At the end of a counselling session I often ask my clients what was helpful in the session. Most of them say the talking helped. However they fail to pinpoint what was really helpful in the session. At times I get frustrated over this lack of details about what helped them. I was expecting them to tell me, so I can just use that to make all my clients feel better. Over time I came to the understanding that it's not easy to identify and describe what was happening in the counselling process that leads to this feeling of betterment.
The process we talk above takes place in what we call the therapeutic relationship. The importance and value of therapeutic relationship was first recognized by the Freudian school of psychotherapy. However over the years therapeutic relationship has become widely accepted as a significant treatment factor in all major theoretical orientations. Researches have shown that a good therapeutic relationship tends to predict positive therapy outcome. So now my quest is to find out and understand the components that will contribute to the therapeutic relationship.
From my limited experience I have noticed that the most fruitful approach in therapy is the one that encourages the client to be himself. If you ask any one or yourself what most likely makes a person feel safe, secure and comfortable the answer is an environment of acceptance. So now I know being accepting of my client is the first thing I have to do in order to build up the therapeutic relationship.
This is easier said than done. After years and years of training in trying to find out what's wrong with a client so I can fix him, it is very difficult for me not to do that. As a therapist isn't it my responsibility to help the clients realize what has gone wrong in their life and how to fix it? It is difficult, but I have to hold back my impulse to correct and the urge to help the moment my clients open their mouths or even before that. I have to keep telling myself over and over again it is not about me, but the client. I do not have to appear as an expert all the time.
The client is going through some difficulties in life or a stage in his life just like everyone else. He is frustrated or overwhelmed at the moment and feels helpless. This doesn't mean he is going to be weak and powerless forever.
As I developed this more helpful way of understanding the client, I have also come to realize what is preventing me from accepting him as he is. But this process is not an easy task for me. This is the art part of therapy and there are no simple rules and formulas to follow. I need to use the right words at the right time in response to the client's thinking and feelings so that he will feel completely accepted. Once I do this successfully the client will perceive me as a trustworthy and caring individual.
Once a positive relationship is established the client will feel free to fully participate in the counselling for an agreed purpose. Through the collaborative effort the client will experience and recognize himself and the therapist as a team. I work with my client, not against him. I am not there to judge or correct him. We have a common goal to achieve and we can discuss and move forward doing tasks that lead to successful outcomes.
If one thing doesn't work we can always modify or change the strategies to make them work. The major part of the process involves listening and responding in an empathic manner. The roles are never fixed and invariable. At one moment my client may be talking and I listen. Next I would be reflecting what I hear and he would listen. The client feels free to correct me if I misunderstand him. I too will ask for clarifications.
So, it is difficult to identify who is leading and who is being led, by looking at a particular moment in the process. However the whole process is based on a common goal so the process should be moving toward that general direction even if it has ups and downs.
It is important to point out that while I am accepting my client, that does not mean I am agreeing with him in everything he does and if appropriate this message may need to be conveyed to the client. Also as a therapist it is my job to bring the client's attention to where we start and encourage him to revisit the goals from time to time. So this whole process is not an aimless effort without a purpose. Another important point to remember is that the therapeutic relationship fluctuates from moment to moment during the course of therapy.
It is important to keep in mind that the whole process moves forward with client's consent, agreement and collaboration - from goal setting to intervention and follow up. The earlier a therapist is able to establish positive therapeutic relationship the better therapy outcome will be.
Remember, no amount of learning, degrees or experience can make you a good therapist. One of the most eminent psychotherapists, Carl Rogers, brilliantly articulated this point when he said, "Intellectual training and the acquiring of information has, I believe many valuable results-but, becoming a therapist is not one of those results (1957)."
(For convenience all clients in the article are referred to as males.)
-Darly Sebastian works with Child and Youth Mental Health and Addictions Services with the Prairie North Regional Health Authority