CHAPTER 3: The Therapeutic Relationship Learning the Art of Helping: Building Blocks and Techniques Fifth Edition Mark E. Young Updated by: Tracy S. Hutchinson, University of Central Florida

Chapter Outline Importance of the Therapeutic Relationship and Change How to Create a Therapeutic Relationship Other Factors that Help or Strain the Relationship

Therapeutic Relationship Research shows relationship is more important than any technique (e.g. think about professionals, doctors). Achieving goals is more likely when a positive working relationship exists. Assists with preventing attrition Uncomfortable with helper Not liking helper Helper is incapable of helping Relationship needed to move through the helping stages

Therapeutic Relationship Drop out rates often due to Being uncomfortable with helper Not liking helper Deciding that the helper is incapable of helping Establishing a strong, cooperative relationship early on supports all other stages and instills hope

Six Common Therapeutic Factors Enhancing Efficacy And Self-Esteem Maintaining a Strong Helper/ Client Relationship Providing New Learning Experiences Activating Client Expectations, Hope, and Motivation Lowering and Raising Emotional Arousal Practicing New Behaviors

What helps establish the therapeutic relationship? Helper is nonjudgmental Helper’s self-disclosure Validation of feelings Normalization of feelings Helper’s commitment to help Helper’s use of humor Helper’s listening skills and nonverbal behavior Client’s choice

What Clients Say The helper taught me a technique such as making a list of goals. The helper showed good non-verbal's such as eye contact and leaning forward The helper showed good listening behaviors: remembering what was said and paraphrasing The helper self disclosed that he or she had had a similar experience. Encouraged me by making comments including pointing out strengths

What Clients Say Emphasized that it was my choice and that I knew myself best. Was open to my criticism about the structure of the sessions or what he or she said. He or she validated my feelings and gave me support. The helper greeted me, introduced himself or herself and said goodbye. I had a positive first impression.

What Clients Say The helper used humor. The helper’s office environment helped to enhance the relationship (including relevant books). I liked some personal characteristics of the helper (well groomed, similar background).

What Clients Say The helper normalized my the feelings I was having. The helper came highly recommended. The helper was honest and frank. The helper explained how therapy would work. The helper went beyond a business relationship and made extra efforts to help.

Most helpful Things Labeling and expressing feelings. The relationship as a non-judgmental space where they could open up to a supportive person. Becoming more aware of themselves through self-exploration Finding new ways of relating to people because of their experience in the therapeutic relationship. Having therapists ask question to help them find patterns in their lives

Characteristics of a Therapeutic Relationship Mutual liking or respect Purpose of relationship is resolution of client’s issues Sense of teamwork while working towards agreed-upon goals Contractual relationship may terminate at any time Compensation Disclosure Professional boundaries Termination

Relationship Enhancers NON VERBAL SKILLS (empathy, expertness, self-disclosure) leads to RELATIONSHIP COMPONENTS (liking, respect and trust) RELATIONSHIP CONSEQUENCES (communication, openness, persuasion) CHANGE

Question? What is the difference between EMPATHY and SYMPATHY ? Sympathy is equal to the notion of Pity. “ahh poor you”. Pity, can suggest that the sufferer is less than the person who is giving the sympathy. Nietzche suggest that this could create and power imbalance. Can you understand me?

Empathy vs. Sympathy How do you know, that someone is really understanding you? How do you feel, when someone is sympathizing with you?

Relationship Enhancers Empathy Conveying understanding of client’s subjective experience Not agreement with behaviors or taking sides Helpers should not “own” the problem Non-judgmental Helper as learner Sincerity Consistency Helper must communicate understanding of facts, feelings, and meaning of client’s story Learn from the client when situation is different from your own (tutorial stance) “I wonder what this must feel like”. Can empathize, without taking sides.

Empathy is not… Simply agreeing with the client Pretending to understand Taking on the client’s problems Sympathy A one-time event

Empathy and Expertness Watch for client’s overestimation, idealizing, or attributing therapeutic success to the helper “Ascribed” vs. “Achieved” Credibility

Self-Disclosure What to share with the client? Conveys honesty and openness Modeling behavior for clients Attractiveness of helper Trust Deepens client self-disclosure Self-disclosing vs. self-involving statements

Self-Disclosure What to share with the client? Self-disclosing vs. self-involving statements Watch timing and extent!

Self-Disclosure Mistakes Self-disclosure is… too deep poorly timed not matching client’s experience Which factors may be difficult to avoid?

Roadblocks to Communication Ordering, directing, commanding Moralizing, preaching, imploring Advising, giving suggestions or solutions Judging, criticizing, disagreeing, blaming Interpreting, analyzing, diagnosing Reassuring, sympathizing, consoling, supporting Probing, questioning, interrogating Distracting, diverting, kidding

Transference & Countertransference Residue from other relationships Personal needs impinging on relationship Problematic or Therapeutic?

Transference Carry-over feelings from the past influences the current relationship Can be a source of therapeutic material Can be positive or negative The therapeutic relationship as a model

Transference Counselor as ideal Counselor as seer Major transference patterns: Counselor as ideal Counselor as seer Counselor as nurturer Counselor as frustrator Counselor as nonentity

Dealing with Client Transference Convey acceptance of client’s remarks - do not retaliate Explore client’s feelings Use self-involving statements to disclose your genuine thoughts and emotions about the client’s behaviors Use transference to help client find different ways to express feelings and meet needs

Countertransference Helper’s strong emotional reactions to client Anger is the most common Supervision is the key! Do NOT disclose feelings unless it will benefit the client

Common Patterns of Countertransference Paternal/maternal nurturing Fear of client’s anger Disgust, disapproval Need for reassurance, liking

Common Patterns of Countertransference Anxiety Insecurity Feelings of identification Sexual / Romantic Frustration / Anger

Exercise Barriers to Communication