Understanding the Counselling Relationship

Colin Feltham, Colin Feltham

• Publisher: SAGE Publications Ltd
• Year: 1999
• ISBN:
  9781446239698
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`This book presents contrasting views of the relationship between the counsellor, or therapist, and the client, as held by practitioners from diverse theoretical orientations. Each chapter clarifies and considers the elements of the counselling relationship which have the most bearing on therapeutic practice and the strengths of each are highlighted in terms of understanding, theory and skills? - New Therapist

It is now widely accepted that the therapeutic relationship - referred to here as the counselling relationship - may be the most significant element in effective practice. Understanding the Counselling Relationship presents contrasting views of the relationship between the counsellor or therapist and the client, as held by practitioners from diverse theoretical orientations.

Each chapter clarifies and considers the elements of the counselling relationship which have most bearing on therapeutic practice. The strengths of each position are highlighted in terms of understanding, theory and skills. The relevance of certain psychological, sociological and research-based issues for practitioners from a variety of theoretical backgrounds are also considered.

1 Contextualiztng the Therapeutic Relationship

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Colin Feltham

The very topicality of the therapeutic relationship in counselling and psychotherapy may cause it to be either taken for granted or over-inflated. In this chapter I aim for some definitional purchase on the term, I then look at certain historical, cultural and trans-theoretical issues, at maps and Schemas of the relationship, and finally at critiques of the assumption that the therapeutic relation-ship is the central factor that it is claimed to be.

Meaning and Aims

The term therapeutic relationship can literally refer to any relationship, professional or otherwise, longstanding or fleeting, in which some form of therapy, help or healing, takes place. Unfortunately the term is often but perhaps inevitably used loosely or ambiguously. Sandier et al. (1992), for example, note the problems of conceptual confusion that are involved, and Keith Tudor explores definitional problems in his chapter in this book. While I do not intend to become ensnarled unnecessarily in fine semantic distinctions, it is as well to attempt briefly to clarify use of the term here.

This book dwells mainly on the specifically relational therapeutic aspects of largely professional encounters in the fields of counselling, counselling psychology, clinical psychology and psychotherapy. These professionally defined encounters usually contain some mixture of intentional use of prior training, theory and techniques, but also utilize elements of relational or interpersonal skill and artistry, placebo factors, and a host of indeterminate therapist and client factors of fortuitous rapport, matching, mis-matching, timing, and so on.

For practical-editorial reasons the concentration is on individual therapy Clearly the complexity of relationships in couple, family and group therapies is great. Differential considerations in the special nature of the relationship in the therapy of disparate groups – children, tortured refugees, drug addicts, those diagnosed as having a personality disorder, and so on – as well as the modalities of brief therapy, arts therapies, etc., are similarly not possible to go into separately here.

Our aim in this book is to focus on what transpires between therapist and client consciously and unconsciously, by design and by default, positively and negatively; on the attempt to understand what the components of therapeutic relationships are and how we may better learn from, integrate, utilize or perhaps when necessary surrender to or abandon some of these components.

Some Evolutionary, Historical and Thematic Highlights

Of course there have been healing relationships long before the advent of our modern clinical conceptualizations. Centuries of myth, religion and philosophy testify to the human experience of suffering in many guises and the search for remedies of many kinds. Many of these remedies would appear to have involved faith or placebo factors, longing for relief and expectation of finding it – and therefore finding what we expect to find – in relation to designated healers. Ehrenwald (1976) reminds us that even reluctant healers such as English monarchs were sometimes known to effect cures by their ‘royal touch’. It is well noted by certain psychotherapy researchers that the most common transcultural healing factors are probably faith in sanctioned healers, designated settings, and so on (Frank, 1973; Kiev, 1964). Along-side this power of the mind to effect healing by expectancy and benign self-deceit, there has perhaps always existed the question of a possible actual power, residing in divine representatives (for example Jesus and his miracles), in gifted individuals or in special interpersonal encounters or holy places (Benson, 1996).

We have to consider that for evolutionary reasons humans take a long time to develop from vulnerable and dependent infant to relatively robust and autonomous adult. The implications of this probably are that we are peculiarly prone to emotional suffering and its endurance, and also that we seem peculiarly sensitized to the nuances of mood, threat and warmth in the presence of others. Our lives are lived both in small groups (families, friends and colleagues), from which we derive comfort and suffer hurt, and in larger communities and societies from which we derive sustenance, support and meaning, but which are also a source of alienation, oppression, shame and fear. Presumably we have deeply internalized an awareness of the constant co-existent dualism of love and hate, kindness and brutality, truth and lies, and have evolved adaptive strategies which both protect us and make us sick (Campbell, 1975; Langs, 1996; Stevens and Price, 1996).

The significance of this is that clients seek out therapists for the safety, understanding and healing they represent but any and every encounter combines degrees of benign, civilized interaction and primitive, ambiguous interaction: all is not what it seems. Some healers abuse, and probably all healers fail their clients some of the time. Every human encounter in therapy may be, among other things, partly a polite parlour interaction and professional relationship and partly a mutually primitive, unconscious weighing of trust, attraction and threat. Smith (1998) puts succinctly the argument of evolutionary psychoanalysis that our encounters take place at two levels, one of which is always unconsciously sensitized to pervasive interpersonal deceit. However, as elsewhere, in the emerging field of evolutionary psychotherapy there is relatively little consensus. Campbell (1975) argues that emotional expression has been stunted by the conditions of survival and that the full expression and restoration of feelings is the main task of therapy, whereas Langs (1996) infers from evolutionary science that unconscious communication within a tightly held therapeutic frame is probably the most significant part of therapeutic practice.

Religion

We cannot ignore the influence of centuries of religion and religious practice in daily life and ritual. Although we live in an increasingly secular and multicultural time, almost certainly there is within us some transgenerational and perhaps collectively unconscious knowledge of powerful past community-binding structures and relationships. Here I simply want to highlight the idea of a personal relationship with God; relationship with community, especially via a priest; and the pervasive sense of a call to love. I mention these ironically, since it is probably largely in their loss that we know them. In other words, secular humanism leaves many without a God to turn to; fragmented and mobile, competitive societies leave many without stable supportive communities and community figures, such as priests, who previously supplied many valued facilities including the confessional; and the breakdown of the concept of selfless duty, altruism, or love (Agape) also leaves a large hole in the social and interpersonal fabric. Nevertheless certain Christian counsellors, such as Howard Clinebell and Paul Tournier, have built systems of counselling that are explicitly, religiously, relationship-based (Hurding, 1985).

Religions, like psycho therapies, differ in their understanding of how human beings do and should stand in relation to each other. In some eastern religions, for example, the reality and distinctiveness of selves, and ultimate separateness of persons is considered illusory. However in most western therapies there are by contrast many reservations about the dangers of confluence, symbiosis and over-identification. Some of these problems are identified by Brazier (1993).

Love

Associated with all this is the breakdown of the stable close relationships of marriage and friendship. It is well noted by sociologists that psychotherapy has probably implicitly occupied the void left by the crumbling of these social structures (Halmos, 1965). There has also been a detectable shift from valuing kindness and altruism (words and qualities rich in associations) to a stress on assertiveness and autonomy. While many therapists are wary, particularly in our current professionalizing context, of invoking and being associated with the concept of love, some have explicitly acknowledged this.

When one brings together the various aspects of the facultative conditions – empathy, warmth, respect, concern, valuing and prizing, openness, honesty, genuineness, transparency, intimacy, self-disclosure, confrontation – it becomes apparent that they constitute love in the highest sense or agape. . . . We already have, in essence, the answer – the answer that has been reached through thousands of years of human experience and recognized by the great philosophers of various times and cultures, (Patterson, 1974: 89–90)

If God is dead and love in all its varieties (Fromm, 1975; Lewis, 1963) has been subjected to reductionistic philosophical analysis and psychoanalytic doubt, it is understandable that individuals look for meaning, guidance and affection in therapy. And while even Freud could accord love the distinction of being, along with work, one of the indices of mental health, and he could suggest that psychoanalysis is a ‘cure through love’, it is not at all clear what love is now thought to be. Erotic and/or committed love, also known sometimes by the cliché of the ‘deep and meaningful relationship’ is perhaps the main form of ‘pure relationship’ understood by sociologists to exist only for the ends of the participants themselves (Giddens, 1991). According to Giddens, emphasis on pure relationship naturally generates a demand for therapy in order to better understand, define and improve oneself. Unfortunately, the dyadic intensity of most therapy then creates its own problems and, perhaps in too many instances, can lead to dependent, exploitative, abusive and sometimes dehumanizingly ritualistic therapeutic relationships (Heyward, 1993; Rutter, 1989; Wilmer, 1992; Janice Russell in Chapter 9).

Concepts of Energy Fields

Franz Anton Mesmer (1734–1815), while often written off as a charlatan, has at least something to teach us about therapeutic relationship. Mesmer turned his attention from theology to medicine and, initially influenced by the late eighteenth-century Austrian astronomer, Father Maximilian Hell, came to specialize in treatment by magnetism. Beginning with actual magnets (also used by some other physicians), Mesmer achieved some apparently dramatic cures. However, he came to believe that ‘animal magnetism’ (a kind of fluid) was located in his own body. Ellenberger (1970: 62) suggests that this is analogous to the ‘Polynesian concept of “mana”, a universal, impersonal energy that can be stored in persons, objects or places’. Mesmer used many electrical metaphors to explain how his therapeutic magnetism worked, but also referred to the importance of a ‘general agent’ and of inducing crises in sufferers. According to Ellenberger, Mesmer probably did embody high levels of charm and authority and immense belief in himself as a discoverer.

Mesmer was preceded and followed by others (Gassner, Puysegur, Lafontaine, Braid) using similar methods, and magnetism historically shades into hypnosis and its methods. A commonly noted phenomenon was rapport and the ‘powerful interpersonal attraction issuing from the rapport’ (Ellenberger, 1970: 77). The Mesmerist Kluger acknowledged the significance of rapport but spoke of it as a magnetic circle, which Ellenberger (ibid.) refers to as ‘a closed world of two individuals, which had to be protected from noise, light, and outward interference’. Another Mesmerist, Hufeland, compared the magnetizer and magnetized to a pregnant woman and her foetus, and the magnetizing process to the stages of pregnancy. Such writing stems from the early nineteenth century. Much later, Winnicottian notions of the maternal reverie and its recurrence in the psychoanalytic dyad, have obvious similarities.

Concepts and practices associated with energy fields are not confined to Mesmer or to his historical niche. Jungians such as Schwartz-Salant (1998) and Stein (1995) argue for the significance of the interactive field between therapist and client, based on alchemical principles stemming from around 200 BCE. The inter-active field is also known as a ‘third area’ or ‘analytic third’, as the atmosphere between the participants in therapy, or as a palpable mingling of souls (Moore, 1994). It is closely associated with the Greek pneuma or ‘subtle body’. The Indian prana and Chinese chi also underpin explanations of psychic energy (Tart, 1975). Metaphorical (or not) references to interpersonal chemistry, magnetism, electricity, vibrations, energy, attunement, etc., are quite common. West (1997) discusses contemporary spiritual healing in somewhat similar terms, although alluding also to a presence which is sometimes felt to be distinctly other (for example auras, the presence of healing energies, God and grace).

Grossinger (1982) finds evidence throughout history and pre-history of conceptions of a universal energy. Paracelsus in the sixteenth century referred to a ‘quintessence’ or nature, force or virtue. This is often conceived in terms of a feminine principle, Grossinger suggesting for example that women are more natural healers than men (see for example, Friedman, 1992; Josselson, 1996; Sayers, 1991). More recently, the physicist David Bohm’s (1980) concept of an implicate order has been taken up by Ullman (1991), who argues that interconnectedness, or unbroken ontological wholeness, manifests itself especially in dreams. It may follow from this that illusion-dissolving, healing encounter is supremely available both in therapeutic relationships and in other forms of serious dialogue, as suggested by Martin Buber (1965; 1970); Béhm (1996); de Mare et al. (1991); and Maurice Friedman in Chapter 4.

From Mind to Mind

Another nineteenth-century physician, Carl Gustav Carus (1789–1869) is worth noting for his conception of layers of consciousness. Within his schema, he argued for the operation of interpersonal relationships at these levels: from the conscious of one person to the conscious of the other; from conscious to unconscious; from unconscious to conscious; and from unconscious to unconscious. Again, these ideas were later developed by twentieth-century psychoanalysts. Ellenberger (1970) and later Howe (1993) note the important contribution of certain philosophers, such as Max Scheler, who probed for answers to the question of h...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• Notes on Contributors
• Introduction
• Chapter 1 Contextualizing the Therapeutic Relationship
• Chapter 2 The Relationship in Psychodynamic Counselling
• Chapter 3 The Relationship in Person-Centred Counselling
• Chapter 4 Dialogical Psychotherapy
• Chapter 5 ‘I’m OK, You’re OK – and They’re OK’: Therapeutic Relationships in Transactional Analysis
• Chapter 6 The Therapeutic Relationship in Cognitive Therapy
• Chapter 7 The Relationship in Multimodal Therapy
• Chapter 8 The Counselling Relationship and Psychological Type
• Chapter 9 Professional and Socio-Cultural Aspects of the Counselling Relationship
• Chapter 10 Learning from Research into the Counselling Relationship
• Index