Critically Reflect on Forms of Relationship in The Therapeutic Encounter and The Challenges of Identifying and Working with These Relationship Processes

Introduction

The relationship between the client and the counsellor is an elusive and mystical sometimes, debated frequently and is always a psychotherapy enterprise aspect that is interesting. Gelso & Carter (1985, p. 155-194) indicated that the global definition of relationship as all the behaviours, attitudes and feelings, conscious and unconscious that occur between two people, where one between them is a help-giver who has been sanctioned professionally, and the other is a patient or a client. However, given that the definition is broad, Gelso & Carter (1985, p. 155-194) proposed a narrower definition of relationship as the attitudes and feelings that counselling participants have toward each other and the manner in which these get expressed. In this narrower definition, the procedures and techniques applied by the therapist that are wedded to the theory from which he or she is operating may reflect the issues of relationship, but do not provide relationship definition. There exists six forms or modalities of relationship in a therapeutic setting, and they include; (1) working alliance, (2) transference-countertransference, (3) reparative/ developmentally deeded, (4) person-person, and (5) transpersonal modalities (Clarkson, 2014, p.113). In this essay, I am going to discuss the forms of relationship in the therapeutic encounter and the challenges of identifying and working with these relationship processes. Lastly, I will reflect on how I have experienced two of these forms/modalities in therapy drawn on my own experiences in illuminating these issues.

According to Clarkson (2014, pp. 8), all the six modes interlink and overlap.  Working alliance is the part of the therapist/client relationship enabling the therapist and the client to work together even when any of them do not wish to work together. The aspects of working alliance include the bond, goals, tasks, the ability of the client to form relationships, and significant early work stages. In transference-countertransference relationship, modality is the experience of working alliance distortion by the experiences, fears and wishes from the past carried over into the therapeutic relationship. This is also known as the therapist/client bias (Culley & Bond, 2011, p. 22).

On the other hand, reparative/ developmentally deeded relationship modality is the intentional provision by the therapist for replenishing, reparative or corrective relationship or action where the previous experiences or original parenting was overprotective or abusive or deficient. This relationship modality sometimes is known as a maturational response or corrective emotional experience (Clarkson, 2014, p. 13). This modality focuses on re-instating the healthy development process or repairing previous damage. This implies that the relationship aspects that were traumatic or have been absent for client at his childhood parts are repaired or supplied by the therapist. In essence, emphatic reflection’s person-centred responses are reparative.

In person-person (real) relationship modality is the core relationship or dialogic relationship that concerns the authentic humanness shared by the therapist and the client. This modality has also been referred to as the real therapeutic relationship dimension (Clarkson, 2014, p. 16). It is here and now an existential meeting between two individuals and requires mutual recognition and participation that each gets changed by the other. The real person of the therapist cannot be entirely being excluded from interactional therapy matrix. Moreover, this relationship modality does not involve changing the therapeutic relationship into a social relationship or trying to seek personal gratification by dialoguing with the client. However, it includes confirmation of client as deserving respect. Psychoanalysis recognises real relationship as significant deeply and potentially profound force of healing (Gilbert & Orlans, 2011, p.56).

Transpersonal relationship modality according to Clarkson (2014, p. 20) is the timeless psychotherapeutic relationship facet, that is impossible to describe but refers to the mysterious, spiritual or currently inexplicable dimension of the healing relationship. This relationship modality also acknowledges the influence of the qualities that presently transcend the limits of humans understanding. It is difficult to express it as its rare and is also not accessible easily to the descriptions that are used in discussing other relationship forms. Clarkson (2014, p. 22) also indicated that it lets go of skills, experience, knowledge, the desire to health, preconceptions to be present. It also allows receptiveness and passivity, hard to prepare and cannot be made to happen. It can only prepare conditions that are conducive to the spiritual activity. This relationship modality is also characterized by intuition to know facts, intent and feeling of the client without evidence to come to these conclusions. This relationship modality also flourishes more when the therapist dissolves their ego and allows insight and wisdom to emerge (Wallin, 2015, p.33).

 

1)    The Working Alliance

Gelso & Carter (1985, p. 155-194) suggested that working alliance is the alignment that takes place between the client and the counsellor, and more precisely, between the counsellor’s therapizing or working side and the client’s reasonable side (the reasonable or the observing ego). It is helpful at this point to think of two disparate ingredients or qualities of personality. One of these allows for objectivity and reason in observing situations and more so on the individuals. The second is the one which does not observe but instead experiences and feels unreflectively. This is referred to as a split in the ego by the psychoanalysts, and for expressive therapy or for successful analysis to occur, the client must have the ability for oscillating between these two sides. He or she must have the ability of rationally experiencing the feelings and observing those feelings.

In the working alliance, the reasonable side of the client aligns with the working side of the counsellor (which is also his or her reasonable side). This allows the client to experience negative feelings towards the counsellor without work disruption. Therefore, the reasonable side of the client, which gets aligned with the counsellor, permits the client to look at these negative feelings and try grasping their source. Also, it is the working alliance, and more importantly, that creates the sense that the counselling relationship participants are joined together in a shared enterprise, with each contributing to the work (Gelso & Carter, 1985, p. 155-194).

Bordin (1975, p. 252-260) conceptualized the working alliances as comprising of three parts: emotional bond existing between the participants, agreement on the task of the work, and an agreement about the goals. Therefore, there exists a positive attachment between the participants and an explicit or implicit view that the explicitly or implicitly desired goas of the work are very much appropriate for both the client and the counsellor. Moreover, again either explicitly or implicitly, the participants agree on what extra and in-therapy behaviour (tasks) will be helpful in achieving the goals agreed upon.

Extending the Bordin’s formulation, Gelso & Carter (1985, p. 155-194) suggests that the working alliance is an emotional alliance that is both fed and fostered by the emotional bond, agreement on tasks and agreement on goals. This contrasts the definition Bordin proposed for the alliance as agreements and bonds. Despite the disagreement on the definition, Gelso & Carter (1985, p. 155-194) shared the hypothesis by Bordin that the working alliance strength is a primary contributor to the helping relationship’s outcome.

The side of the counsellor in the relationship, it is suggested that the professional compassion and concern and the abiding willingness of helping the client in facing his or her problems, contribute to the alliance between the participants. The well-understood client-centred conditions of respect, genuineness and empathy are possibly central in developing the alliance, and it may be that these conditions do have their key effect through the alliance they establish.  Just like the working alliance necessitates the client to be making use of his or her observing, reasonable side, the therapist, also must utilize this part of herself or himself in facilitating a sound alliance. In most instances, therapists experience very strong reactions towards their clients. In these instances, the job of the therapists is to understand these feelings, and then make appropriate responses to the client with the aim of fostering an understanding and change of behaviour. Therefore, there must be constancy and consistency in the stance of the counsellor toward the client. The relationship is for the client’s therapeutic benefit, and the observing side of the counsellor is dominant in getting to understand his or her feelings, and disallowing these feelings to be used in ways that are antitherapeutic.

From the side of the client, he or she needs to be having some trust capacity for the healthy bonding to take place. Relatedly, it also follows that the client must have the ability to form attachments to people, to invest caring and energy in relationships. Moreover, probably the client needs to be having a similar worldview to the theoretical stance of the therapist that the task and goals of the counselling make sense to him or her. For all people, probably, their worldviews would be incompatible simply with the operations of particular counselling forms. This aspect addresses an issue of fit more than just the factor of the client. If the client cannot appreciate or understand what is to be offered by the therapist, one cannot expect working alliance that is sound to develop (Gelso & Carter, 1985, p. 155-194).

 

2)    The Real Relationship

Historically, the notion of real relationship has been rooted in humanistic conceptions of therapy and counselling. Additionally, the increasing emphasis in the therapies of learning on issues of relationship appears, in part, to be representing a focus on the real relationship. It appears that the humanistic therapies tend to equate the real relationship with the therapist’s authenticity, genuineness, opened and congruence. A real relationship, in effect, exists to the extent that the therapist is able and willing to be genuine and open about her or his feelings in the relationship. This seems to be particularly clear from recent presentations of what is today known as a person-centred approach (Gilbert & Orlans, 2011, p.36). Also, it seems true of the gestalt therapy which is considered essentially humanistic though to a lesser extent as elaborated by Simkin and Yontef (1984, pp. 279-319). The approaches to learning, to the degree, that they are describing these phenomena, seems to be equating a real relationship with the openness of the counsellor, despite the fact that they do not view the real relationship as vital to positive outcomes almost to the extent that is done by the humanistic approaches.

Gelso & Carter (1985, p. 155-194) suggested that equating the genuineness and openness of the counsellor with a real relationship is misleading and incomplete for two reasons. First, by doing so it leaves out the client from the equation, or it gives the client a minor role. The impression that will be gotten by an individual from the humanistic literature, for instance, is that the therapist is offering a set of behaviours prescribed, such as the behaviours that reflect openness, and this facilitates the movement of the client in certain directions, including increased openness. On the other hand, real relationship implies at least a two-party interchange, whereby each is involved with the others in a developing a process. A real relationship according to Gelso & Carter (1985, p. 155-194) is something that develops and exists between a client and the counsellor as a result of the actions, attitudes, perceptions and feelings of each towards and with the other.

It may well appear that the major focus is on the counsellor, and that essentially the contribution of the client to the real relationship has been ignored partly, at least because of the role expectations of the counsellor are in a way contradictory and confusing, whereas the role expectations of the client are clearer. Therefore, it is an expectation from the client to try to be genuine and open at all times, despite the fact that at times it is not expected of them to succeed. On the other hand, the expectation to the counsellor is to be genuine and open and at the same time be working. By working means observing an individual’s communications and behaviours, and keeping them under some form of rational control. In many ways, this appears to be contradicting the dictates that state that the counsellor should be genuine and open. Such kind of contradictory expectations are evident and can see, for instance, in the prescription for experiential therapy by Mahrer (1983, p.45). These complexities, in effect, have created the need for more discussion of the contribution of the counsellor to the real relationship than the contribution of the client. Be it like that, the inattention of the contribution of the client and to the reciprocal influence of the counsellor and the client in fostering real relationship here is seen as a serious deficit.

There exists a second and perhaps even more serious problem in the tendency of equating a real relationship with the genuineness and openness of the counsellor. Greenson (1971, pp. 213-232) underscored that a real relationship comprises of the realistic and genuine reactions and perceptions of the participants to each other. Realistic reactions and perceptions are reality oriented, undistorted and appropriate. They have not been contaminated by the distortions of the transference. On the other hand, genuine reactions and perceptions reflect truthfulness, authenticity and honesty, as opposed to synthenticness and artificiality. While the component of transference of the relationship is genuine, by definition, it is never genuine.  In other words, when enacting transference and when involved in, honestly the client does experience these feelings., and in most instanced they are intensely experienced. However, they are the therapist’s distortions, misperceptions based on relationships and experiences from another place and time. A differentiation between interpretations and attributions on the one hand, and on the other and are the feeling reactions may help in clarifying how a person may be genuine within the unreal relationship. This implies that any interaction may be seen as comprising of four steps that are sequential. That is, (1) an individual perceives a behaviour (2) an individual makes interpretations or attributions about that behaviour (3) one reacts internally, that is having feelings about the behaviour (4) an individual emits some response.

In their article, Gelso & Carter (1985, p. 155-194) proposed a position that the real relationship exists in all therapies, and it does so intermingled and also alongside the transference or unreal relationship. Gelso & Carter (1985, p. 155-194) indicated that in a real relationship, an individual’s interpretations and perceptions of another’s behaviour are realistic and appropriate, the behaviour is congruent and the feelings are genuine. The real relationship may possess two parts, that is the nonintimate or impersonal, and more personal and intimate. Both of these parts are significant and should be attended to and appropriately used. The more non-intimate real relationship part would entail chatty interactions, which may paradoxically convey a very human form of respect. On the other hand, the more intimate interactions entail feelingful and personalized messages. Therefore, the real relationship has a significant effect on the outcome and processes of every form of counselling (Culley & Bond, 2011, p.25).

3) Developmentally needed/reparative relationship.

This is the intentional provision by the corrective/reparative psychotherapist or parental relationship replenishing where the original parenting was deficient, overprotective or abusive. This relationship mode refers to the relationship aspects which may have been traumatic or absent for the client at certain periods of his or her childhood and which the psychotherapist repairs or supplies, normally in a contracted form during the psychotherapy. That is on request from the patient with an agreement. Ferenczi Sandor, one of the early followers of Freud attempted this by departing from impassivity and neutrality in favour of offering nursing care, management of regression or friendly hugs to very sick patients, day or night, including those he saw anytime as well as taking them on holidays. According to Ferenczi, thee needed to be a contrast between original infancy trauma and the analytical situation so that it can be facilitative in remembering rather than patient’s renewed trauma remembering (Gilbert & Orlans, 2011, p.62).

A reflection on how I have experienced two of these forms/modalities in therapy

In this section, I am going to offer a reflection on how I have experienced two of these modalities of relationship in therapy. Specifically, I will focus on working alliance and Reparative / Developmentally Needed modality.

To begin, during my therapy session, I often had a rupture with my therapist who was always showing up late for our appointments. Based on the working alliance modal, we were able to establish a relationship and work together. We were able to apply the principles of working alliance mode to repair the rupture and regain the trust again. In working alliance, the first stage is all about building a shared foundation and an understanding. Therefore, if the relation falters on the first stage, both parties can go back to the contract and repair the therapeutic alliance (Wallin, 2015, p. 49). The working alliance is the basis of the therapist-client relationship that enables both the therapist and the client to work together and would include things like presenting issues. Therefore, we were able to sit down with my therapist, discuss the lateness to appointment issue and came to an agreement that she will always try to send an apology if she will be late or engaged somewhere.

One of the problems why I had therapy sessions for counselling the trauma that I had when I was a child. When I was a child, my mother was an alcoholic, and this was traumatic for me when I was growing up. Attachment theory according to Fonagy (2018, p.1) is all about the nature of children’s early experiences and the impact of the experiences on the characteristics of later functioning of specific relevance to disorder of personality. The theory address how deprivation, particularly early trauma, will come to affect a person’s propensity to personality disorder. Moreover, it also concerns with how these adverse consequences can be avoided. The key assumption in this theory is that the social behavior of an individual may be understood in terms of social relationships generic mental models constructed by an individual (Fonagy, 2018, p.1).

Based on the Reparative / Developmentally Needed modality, we were able to see improvement in my counselling sessions. As a client to my therapist, I came to see her as the better alternative at some level, I emotionally took on my therapist as a parent figure to support me in my personal growth which takes place when I am with her during her sessions. Given that my mother was an alcoholic during my childhood and was traumatic for me, my therapist asked me to imagine that my daughter was experiencing what I did as a teenager. Would I have more compassion and understanding for myself when I could mentalize that trauma happening to my daughter?  With those thoughts and mentalizing my daughter growing up with an alcoholic parent, I began having compassion and trusting my judgement. I also began using the therapist as emotional support, and this helped in relieving off the emotional burden that I have been carrying since childhood.

 

Conclusion

In conclusion, the paper Critically reflected on forms of relationship in the therapeutic encounter and the challenges of identifying and working with these relationship processes. It also drew on my own experiences in illuminating these issues. Going forward, I will work with the three relationship modalities; Working Alliance, Real Relationship (Humanistic person-centred) and Developmentally needed/reparative perspectives in various ways. I will apply working alliance modality by aligning the reasonable side of the client with my working side as a therapist. This will create the sense for us (client and therapist) in the counselling relationship get joined together in a shared enterprise with each of us contributing to the work. I will also apply Developmentally needed/reparative perspectives modality on clients which had overprotective, abusive or deficient original parenting to replenish relationship. Lastly, will use Real Relationship modality in creating some genuineness and opened with my clients. 

References

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Culley, S., & Bond, T. (2011). Integrative counselling skills in action. Los Angeles: SAGE.

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