The Therapeutic Relationship in Counselling and Psychotherapy

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Rosanne Knox & Mick Cooper

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    Acknowledgements

    Essential Issues in Counselling and Psychotherapy

    Edited by Andrew Reeves

    Counsellors and psychotherapists consider a number of important factors in their work with clients. Some are defined by training and theoretical orientation, some by context, and others by the client group with whom they work. However, across all these areas there are a number of essential issues – those that sit at the very core of practice – that must be considered by all therapists.

    Essential Issues in Counselling and Psychotherapy is a series that brings together a number of new, accessible and practice-informed books that carefully and thoroughly address those considerations: the essential issues of practice that can challenge and shape all aspects of counselling and psychotherapy.

    For new and forthcoming books in the series please visit www.uk.sagepub.com/cp

    Assessment and Case Formulation in Counselling and Psychotherapy

    Biljana van Rijn

    The Therapeutic Relationship in Counselling and Psychotherapy

    Rosanne Knox and Mick Cooper

    Working with Risk in Counselling and Psychotherapy

    Andrew Reeves

    Acknowledgements

    To my partner Howard, and my three daughters Laura, Helena and Amelia, whose love and support has been immeasurable. – RK

    To Graham, for all his support, warmth, and guidance over the years. – MC

    About the Author

    Rosanne Knox is a manager in a UK children’s charity, and a BACP accredited therapist with a private practice in West Sussex where she lives with her partner. Rosanne’s doctoral research, undertaken at the University of Strathclyde, involved explorations of aspects of the therapeutic relationship from the perspective of clients. Publications include a range of research papers on clients’ experiences of the relationship, and in particular relating at depth. Rosanne is a co-editor of Relational Depth: New Perspectives and Developments,and contributed a chapter to the Second Edition of The Tribes of the Person-Centred Nation. Rosanne has three daughters living and working in London.

    Mick Cooper is a Professor of Counselling Psychology at the University of Roehampton, a chartered counselling psychologist and a UKCP-registered existential psychotherapist. Mick is author and editor of a range of texts on person-centred, existential, and relational approaches to therapy, including Working at Relational Depth in Counselling and Psychotherapy (Sage, 2005, with Dave Mearns) and The Handbook of Person-centred Psychotherapy and Counselling (Palgrave, 2013, with Maureen O’Hara, Art Bohart and Peter Schmid). His most recent book is Existential Psychotherapy and Counselling: Contributions to a Pluralistic Practice (Sage, 2015). Mick has led a range of research studies exploring the process and outcomes of humanistic counselling with young people, and is author of Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly (Sage, 2008). Mick lives in Brighton with his partner and four children.

    Preface

    Aims

    In writing this book we aimed to address some of the most commonly asked questions around the therapeutic relationship. Our hope was that it might provide a guide as you navigate your way through the intriguing and sometimes complicated terrain of engaging in, understanding, and making full use of the therapeutic relationship in individual counselling and psychotherapy.

    The book will take you through different aspects of the relationship, from the initial boundary setting to the deepest levels of connection, exploring the uncertainties, risks and controversies along the way. Each chapter will focus on a particular aspect of the relationship, addressing the key questions which are commonly asked. Discussions will be grounded both in our (the authors’) own experiences as therapists, and in empirical evidence on the experiences and perspectives of both therapists and clients engaged in a range of different therapies.

    Different perspectives on the therapeutic relationship

    The relationship itself is valued in a variety of ways, depending on your therapeutic approach. For CBT therapists it is akin to a close partnership, agreeing on particular aims and tasks with the client. The classic psychoanalyst is perhaps the least personally involved, sometimes sitting out of view of the client, giving them free space to explore their past and present, and their own thoughts and feelings, with few interventions being made. The psychodynamic therapist is looking out for the transference and countertransference that arise through the relationship, relating past experiences to present responses to them in the relationship. For the person-centred and experiential therapist – existential, gestalt, or humanistic – the relationship in the present is core to the therapy. However all therapists require a depth of relating, in their own way.

    While the aims for each individual client should be those of the client and not the therapist, our own beliefs as therapists as to what constitutes a positive outcome will be coloured not only by our own personal views, both overt and hidden, but also by the therapeutic approach in which we are trained. For example, cognitive behavioural therapists are likely to see the main aim for the client as becoming a reasonably happy person who is able to problem solve. Psychodynamic therapists might see a client’s overall aim as being to move from unconscious despair to acceptance of life and loss, while humanistic/experiential therapists might see a client’s underlying aim as being authentic and moving towards actualisation in accordance with their own individual potential. Our own relating to clients cannot help but differ accordingly: cognitive behavioural therapists are likely to be exploring patterns of thinking and challenging cognitive errors, psychodynamic therapists are likely to be encouraging insights into unconscious links to significant relationships in the past, and experiential/humanistic therapists are likely to be trusting in a client’s own process and providing an authentic relationship through experiencing empathy, congruence and unconditional positive regard for that client.

    While we would acknowledge that the experience of both authors has been predominately gained from within the person-centred and humanistic field, our aim has been to produce a book which is relevant to therapists from all orientations. The questions addressed are those of new and trainee therapists from a range of approaches, and the issues are those which any therapist may be faced with at some point in their client work.

    Readership

    This book is written both for newly qualified and trainee therapists as they start out on their professional journey. It may also be of interest to more experienced therapists as they progress through the world of counselling and psychotherapy, enhancing their skills, abilities and knowledge. We have covered areas that at some point are likely to face all therapists, whatever their experience or orientation.

    Use of evidence

    In addressing various areas we have striven, as far as possible, to explore what the evidence says about the different topics, so that our answers are grounded in research. In this way we hope to provide you with advice, suggestions and explorations that are supported by the experiences of clients and therapists alike, across a range of approaches.

    The examples given in this book are drawn from a range of sources. Many come from research undertaken into clients’ and therapists’ experiences of client–therapist relating. Some are from the authors’ own experiences. A few are hypothetical situations for discussion, although also drawn from experience. All have been anonymised.

    Researching key questions

    To help ensure that we were discussing the questions that new and trainee therapists actually want addressed, rather than what we think they might want addressed, we conducted our own research prior to writing this book. This took the form of an online questionnaire, supported by a series of focus groups. We asked participants to let us know the questions they had, the concerns or apprehensions they felt, or any challenges they faced around the client–therapist relationship. This book addresses the main questions that arose.

    We would like to extend our thanks to all the participants of this study, who so generously gave their time and shared with us the questions that most concern them about the therapeutic relationship.

    Writing the book

    Rosanne is the principal author for this book, and Mick acted as consultant. We worked, together, on the questions that we wanted to address. Rosanne then drafted each chapter, which was commented on by Mick with suggested revisions. Rosanne then redrafted with further comments and revisions from Mick.

    Structure of the book

    The book begins at the start of the relationship, looking at setting the therapeutic frame and the boundaries you might want to put in place. We also look at different ways of managing the ending. Chapter 2 discusses the important aspect of collaboration between you and your clients. We then move on to questions around the quality of empathic listening and some of the challenges for you, as the therapist, leading onto questions around the level of care and warmth you might show your client, and how that care might be perceived and interpreted. Chapter 5 looks at the notion of being ‘real’ in the relationship, and explores the balance between professional expert and a human, personal approach. Chapter 6 discusses the value and challenges of different levels of relating. Chapter 7 looks at the therapeutic relationship with children and young people, and finally we consider additional considerations needed in telephone and online counselling.

    We hope you enjoy our discussions of the issues raised, and find in these pages some useful guidance that may help you as you navigate your way through the rich and varied therapeutic relationships you experience.

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