria or treating every client’s maladjustments as stemming from the same or similar sources. This does however lead logically to a certain notion that there are fairly few techniques or lessons for the therapist that can be transferred between patients, which is not a weakness that other philosophies share (Green, 2010).

The advantages of the humanistic approach arise because the requirements for different clients as well as their apparent expectations for the outcomes of counselling sessions can be quite different. However, there are certain common factors in the humanistic approach. Most importantly is the establishment of a safe, confidential and judgement free environment in which the client is encouraged to be as open as possible (Rogers, 1952).
3. To develop an awareness of ‘self’ and ‘self in relationship’
The ‘self’ in humanistic counselling refers to the structure or organisation which represents in an abstract way to an individual who they are, the characteristics that describe them, their hopes and dreams, the goal-directed behaviour which they are likely to engage in in the future, the consistent and integrated experiences which shape their past and importantly how they exist in relation to other people and objects in their environment (Rogers, 1959). According to Roger’s (1959), 19 propositions the self arises by gradually becoming differentiated from the perceptual field or individual perceived reality of the individual. In the early years of infancy and childhood the perceptual field is undifferentiated, comprises all elements in the environment and is perceived as all of reality to the young individual. As time goes on, the concept of self gradually forms from a portion of the perceptual field which is seen as separate from the rest of the phenomena in the field. This is the stage set for the formation of relationships with external objects and people; now that the self is a distinct concept in the environment it is possible to have this structure appear in relation to something else, and the relationships that form with different objects are likely to be very diverse and of varying natures.
This is the conception of the self in humanistic theory, and it figures prominently in the theories of Carl Rogers on the genesis of psychological maladjustment and distress. Rogers defined development in terms of principles rather than stages, and cited the formation of the self from the undifferentiated perceptual field as the main issue in development. Roger’s (1959, p.927) defines the self-concept as:
“…the organised consistent conceptual gestalt composed of perceptions of the characteristics of ‘I’ or ‘me’ and the perceptions of the relationships of the ‘I’ or ‘me’ to others and to various aspects of life, together with the value attached to these perceptions. It is a gestalt which is available to awareness though not necessarily in awareness. It is a fluid and changing gestalt, a process, but at any given moment it is a specific entity.”
In the development of the self it is unconditional or conditional positive regard which is the key in determining psychological adjustment in later life according to Rogers (2008). If while a person is being raised they only receive positive regard if they meet ‘conditions of worth’ then they will only feel worthy if they meet these criteria and this will affect the perceived relationships they build in the future by shaping the perceived expectations and perceptions of others. A person raised with unconditional positive regard on the other hand has the opportunity to self-actualise, which in turn enables the person to continually aim to fulfil their whole potential and become a fully functioning person (Rogers, 1952; Rogers, 1961).
The ‘self in relation’ in the context of humanistic counselling refers to the conception of the client of themselves juxtaposed against other people and objects in their environment. This is the foundation for much of the thinking in humanistic counselling on the origin and treatment of psychological maladjustment and distress. It leads first to the encouragement of self-awareness and self-concept clarity; the characteristics that are ascribed to the self (Dryden, 1989; Hansen, 2009). Subsequently, the self can be considered in relation to other people. This has led to the development of relationship-centred counselling (Kelly, 1997; Green, 2010) which is the logical extension from the client-centred model of counselling. This form of counselling values the individual qualities of the client and the therapist and focuses on the bond they from through the course of therapy. This approach therefore views technical expertise as the instrumental extension of relationship, and there is evidence to support the effectiveness of such focused therapies (Kelly, 1997).
Psychological maladjustment occurs in this model when the paradigm a person holds for relationships is based on ‘conditional positive regard’ or if a problem arises with the conceptualisation of the self in relation to other people resulting in perceived experiences which cannot be symbolised and integrated with the self (Baumeister, 1987; Rogers, 2008). Individuals for whom this has occurred Rogers calls ‘incongruent’ and states that they suffer from a loss of authenticity in their lives, therefore living lives for other people rather than for themselves.
Rogers (2008) suggests the formation of the self-concept and the subsequent relationships formed with external objects can result in a fully functioning person. The ‘self in relation’ of a fully functioning person for Rogers has a growing openness to experience, has the ability to live in the moment, has an increasingly optimistic trust of other people and the world, is able to make free choices without constraints coming from the perceived wishes of others, is free to be creative, and can be relied on to be constructive since they are fully aware of all their needs and can therefore balance them (Rogers; 1952).
4. To demonstrate an understanding of the importance of the therapy relationship, how it develops over time and how it can be used as a vehicle for change and growth
In humanistic counselling, the relationship between therapist and client is perhaps the most important part of the process. This is because the humanistic model of man views each person as a unique individual who cannot be interpreted with the use of prescribed rules or archetypes that suit any other person (Rowan, 1998). Because counselling is focused on the client as an individual, it follows that the client is the ultimate authority on their own feelings, experiences and suffering (Green, 2010). Therefore, the role of the therapist in this style of counselling is not to interpret what the client says, to ascribe labels to them or to push the direction of the conversation in sessions in any particular direction (that is to say, there is not a set of universal factors which should be explored in every client; since different things are important to different people the conversation must proceed in different directions for different people). This allows for the client to determine the direction as the relationship unfolds over time.
For the client to be able to discuss relevant experiences or feelings which are causing them distress in the counselling sessions then the counselling environment is the most important thing. According to client-centred and humanistic theory the client must feel they are in a safe and completely threat-free environment to bring to light the relevant issues, reinterpret them in relation to the self, properly symbolise them and finally integrate them into the self-framework and own them. This will result in the client having greater self-awareness, and a greater capacity to perceive all of their desires and experiences as being part of a whole entity; they will then be more able to balance their needs internally and lead a more fulfilled life in which they do not have to always be on the defensive (Rogers, 1952; Rogers, 2008). This sets the scene for the development of the relationship, it of course will take time for the client to be comfortable enough with the therapist to explore the most pertinent issues.
In order for a client to feel that the therapy environment is a safe, confidential and non-judgmental place quite apart from any other place in their lives it is vital for the relationship with the therapist to convey this. The relationship that is formed is a tool for communicating that this is the place to explore and expand the self, and address feelings and experiences which are normally buried. Kelly (1997) and Green (2010) provides support for the effectiveness of relationship-centred therapy which as the name suggests focuses on the aspects of a good working relationship between therapist and client which is conducive to the client openly discussing with the therapist the things which contribute to their maladjustment, and in turn the exploration of the self in relation to other people and unsymbolised experiences, behaviours and feelings. Gradually as the relationship progresses then, the client will be more aware of facets of themselves which were previously unavailable to their conscious mind.
Psychologically vulnerable people are viewed by Rogers as being constantly guarded and in some way on the defensive, therefore not opening themselves up to a wealth of experiences (Rogers, 1952; Rogers, 2008). This defensiveness reduces the magnitude of the threat in consciousness but not the threat itself. Such ‘incongruent’ individuals perceive conditions imposed upon them by others, and therefore in the pursuit of positive regard they live lives which include actions which arise from perceived demands of others and therefore include falseness, a lack of authenticity. They therefore live in a manner which is not true to the individual on the inside, even if this happens only in an unconscious way (Rogers, 1952; Rogers, 2008). For such individuals, it is very important that the therapeutic relationship does not conform too closely to this paradigm of relationships the person has formed because this will surely include demands and expectations from the therapist being perceived by the client. This is why the establishment of a specific kind of relationship which is non-judgmental is so important, and why the therapeutic relationship and environment must be viewed by the client as different to the other relationships they have encountered in their lives because this one is completely safe, enabling them to fully explore their concept of self (Rogers, 1952).
Through a relationship with another person, importantly one who has no agenda towards the client, a rediscovery of the self can occur and support for change can be acquired. This is the basis of the importance of the therapeutic relationship. In humanistic counselling, the mechanisms for how the relationship works to encourage therapeutic change is different to other approaches to counselling. The three broad approaches are typically labelled as psychoanalytic, humanistic and learning. The significance attributed to the relationship style varies between these three approaches.
The relationship is the medium for the application of counselling techniques which ultimately promote personal growth, self-awareness and change (Dryden, 1989; Ryle, 1991). There is little support for the notion that a certain kind of therapy will always be beneficial to every client, suggesting an increased focus on client needs may be the best route for therapeutic progress (Rogers, 1952; Hatchett, 2008). Clarkson (1995) notes the five techniques which can be beneficial if a good reciprocal relationship is established: the working alliance, the transference/countertransference relationship; the developmentally-needed or reparative relationship and the transpersonal relationship; this demonstrates the vital importance of the relationship and the prognosis of how it progresses; the client develops feelings and thoughts about the therapist based on feelings from past relationships and then gradually learns to symbolise and integrate them.
5. To demonstrate an appreciation both of the importance of context in counselling and of the concept of frames of reference
Context in counselling and in fact in human relationships in general is so important because it profoundly affects how present interactions and experiences are interpreted, which in turn affects present emotional states and behaviour. Context could refer to the background and history of a client, could be built up by past interactions with the therapist (or indeed other therapists across therapeutic approaches) or could be invoked to refer to traits or characteristics of a client or therapist. Context could be specifically conceptualised in many ways but broadly can be considered as the setting in which interactions between the client and the therapist take place (Green, 2010). This context can either be conducive to positive therapeutic outcomes or not, because the same message coming from different people can have an entirely different meaning, the context is very important in defining the relationship between therapist and client, and the subsequent atmosphere of the therapy sessions. If the atmosphere is to be supportive, safe and threat-free then ideally the context that exists between therapist and client should be positive and non-judgmental (Bager-Charleson and van Rijn, 2010).
The context between two people could be said to be the feelings and memories that each person holds of the other which they use to build a mental representation of that person. This mental representation is invoked whenever trying to predict what the other person is likely to do or say, to construct a framework defining what that person is like; all the pertinent information in defining the person is organised in this mental framework (Rowan, 1998; Chen, 2001). This framework is necessarily going to be slightly (or very) inaccurate because of the impossibility of knowing everything there is to know about the other person, but it is nonetheless referred to in order to interpret the meaning of what the person is saying or doing. In this way, the same behaviours from different people can be cast in entirely different lights. The meaning which people ascribe to certain constructs or actions is seen as important by both humanistic psychology and vocational psychology. For therapeutic reasons, meaning can be used both to establish the necessary and sufficient conditions and to help in re-examining historic events in the light of greater self-awareness to aid reintegration of unsymbolised events (Dryden, 1989).
This is important for therapy because with the novelty of the contact with a new patient, an opportunity is born to establish a warm, genuine and empathetic relationship, which is used to create a safe and non-judgmental environment for the client to explore their self-construct and grow as a person (Dryden, 1989).
Frames of reference are also an important concept in humanistic counselling; it is a similar but perhaps more specific concept than the context pertaining to the specific client. The notion developed from phenomenology, which is the study of the inner worlds of people in Psychology (Husserl, 2012). It therefore does not deal merely with observations of external behaviour which is the province of the behaviourist approach, but does make some inferences about what it must be like in the inner worlds of different people. There is some overlap with the humanist approach in that the approach is usually to get the individual to elaborate as much as possible on their individual perspective. Phenomenology does acknowledge the intrinsic differences that exist between different peoples’ internal representations of the world which is an assumption shared with the humanistic approach. The inner world is composed of peoples’ thoughts, feelings and behaviours, and the world and experiences that come from it are interpreted through the frame of reference defined as a personal inner landscape. The frame of reference is difficult to separate from the self-concept, is reacted to intuitively, and it is often assumed that other people have similar frames of reference to our own. Additionally, much of a person’s inner landscape can come from another person, with the former person being only unconsciously aware of it (Sutton and Stewart, 2008; Lapworth and Sills, 2011).
The frame of reference for an individual is composed of meanings, cultural influences, beliefs and values, memories, behaviours, experiences, sensations, perceptions, feelings thoughts and emotions (Sutton and Stewart, 2008). In the humanistic approach, the person is seen as a dynamic, ‘fluid’ entity who has many different urges, preferences and characteristics which change with time and are in a state of flux but at any one particular moment it is perceived as a unified goal-directed whole(Rogers, 1952; Rogers, 2008). This is analogous to the concept of the frame of reference since it is seen as something dynamic and determined by many factors. The frame of reference also has a profound effect on how experiences are interpreted (Mearns and Thorne, 1988).
Since everybody’s frame of reference is different it would be foolish to attempt to interpret such a thing externally, especially because the therapist themselves are subject to the same influence from their personal frame of reference. Thus, the practice in humanistic and gestalt therapy is commonly to ‘bracket’ out their own thoughts and feelings as they occur and attempt to recognise their own assumptions and preconceptions (Lapworth and Sills, 2010; Joyce and Sills, 2014). This is the best possible technique since the complete separation from one’s own frame of reference is a near impossible task. Without understanding a client’s personal frame of reference it is extremely difficult to fully understand what they mean when they communicate their thoughts and feelings due to the personal meanings their communications will have for them as they are interpreted through their own frame of reference, like a code with a cipher. Equalisation is another important skill in practice (Green, 1998; Green, 2010). This is the practice of perceiving everything that is communicated by the client as being equally important, when normally the therapist’s frame of reference would make certain things seem more prominent. This is an important technique because this assumption may not hold when the same information is interpreted with the client’s frame of reference.
6. To demonstrate a broad knowledge of assessment issues and the importance of working agreements
Assessment issues in humanistic counselling should be considered whenever a new client is taken on, and also during sessions for current clients. They are important facts and debates which affect how the counselling experience will be perceived and what the impact of it will be for the individual. Without appropriate consideration of these issues, counselling could turn into a reckless endeavour, insensitive to the potential effects it could have on clients. Because of this, certain standards are set, and it is necessary for therapists to be aware of the debates and the way people vary in order to ensure that harmful effects do not befall the client (Dryden, 1989). The issues in counselling can be broadly appreciated from a humanistic perspective since it includes as central aspects any facet of life which may be viewed as important by the client, and therefore takes account of the client’s position on a wide variety of dimensions (Rowan, 1998). The assessment issues refer to potential problems with how the therapist perceived and assesses the client; the issues which may bias this judgment and lead to erroneous counselling.
In general terms there are ethical issues which refer to anything relevant to the protection of clients. These are of course important because at the onset and during the process of counselling because above all it is vital not to cause more psychological damage. There are also cross-cultural issues in counselling which draw attention to the cultural context in which client and therapist exist (D’Ardenne and Mahtani, 1999). These issues undoubtedly affect how clients should be assessed in counselling, because the cultural context has a large effect on the meaning ascribed to different behaviours. The same behaviour may also be interpreted very differently across cultural contexts. Specific cross-cultural issues regard differential levels of equivalence, non-verbal communication, expectations and beliefs, client-counsellor similarities, test bias and response styles (Lonner, 1985). Equivalence in this context refers to the differences in emphasis which people in different cultural contexts place on different objects in their frames of reference; which objects are defined as contextual or tangential and which ones are the ‘figures’ in the foreground taking a place of prominence in their experiences (Rogers, 1952). The significance and meaning of non-verbal gestures is likely to be different across cultures, and the cultural context may also affect the expectations the client holds about the purpose and potential outcomes of therapy.
Client-counsellor similarities refer to potential problems with the interpretation of client communications in light of cultural (or indeed personal) similarities or differences between client and therapist (Rowan, 1998). Finally, test bias and response styles; if tests or psychometric assessments are used as part of the assessment process then the results may only be valid in the cultural context in which they were developed because of differing response styles, cultural norms and knowledge bases between cultures (Dryden, 1989).
There are also issues with the medium that the counselling relationship is communicated on. For example, internet counselling is increasingly popular in recent years, but research suggests that it may not be the best tool for developing the counselling relationship, particularly due to the loss of verbal communication (Robson and Robson, 2000). It appears that there is something lost in communication in the case of internet counselling, perhaps it simply feels less personal to those who use it, especially since they cannot express themselves in their own unique voice. Obviously tone is also lost when communicating over the internet making it even more problematic.
Professional issues in counselling which refer generally to the issues affecting the client-therapist relationship arising from how the therapist views the relationship and their career (Fretz and Simon, 1992). Entanglements of the client’s and the therapist’s frames of reference can result in non-therapeutic outcomes. It is therefore important that the therapist maintains professional standards and views the relationship in a professional capacity while balancing the need to appear warm and genuine to create a therapeutic environment.
There may also be spiritual issues which arise during counselling. It must be established what role spirituality and religion plays in a client’s life, and whether they feel it is appropriate and pertinent for discussion (Rose, Westefeld and Ansley, 2008). The presence of spirituality in a person’s life may be a key variable in determining their state of mind and frame of reference, if this is the case then ignoring it could be disastrous.
Working agreements in the counselling relationship are important for therapeutic progress and change because they allow the client the space and tools to explore their concept of self fully and openly. They help to define the context in which the interactions between therapist and client take place. Working agreements serve to reconcile the issues between therapist and client which become apparent in the course of counselling at least temporarily for the purpose of the counselling sessions (Clarkson and MacKewn, 1993). Some of the possible issues have been outlines above. These agreements therefore allow for the gradual building of the therapeutic relationship, and for the establishment of therapeutic dialogue.
7. To evidence an awareness of the complexities and impact of issues of power on the counselling relationship
The notion of power is related to the juxtaposition of the client in relation to the therapist. It pertains to the regard in which the client holds the therapist and the position in the life of the client that is ascribed to the therapist. The degree of power to which the client assigns the therapist in their personal frame of reference plays a significant role in determining how their interactions are interpreted and what meaning is ultimately taken away from counselling (Green, 2010). In humanistic counselling, the relationship is vitally important in establishing an environment conducive to positive change. The required relationship for many techniques in humanistic counselling requires that the relationship be modelled after the parental relationship (Gelso and Carter, 1985).
The balance of power in the client-therapist relationship is important in creating a constructive relationship. It comes from the concepts of the ‘self’ and the ‘self in relation’, and is largely based on the client’s conception of the other and their power in relation to the other (Bager-Charleson and van Rijn, 2011). Naturally, the therapeutic relationship in the present will be affected by past models of relationships. The parental relationship formed in early childhood has been documented to be vitally important in determining the ability to form attachments and relationships in the future (Dryden, 1989) and a securely attached relationship with a parent is predictive of an ability to form positive and trusting relationships with others in adult life (Cook, 2000). A securely attached relationship with a parent then is an effective relationship to foster a therapeutic dialogue. This is why in humanistic and psychodynamic counselling the client-therapist relationship is ideally modelled on the parental relationship (at least a secure version of it). This sets the tone for the power balance in the relationship, in which the client must feel that they have a secure base in the relationship; they have unconditional positive regard for the therapist.
Clarkson (1995) identifies aspects of the client-therapist relationship which are important to consider when setting the tone for the power balance; the working alliance, the transference/countertransference relationship, the developmentally needed or reparative relationship, the real relationship and the transpersonal relationship. These are important because once they have been properly established they can sometimes be used to enable therapeutic work to proceed even when difficult transference and countertransference feelings occur through the recognition of such feelings, and the invocation of the working alliance and the setting of common goals to continue the therapeutic process. The transference relationship is defined as the repetition of past conflicts which normally (but not always) began in early childhood in which feelings and thoughts which arose during those conflicts are displaces into. The countertransference relationship is the feelings the therapist holds about the client, which is typically understood now as a valuable therapeutic tool (Clarkson, 1995) because it helps the therapist to establish the perceptions of the power balance in the client’s frame of reference. The developmentally needed relationship in the context of adult life refers to the therapeutic relationship which takes place to redress the perceived power balance between the self and the other, and reintegrate experiences in order to bring the power balance closer to equilibrium.
Transactional analysis is the practical outcome of the study of relationship styles and the perceived power balance. It is the analysis of how a person interacts and relates to others (Clarkson, 1992). This method can reveal some insightful inferences about an individual client because it can be indicative of the power ascribed to the self in relation to others in the individual’s frame of reference (Clarkson, 1992). This is done through the establishment of patterns in the client’s relationship history. This can be a useful tool to get the client thinking about pertinent issues in their histories which could be related to the root causes of psychogenic distress (Dryden, 1989).
8. To demonstrate awareness of the need for an ethical framework, their responsibilities to clients, colleagues and the wider community and an ability to discuss these in relation to personal beliefs and values
The ethical framework is perhaps the most important thing to consider regardless of the approach or perspective that is ascribed to by the therapist. Every approach must have ethical principles which must not be violated because this is the primary protection of the rights and safety of the clients. Unethical counselling could result in harmful effects on the client, or exacerbation of current psychological distress (Dryden, 1989). The ethical framework should be prominent in the consciousness of the therapist and the client, and should be communicated to the wider community since this contains all the people who potentially may become clients in the future (Dryden, 1989).
The ethical principles in counselling that should be observed and abided by are fidelity, autonomy, beneficence, non-maleficence, justice and self-respect which will each be addressed in turn. Fidelity is the honouring and respecting of the trust that is placed in therapists by clients (Bond, 1993). Adhering to this principle basically involves being trustworthy; practitioners must treat all information imparted to them by clients as confidential, and assign it the appropriate weight and respect that the trust from the client demands. Additionally, therapists should restrict the dissemination of any confidential information strictly to the purpose of furthering the purpose for which its initial disclosure was intended. This is crucial in maintaining the integrity of the client-therapist relationship since such a relationship must be based on trust and genuineness (Dryden, 1989). This is related to the personal value of unconditional positive regard for the client and of the belief that everyone should have a safe place in which to explore personal issues which are causing them distress.
Autonomy is the respect for the client’s freedom of choice and innate ability to become self-governing. This is related to the issue of the client’s voluntary participation in counselling, and their right to leave therapy at any point. By gaining informed consent from the client and informing them of this important principle, the client can feel more in control, and because their voluntary participation is explicit, this makes it easier to establish a working alliance and secure commitments from clients towards beneficial therapeutic outcomes (Bond, 1993). Part of respecting a client’s autonomy is respecting their ability to make intelligent informed decisions for themselves, which includes giving them all the necessary and relevant information to make these choices. A pertinent example of this would be giving accurate and true information in advertising and information given to potential clients in advance of counselling (Rowan, 1998).
It is also the responsibility of the therapists to gain explicit consent of the client for all commitments, tasks and objectives set in the interest of achieving therapeutic goals, protect privacy and confidentiality, and inform the client of any conflicts of interest that arise. In this way, clients are protected against manipulation and deception. This is a very important point for fostering a sense of self in clients and respecting their basic rights and dignity. It is not for the therapist to say that a certain outlook or set of behaviours is healthy and another is not; it is the client who is the ultimate authority on their own mental health (Rogers, 1952). It is therefore helpful to have an appreciation for the vast variety of human behaviour and culture to aid understanding of diverse clients. This is simply related to the value of respect for others which all therapists should hold; giving due respect to information imparted in confidence and therefore not disseminating it unless absolutely necessary.
Beneficence in this context refers to the commitment to promoting the client’s wellbeing. Based on professional assessment, the therapist must act in a way that is within their competence and experience and continually assess the outcomes of therapy through continual monitoring using whatever means are most appropriate to the individual client. Research and systematic reflection must inform practice and there should be a commitment from the therapist towards continual professional development. This is an especially important principle when working with clients whose ability to act autonomously is diminished (Corey, 1991). This is important if the therapists values include a desire to alleviate distress and suffering and enhance the ‘realness’ of interpersonal relationships.
Non-maleficence is broadly concerned with avoiding all forms of harm to the client. This includes financial, sexual, emotional, psychological or social exploitation (Bond, 1993). This must be done by avoiding malpractice and incompetence including that of others by challenging behaviour that does not meet professional standards (Bager-Charleson and van Rijn, 2010). The personal value which should be prominent in the minds of therapists is to ensure that no further harm is being caused to clients.
The fair and impartial treatment of all clients and adequate service provision is referred to as justice (Dryden, 1989). This requires a commitment to fairness and equality of opportunity and treatment regardless of background or characteristics of clients. It involves respecting human rights and dignity and remaining alert to any potential legal or ethical conflicts. It is important to appreciate differences between clients without discriminatory practice (Green, 2010). The personal belief in equality of all people is at the forefront of ensuring that all therapists treat clients with the fairness and dignity which they deserve.
Finally, self-respect means that the therapist should be continually applying all of the above principles to themselves. This includes seeking appropriate therapy and pursuing opportunities for personal development themselves. This is important because in order for the counselling relationship to be conducive to good therapeutic outcomes the therapist should not be compromised by personal issues which are preventing them from cultivating a helpful atmosphere for the client. If therapists hold the value of keeping personal issues separate enough from counselling relationships that it does not negatively interfere then this principle should hold.
Based on these ethical considerations it is necessary to make an assessment on whether any one particular client is ‘ready’ for therapy (Bager-Charleson and van Rijn, 2011). The task is to assess in a professional manner whether the client is in a psychological position to address and challenge the way they are leading their lives (Green, 2010). It may be that a client is currently in too fragile a state to warrant attempts to alter their perceptions of themselves or their world, as these may be a valuable defence against unresolved issues. It is important for therapists to respect these defences and monitor the responses to any treatments because if the client is not ready, tampering with their internal psychological world could be harmful.
9. To evidence their ability to support and maintain a supportive counselling relationship
The skills that are important for me in establishing and maintaining a supportive counselling relationship in the paradigm of humanistic counselling should aim to communicate a sense of empathy, warmth and genuineness, and create an environment which is completely threat free and encouraging of introspection and self-exploration (Corey, 1991). These skills I use include reflective and active listening (Bager-Charleson, 2010). They are important to communicate presence and interest to the client, and if they are used effectively can convey a sense of empathy because they allow the client to feel listened-to, which in turn enables them to feel as though I am at least attempting to appreciate their perspective and their frame of reference (Rogers, 1952). Active and reflective listening do not involve making inferences about the underlying thoughts and feelings which have prompted the information which is presented, they rather rely on actively engaging with the client and picking up on what they are saying to let them know they have been heard, and also reflecting internally on what has been said and the context it occurred in to get a sense of what their frame of reference might look like (Green, 2010). I can then use this information to construct a counselling relationship that feels right and safe for them as an individual.
Questioning, prompting, and observing are further useful skills in creating the appropriate relationship (Corey, 1991). These skills make it possible for interactions to take place, for the conversation to be directed in ways that encourage self-exploration and expansion, and encourage the client to elaborate to me on the figures and backgrounds that make up their frame of reference (Green, 2010). They can also give me the opportunity to paraphrase and summarise what the client says, which enhances my understanding as well as the client’s sense that I am listening and empathising with them.
I focus on creating a ‘real’ relationship which is transparent with clients, meaning it is highly congruent for clients; they accurately interpret the meaning behind all interactions and the atmosphere is positive and encouraging (Rogers, 1952). This fosters a feel of genuineness in the relationships I develop with clients which subsequently gives the clients a feel of authenticity and real meaning in our interactions. This lends credibility to revelations they may have about themselves during the course of counselling.
It is very important that I create a feeling that I give clients unconditional positive regard. This is important because some clients have experienced key relationships in their life as a player which is only regarded positively depending on them acting or existing on other’s terms. By giving all clients unconditional positive regard this allows for the feeling of warmth and acceptance which is important for every client to open up in constructive ways.
The evidence I can provide for my ability to perform these skills comes from my experience as a senior mental health worker and my placement in Lewisham Bereavement Centre. These experiences have honed my ability to appreciate a diverse range of perspectives, and take into account the cultural context in which the individual client exists. They have allowed me to appreciate the person as an individual with thoughts, feelings, hopes and dreams rather than just a collection of experiences and traits. Therefore, I have become more sensitive, approachable and warm as my experience has increased.
As a member of BACP, I adhere to all guidelines of conduct and make use of personal therapy and supervision. This has made me fully aware of the ethical and legal obligations to clients, making me take client welfare very seriously and think consistently about assessment issues such as whether the client is ready for therapy.
10. To demonstrate an ability to assess the impact of who they are on the counselling relationship
Most notably, my values have influenced the shape the relationships tend to take. At Lewisham Bereavement Centre my value of equality and appreciation of diverse culture, perspectives and characteristics influences how I react to different clients; it ensures that I am non-judgmental regardless of how client’s behaviour is interpreted by my own frame of reference. Separating oneself from one’s own frame of reference is extremely difficult if not impossible, so my tactics involve strictly accepting clients and giving them unconditional support regardless of the content of interactions. I am patient and interested in clients and try to bring an air of thoughtfulness to the relationship, which tends to make the client feel like examining what they are saying more closely as well.
The characteristics that define me as a counsellor are patience and approachability, and a strong commitment to acceptance and positive regard. This involves having appropriate respect for clients and a belief in their ability to get to the root of their problems on their own with minimal guidance. I believe this is what sets me apart from some other counsellors because I tend to give the clients more leeway to choose their own direction for the direction of conversations, as I believe wholeheartedly in all clients as intelligent entities who are the supreme authorities on their own wellbeing and the causes of their personal suffering. This value causes me to listen very carefully to what the clients say and make minimal to no use at all of personal speculations that I naturally draw about underlying causes using my own frame of reference. Naturally, this sometimes leads to clashes with some client’s expectations and the service that I actually deliver. Some clients expect more interpretations to be drawn by the therapist based on what they tell them; they believe the therapist can diagnose them or draw on expertise to present them with an underlying cause. In these cases without seeming confrontational I will use therapeutic techniques to empower the client into believing that they hold the power to identify in themselves any problematic issues and begin the healing process.
I believe I am not given to overly emotional reactions, and can therefore remain emotionally neutral even when presented with very emotional information from clients which may perturb other people. By remaining a neutral and safe contact for clients to relay this information to the relationship can take the form of a confiding relationship which is positive for the client no matter what happens. This can lead clients to suspect that I am hiding my true emotions, which can be a difficult thing to deal with, but I believe the benefits outweigh the costs of this method.
I create constructive boundaries and respect confidentiality and privacy in my work. This leads to my constantly remaining vigilant for client permission and participation in the therapeutic process; informed consent must be gained at all stages of the process, and so I do my best to keep the client in charge of the direction of the conversation during sessions. In this way, the risk of venturing onto subjects the client is not ready to talk about is minimised. I believe that no one issue is universally going to cause psychological distress and some issues which would be innocuous to other people may be extremely influential over others. An appreciation of this is vital in how I approach therapy, and guides me in letting the client mostly determine the direction of the conversation. As such I can appear flexible in counselling sessions which can come across as slightly disinterested, but the benefits of being flexible include the client having time to relate exactly what they want to say and quiet space to explore their own self-concept.
When interacting with client’s I adopt a non-threatening posture and I am fundamentally interested in subjective stories of human experience and emotion. This gives me a demeanour in sessions which is engaging, warm and accepting, and ready to put subjective judgments aside when clients present relevant content. The counsellor-client relationship is a dynamic and dialectical relationship which is shaped almost as much by the therapist’s characteristics as the client’s. A final characteristic which I believe influences the relationships I form with clients is the drive to help others, and an uncompromising stance on providing a positive response despite what the client may be expressing. This gives me a strong ability to work with clients who believe they have been put at risk by other professionals.
11. To evidence an appreciation of the use of self in the counselling relationship
The self in the counselling relationship is useful in that it can be used to relate to the client. It is an important point that differentiates humanistic counselling from other approaches that the humanistic approach puts so much emphasis on self-awareness (Rogers, 1952). A person who is not fully self-aware has feelings and/or experiences which are not fully symbolised and integrated into the current conscious self-concept. According to the humanistic perspective these concepts which are ‘outside’ the self-concept could be influencing thoughts, feelings and behaviours about the self and others in the environment even without conscious awareness (Rowan, 1998). Because of the intimately private subject matter that often arises during counselling, it is very important that the counsellor themselves be fully self-aware, in a way that they are trying to encourage the client to become. While it is important to develop a ‘real’ relationship with clients, I have found that it is necessary to remain a least somewhat emotionally detached from them. This is because when emotional attachments form between counsellor and client, they can bias the thinking of the therapist and begin a cycle based on judgments stemming from perceptions in the counsellors frame of reference, which is unacceptable. With full self-awareness the counsellor can use self-reflection to monitor feelings and thoughts, integrate them with the whole and reconcile them with their role as counsellor.
In the counselling relationship the self can be used as an instrument (Reinkraut, Motulsky and Ritchie, 2009) in monitoring the development of the relationship, in setting up a basis for acting well on the client’s behalf through the development of counselling skills, for modelling self-awareness to the client and for keeping track of the transference relationship and power balance. When working with clients I see opportunities to assess my own personal strengths, limitations, thoughts and feelings as they relate to other people. This allows for greater self-awareness and gives me the ability to draw on personal life experiences and cognitive strategies for reflection which can be used to relate to the client.
The self as an instrument also refers to the learning process of mastering techniques to discover information about the self which as a counsellor I have experienced. Throughout my work with clients, I have had opportunities to examine my own beliefs and values and the impact they have on my personal life and on others. This self-awareness is in a way the foundation of the client-counsellor relationship for me because without this it would be very difficult to relate due to the difficulty in describing what I am thinking and feelings. Personal growth can only truly be assessed through self-awareness and this goes for the client and for the therapist.
Being fully conscious of all facets of my own self-concept also allows me to remain professional under circumstances that would otherwise be quite challenging. For instance, when a client is divulging very personal and intimate information which may make them feel psychologically vulnerable during expression, being self-aware in these moments will enable me to acknowledge my own counter-transference feelings towards the client and interpret them in light of the professional persona which I must don when counselling clients.
The self then, is an important tool in establishing a positive and productive therapeutic relationship. If I am not in touch with my own thoughts and feelings and I do not psychologically ‘own’ all of my experiences then this could have serious consequences for the relationships I form with clients. It is likely that the relationships would suffer less positivity and there would be less transparency in the relationship, leading the client to wonder about the true meaning of our interactions and a loss of trust. This is an environment which is not conducive to the client growing in self-awareness or having positive therapeutic change.
12. Students to demonstrate an ability to analyse their strengths and weaknesses and assess themselves effectively in relation to others
I believe that my strengths as a counsellor include the ability to empower clients in the relationships that I form with them. I also make good use of supervision and counselling services myself. I see this as a strength of mine because not only does it give me an opportunity to observe new techniques or the application of known techniques but it also helps me to continually grow as a person and become more self-aware. This is necessarily an ongoing process because as new experiences occur and become integrated into my own self-concept it truly helps to have a safe and non-judgmental place to explore this. This is the kind of ethos which I bring into the counselling relationship with my clients; I do not provide this service because I believe it is unimportant, in fact I believe that everyone could benefit from counselling if it is conducted appropriately; it is not just something for people who have experienced traumatic events. In this way I believe that I effectively and continuously evaluate my own frame of reference, which makes it easier when forming relationships with clients to identify what aspects of my perception of relationships and of the client are due to my own biases in perception.
Separating entirely from one’s own frame of reference is not something I am able to do any more than anyone else; I believe it is simply a part of being human and therefore the best thing to do is become as aware of my own frame of reference as possible. I therefore have good awareness of my own personal conflicts, thoughts and feelings when interacting with clients and I am well practiced in keeping a healthy emotional distance from clients. This attitude gives me an accepting and patient demeanour towards others, and I do not push for more information on issues when others do not want to divulge further. With greater self-awareness I have an enhanced ability to assess how I appear in relation to others.
Remaining non-judgmental and impartial and separate enough from the pertinent issues in a client’s life is a further skill that I see as a strength, because in my experience this serves to empower the client and encourage them to explore the very pertinent issues which may be having a negative impact on their lives. My values are an important part of this, the principles which I hold to be important in helping people are something which I can rely on to not change and to guide me in the pursuit of honing more effective techniques in counselling. With the use of these values and principles I am also proficient in establishing boundaries and overcoming distortions of perception and personal feelings as they occur during counselling. This allows me to effectively treat all clients with equality and unconditional positive regard. Although I establish a real relationship with clients, I continually assess my relationship with clients and how I appear in relation to clients, this helps to establish the model of prior relationships which the counselling relationship is based on.
An open mind and commitment to continuously bettering my skills is another positive aspect of my practice because it enables me to absorb knowledge and ideas from a diverse range of sources and consider the merit of their application in my own practice in an unbiased way. This is another way in which I am continuously attempting to better my counselling skills and assess myself in relation to others.
It is also important for practitioners to acknowledge their own weaknesses so that at the very least they can increase their own self-awareness and make allowances in their practice of counselling to compensate for areas in which their practice is not as strong. It is also vital for weaknesses to come to light so that the practitioner can continue to try and improve in these areas. In the case of my own practice I believe I could further improve my use of paraphrasing and active listening. In the past, I noticed that my use of these techniques varied from other counsellors, and so in liaising with other professionals and through continuous supervision and commitment to understanding the effects of different uses of these techniques I have changed the way I tend to use paraphrasing or more specifically the frequency with which I use it; now only in cases where I believe the specific words or phrases a client has used are important to conveying the same message. This helps clients to understand that I have heard them exactly as they are attempting to express themselves and has made me appear more succinct to clients.
I also differed from other practitioners in my use of prompts in the therapeutic process. I tended to make more use of this technique to direct the conversation in a way I thought would be most beneficial to the patient by uncovering issues which were not symbolised and integrated with their self-concept. However, with continuous use of reflection I realised that these perceptions were at least somewhat coloured by my own frame of reference and therefore tried to give more leeway to the client to direct the conversation. I believe this method is more effective because the client has much more input in defining the course of the conversation and I appear to have a more open-minded role in the client’s perception. Therefore the conversation can turn to the issues which are subjectively important to the client.

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