How to Build a Trusting Counselor Patient Relationship
Critical Exploration of Counselor Client Relationship in Disability and . with a model that allows them in having a different experience with. Discussing the therapeutic relationship with clients. • Contractual arrangements . that counselling tends to work better if both the client and the therapist. 01_Knox .. Try to model the boundaries you are setting. For example. Where the power lies in the therapist-client relationship . intense than ever as digital disruption threatens traditional media's business model.
Here the therapist will determine if the client is at a risk for harm, either from self or others. The therapist will also complete psychological testing or any other paperwork that will help form a diagnosis.
Goal setting with the client should also take place during this phase, guiding the client in setting positive and realistic goals that will lead them to success. Some general positive goals that clients need are to improve coping skills, improve decision making skills, and build better relationships. Once the general goals are set, the client can begin to set more specific goals such as finding a job and the steps to follow. A treatment plan can be established in this phase, laying out the goals and giving a deadline to those goals.
The working phase involves implementing the treatment plan. It is time for the client to start taking actions towards achieving their goals. If a client needs to leave an abusive household for their own safety, they can start making progress towards that goal by completing specific tasks.
If a client needs to confront someone, the therapist can role play the confrontation with them to help the client build confidence and assertiveness.
If a client needs to quit using drugs, this is the time to implement steps such as going to detox or rehab. The resolution phase is where the therapist will begin the termination process with the client. Helping the client find closure and helping them find their independence outside of therapy is a must. Through each and every therapeutic phase it is necessary to have clearly communicated boundaries between therapist and client. The Need for Boundaries There is a need for clear boundaries to protect the therapeutic process and to keep the relationship professional.
Boundaries protect clients from getting taken advantage of due to vulnerability. Boundaries also protect therapists from being sued by patients. In some ways, the client automatically trusts their counselor as an authority figure.
Necessary Boundaries for a Healthy Counseling Relationship
Although they may not trust them with all of their secrets right away, there is a level of trust that the therapist is not going to harm them. Therapists know this and should take extra steps to let the client know they will not take advantage of that trust and confirm they will do everything in a manner that is beneficial to them getting help.
Therapeutic boundaries are of significant importance because it makes the client feel safe. Boundaries are based on good decision making skills.
Steps to ethical decision making include some of the following: State the question or concern clearly and simply to avoid confusion Anticipate who will be affected Determine who is the client Assess if you are the right person to do the job Review ethical standards Review research and history relevant to the situation Consider any or all things they may affect ethical judgment Develop plan B to decisions Think through alternative courses of action Document process and results along the way Types of Boundaries There are different types of boundaries including boundary crossings and boundary violations.
Boundary crossings are not harmful to the client or the client therapist relationship. There are many times when a boundary crossing can actually be beneficial.
For instance, a drug abuse therapist may want to disclose certain information about their experience with drug abuse in order to help the addict they are counseling feel like they have a competent and knowledgeable counselor who can offer them hope of success. Boundary violations, however, can be harmful to the client and the therapeutic relationship.
Examples of boundary violations include providing more time for one patient than for others; meeting clients in any location other than a professional office; seeing a patient for free or allowing gifts to be exchanged; physical contact of any kind.
Other types of boundaries include physical, emotional and intellectual. In addition, personal boundaries that some clients may have can include rigid, porous and healthy boundaries.
Rigid boundaries are described as being detached and unlikely to ask for help. They can seem anti-social and not have a lot of friends, especially close friends. Porous boundaries of clients appear as overly friendly, finding it hard to say no, over-sharing information about them, fearing rejection and seeking approval from others.
Healthy Boundaries Healthy boundaries allow a person to have high self-esteem, be assertive and make good decisions. Healthy boundaries leave a person feeling good after the session. We all have that nagging feeling or instinct that tells us when something is right or wrong. Listen to your instincts and follow guidelines to make absolutely sure no boundary violations are being made.
Healthy boundaries are based on five different principles: Beneficence is where the therapist recognizes the importance of doing what is best for the client and benefits the client the most. It is an action that is done to benefit the client. Nonmaleficence refers to the therapist who avoids any activities that may do harm to the client.
This is compared to the Hippocratic Oath of do no harm to the client. Autonomy is when the therapist promotes the client being independent from them. Autonomy helps clients make their own decisions. Justice is when the therapist gives counseling that is equal and fair and does not show favor.
Justice can involve equity, access, participation and harmony. Fidelity is being honest and committed to helping the client make progress. Unhealthy Boundaries One way to avoid unhealthy boundaries as a professional is to ask yourself the following questions when working with a client: He came to believe that it was essential for the therapist to recognize this transference and to know how to respond to it, since he felt it could progress or hinder the therapy depending on how it was dealt with.
What Gill and Kohut brought to the debate of the therapeutic relationship was a balancing of the psychoanalytic and humanist traditions.
- How to Build a Trusting Counselor Patient Relationship
- Necessary Boundaries for a Healthy Counseling Relationship
- Where the power lies in the therapist-client relationship
Many psychoanalysts were uncomfortable with the Rogers concept of authenticity since they felt that if one accepted the notion of counter transference, or the unconscious feelings that are stirred in the therapist towards the client, then how much was the therapist to act out his old dramas and to gratify old unsatisfied needs?
Merton Gill, as a psychoanalyst, felt that for therapy to work, it was not sufficient for the client to simply remember thoughts and feelings long repressed. He felt that it was more important for the client to actually re-experience the unconscious emotions.
While he acknowledged the importance of a client understanding the origins of their difficulties, true therapy could only occur when the client re-enacted certain aspects of his past and this could only happen in the therapeutic relationship.
The old impulses and feelings had to be experienced in the presence of the person toward whom they were now directed, while also being expressed toward that person and not simply experienced in silence. Furthermore, the therapist, the person to whom the feelings have been expressed, has to then discuss such feelings and impulses with the client Kahn, Very importantly at this stage, Gill believed that the therapist had to discuss these feelings in a non-judgemental, nondefensive, interested fashion making the client feel safe to express them further.
The relationship is truly the therapy here for through the nondefensive support and encouragement of the therapist to help the client re-experience his old feelings and expectations, he provides the client with a unique experience, whereby he becomes aware of his feelings about the therapist while understanding how those old attitudes determine his interpretation of the events of therapy.
For the client to experience in the therapist a genuine, interested, nondefensive attitude provides him with a situation he has never experienced before and leads to a therapeutic relationship.
Heinz Kohut was even more responsible for bridging the gap between psychoanalysis and humanism than Gill. He, too, believed in the importance of the relationship between therapist and client and in the centrality of the transference but he went even further with a new understanding and appreciation of the value of empathy communicated to the client.
Kohut believed that every child, or developing self, had three important needs that had to be met in order for the self to develop fully. Kohut felt that one of the benefits of the therapeutic relationship was for the therapist to provide the mirror for the client. This was to be done with empathy and understanding, showing the client that his difficulties and way of being were both understandable and understood.
Such a freely empathizing therapist gives the client a sense of being listened to, being deeply understood, and being accepted while providing an opportunity to learn the ancient roots of their difficulties and building new self structures to compensate for the old deficits Kahn, The above therapists and their theories all point to the premise that it is the relationship that is the most beneficial aspect of the therapy.
Awareness of the subtleties and changes in the relationship provides the therapist with perhaps his most therapeutic tool of all.Counseling: Multicultural Clients
However, there are some who would disagree with the full importance of the working alliance. Practitioners using cognitive and behavioural approaches tend to see the therapeutic alliance as simply a means to an end. They feel that it is wrong to overstress the relationship since it obscures the ultimate goal of helping a client manage a problem better. They do accept that such a goal cannot be achieved if the relationship is poor, but feel that an over-emphasized relationship can be a distraction from the real work to be done Egan, Albert Ellis proposes that recently there has been a one-sided emphasis on relationship as the crucial element in therapy.
He states that while a good therapeutic relationship is usually important to help people feel better, good theory and technique are actually more important to help them get better.
However, Barbara Berzon listed eight features of helping which reflect the characteristics of helping most valued by those who have been helped. The basic features of effective helping relationships can be summarized as follows; when there is increased awareness and self understanding on the part of the client, in particular, about the ways others see them; when they realize how similar they are to others, contradicting their original reason perhaps for seeking therapy, that is, feeling out of touch with others; the extent to which the client feels understood, accepted and reacted to genuinely by the therapist; being made aware how others perceive them; being encouraged to self-disclose, to be assertive and to be immediate in their reactions; feeling a sense of open communication even when the counsellor is being confrontative; when the client senses the warmth and genuineness of the counsellor being himself and not simply functioning in the role of a helper; when the client feels he can divulge his inner thoughts and feelings in a safe and neutral environment.
These eight characteristics of a counselling relationship that clients believe have benefited them therapeutically all have their source in the working alliance and stem from the high level of energy and commitment that the therapist brings to the relationship. Although I have yet to work with clients, I do find I can agree with the above list simply from my own experience as a client in a counselling situation.
In particular, the warmth and openness of communication that my counsellor has brought to our relationship has encouraged me in an area of great difficulty — that of self-disclosure and owning my feelings.