Building and Maintaining Therapeutic Relationships
Chapter Four: Initiating and Maintaining a Working Relationship
Purpose of the Chapter
The chapter centers on building and maintaining a therapeutic relationship between counselor and client.
A positive relationship is one of the three requirements of a strong working alliance in counseling.
The working relationship is crucial through all stages of counseling, impacting all counselor and client interactions.
Relationship Experiences Reflection
Consideration of personal relationship experiences:
Supportive or meaningful relationships.
Personal needs satisfied within various relationships.
Reflection on personal impact on others in relationships:
What qualities or actions make you supportive or meaningful to another?
Self-Knowledge and Relationships
Understanding one's own characteristics:
Exploration of eccentricities, values, and self-perception.
Cultural and ethnic identity of family background.
Reflection on relationships with culturally different individuals:
Adjustments made to accommodate those relationships and the outcomes of those adjustments.
Family values influence:
Closeness vs. separateness, organization vs. disorganization, confrontation vs. avoidance, affection vs. distance, inclusiveness vs. exclusiveness.
Listening and Understanding in Counseling
Importance of listening and understanding for successful counseling:
Clients must feel heard, understood, and genuinely engaged in the therapeutic process.
Concepts of rapport and relationship:
Rapport: conditions of mutual trust and respect; essential for establishing a therapeutic relationship.
Rapport as the initial entry point into therapeutic relationships.
Definition from the American Heritage Dictionary (02/2012): "Rapport refers to conditions of mutual trust and respect within the relationship."
Core Characteristics of a Therapeutic Relationship
Carl Rogers’ conditions for a humanistic therapeutic relationship (Rogers, 1957):
Two persons in psychological contact: client (incongruent) and counselor (congruent).
Counselor must experience and communicate unconditional positive regard and empathic understanding.
Key conditions for effective counselor-client relationships:
Accurate empathy, genuineness, unconditional caring/positive regard.
Counselors must be self-aware and value each client as a unique individual, recognizing cultural backgrounds in understanding their experiences.
Entry Behavior and Barriers
Concept of entry behavior:
The initial superficial layers presented by individuals when meeting new people based on past experiences.
Can be perceived as positive or negative; may serve to manipulate others’ perceptions.
Examples include hostility, humor, withdrawal, or friendliness, often unconscious habits formed through life experiences.
Counselors also exhibit entry behaviors related to their self-image and the impression they wish to convey.
Importance of recognizing and managing one's entry behavior to facilitate more authentic relationships.
Responding to Client Entry Behavior
Counselors should observe client entry behaviors without direct reaction:
Respond to the individual behind the behavior with understanding and empathy.
Example intervention: “I can see that you are not too happy to be here. I think that’s understandable. No one likes to be forced to do something.”
Change in counseling may happen slowly and incrementally, acknowledging that initial entry behaviors are only part of a person.
Empathy in Counseling
Definition of empathy (Rogers, 1989):
Accurate sensing of the client’s experiences and communicating understanding back to the client.
Effective empathic listening helps clarify meanings, contribute to change, and encourages client awareness.
Welch and Gonzalez (1999) propose two levels of empathy:
Understanding Content: Grasping the narrative, events, and themes in the client's life story.
Understanding Meaning: Recognizing what the narrative signifies in the client's life.
Client reactions signal whether effective empathy is communicated:
Examples: expressions like "yes, exactly" or affirmative body language.
Two stages of empathy (Gladding, 02/2012):
Primary Empathy: Basic understanding of feelings and experiences.
Advanced Empathy: Reflecting deeper feelings that may not be overtly communicated by the client.
The Kharkhoff Empathy Scale
Developed to assess counselor empathy levels:
Level 1: Lowest level of interpersonal functioning.
Subsequent levels involve varying degrees of adding to client expression.
Level 3 is considered a start for effective empathic communication.
Debate exists over whether empathy is learned or an innate quality; possibly both influenced by early life experiences.
Cultural Empathy Skills
Importance of cultural sensitivity in developing empathy (Chung & Bemak, 02/2002):
Understanding the client’s culture, showing genuine interest, and being aware of cultural differences.
Cultural perspectives may shape client views and should be respected in counseling.
Encourage self-exploration of what it means to be part of various cultural identities and perspectives.
The Role of Genuineness in Counseling
Genuineness defined (Holzdoc and Rogers, 1977):
Responding as a full human being rather than solely as a therapist.
Authenticity leads to comfort and congruence, where thoughts and feelings align with expressed behavior.
Importance of self-awareness in being genuine with clients:
Genuineness associated with openness, congruence, and the ability to connect with clients.
Unconditional Positive Regard
Defined by Rogers as valuing the client’s inherent worth irrespective of behavior (p. 1957):
Positive affirmation for the client as a human being.
Essential for fostering positive personality change.
Communication of Empathy
Conditions required for experiencing and communicating empathy:
Focus on the client’s world without distractions.
Relating meaningfully to the client's experiences.
Importance of nonverbal and verbal communication in conveying empathy, including tone, facial expressions, and listening behaviors.
Building Relationships with New Clients
Nonverbal attentiveness observed through eye contact, body language, and presence is critical in establishing rapport.
Cultural differences in nonverbal communication require careful consideration to avoid misunderstandings.
Example: Different perceptions of eye contact across cultures.
Verbal Attentiveness
Supporting nonverbal behavior with verbal communication to signal attentiveness:
Engaging with short encouragers, following client narratives, and natural voice modulation.
Reflecting client messages through paraphrasing and perspective checks to confirm understanding.
Techniques for Reflecting Client Messages
Paraphrasing: Restating key ideas while maintaining the client’s original tone and intent.
Reflection of Feelings: Capturing the emotional quality of client statements to deepen understanding and connection in the therapy.
Therapeutic Relationship Functions
The role of a strong counselor-client relationship includes:
Creating a trusting environment conducive to open sharing of personal material.
Allowing for expression of intense emotions, leading to self-awareness and control.
Providing a healthy relationship model that enhances interpersonal skills outside therapy.
Client Effects from Therapeutic Relationships
Varied client reactions to the counselor's involvement can both positively and negatively impact outcomes:
Positive reactions: feeling understood, hopeful, and engaged.
Negative reactions: skepticism, discomfort, fear of intimacy, or questioning intentions.
Strategies for Enhancing the Therapeutic Relationship
Employing sensitivity to clients' cultural backgrounds to inform practices and reactions.
Understanding client behaviors can help tailor responses to meet individual needs without fostering mistrust.
Case Illustration: Building a Relationship with Amy
Amy’s initial resistance and gradual responsiveness highlight:
Importance of patience and understanding in fostering connection.
Using personal topics (children) to encourage sharing and enhance comfort over time.
Working with Children in Counseling Relationships
Special considerations for establishing rapport with younger clients:
Control over physical distance and environment is crucial to foster comfort.
Adapt communication styles to suit children's developmental levels and avoid assumptions.
Building a Summary
Establishing a therapeutic relationship depends on:
Accurate empathy, genuineness, and respect.
Utilizing both verbal and nonverbal skills effectively.
Acknowledging the impact of client entry behaviors and cultural context.
Continuous reflection and adjustment to client needs enhance the effectiveness of counseling relationships.
Exercises and Discussions
Empathy Engagement: Interact with a partner to practice sending and interpreting nonverbal cues over differing contexts.
Verbal and Nonverbal Cue Identification: Recognize feelings through nonverbal expressions and create verbal responses.
Reflecting Practices: Paraphrase client sentiments and practice reflecting on thoughts and feelings appropriately.
Discussion Questions
How do you approach new relationships within a cultural context?
How do family norms affect your interactions with clients?
What functions of therapeutic relationships challenge you, and how can you enhance your practice?