What is the importance of a therapeutic relationship? - Chapter 4

This chapter will explain the importance of a therapeutic relationship through subquestions.

When Judith Beck teaches her psychiatric residents about establishing a good therapeutic relationship, she gives them four essential guidelines to remember:

• At every session, aim to treat every client the way you would like to be treated as a client.
• Be nice and create a safe environment.
• Clients are in therapy for a reason and will therefor pose challenges.
• Make sure that the expectations for my client and yourself stay reasonable.

These four guidelines are essential to start building a good relationship with your clients from your first contact with them. A good relationship is important because it is correlated with positive treatment outcomes. Spend time on this, but make sure that you have enough times to help clients reach their goals. Research demonstrates that the relationship strengthens when clients perceive improvement.

The focus should lie more heavily on the relationship, when you treat clients with serious mental health conditions. These clients, more often than not, have strong negative beliefs about themselves and others. They may assume that you will view them negatively, until extremely proven otherwise.

What are effective counseling skills?

Effective counseling skills are the Rogerian counseling skills. Empathy, genuineness and positive regards are most important. It is necessary to keep showing your commitment to and understanding of the client. This can be done by empathic statements, tone of voice, facial expressions, choice of words and body language. The most important basic counseling skills are:

• Positive reinforcement.
• Empathy.
• Encouragement.
• Acceptance of client.
• Caring.
• Validation.
• Positive regard.
• Accurate understanding.
• Interest.
• Inspiring hope.
• Genuine warmth.
• Humor.
• Offering a positive view of the client.
• Compassion.

Be alert for your clients' emotional reactions troughout the session. Address the issue right away, when you recognize that clients are experiencing increased distress. Positive reinforce expressed negative thoughts about themselves, the proces or you. It is wise to then conecptualize the problem and plan a strategy to resolve it. When the negative feedback of a client is not addressed, it may cause problems later on. 

The skills named above are important, but so is your ability to assess and adjust the degree to which you use these skills with every individual client. Most clients will react positively, but do not overdo or underdo it. The right balance is different per client. Emotional reactions give a clue to wether or not you should adjust yourself.

Different characteristics of the client can influence the therapeutic relationship:

• Age.
• Gender.
• Ethnicity.
• Socioeconomic status.
• Disability.
• Sexual orientation.

Remember that your own background and culture exert an influence on your values and beliefs and on how you perceive, behave to and speak toward clients. Being aware of this can help you react to your clients in a culturally sensitive way.

Should a therapist use self-disclosure?

In CBT, it is advised not to be a blank screen as a therapist, and thus use self-disclosure. Clients should perceive you as a warm, authentic person who wants to help them. Of course, self-disclosure should have a definite purpose. It is important to pay attention to yout clients' verbal and nonverbal reactions to your self-disclosures. Timing is everything. 

What causes difficulties to arise in the relationship with some clients and not with others?

Clients bring their general beliefs about themselves, other people, and relationships to the therapy session, as well as their characteristic behavioral coping strategies. These beliefs navigate their behavior, percepions and reactions in therapy. 

Problems in the relationship can arise, because you made a mistake. Common mistakes are:

• Misunderstanding what the client said.
• Being too directive or too nondirective.
• Interrupting too much.

If you have not made a mistake, the problem is likely to be related to your client's inaccurate cognitions. When clients have an incorrect view of you, they may very well have a similarly incorrect view of others. If this is the case, you can help them draw a conclusion about your relationship and then test it in the context of other relationships.

Your client and you influence each other. You, as a therapist, will likely bring your general beliefs about yourself, other people, relationships and your characteristic behavioral coping strategies. You may react in an unhelpful way if your negative core beliefs get triggered. Your client then may engage in an unhelpful coping strategy. Be aware of this and try to anticipate.