Respect-Focused Therapy
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Respect-Focused Therapy

Honoring Clients through the Therapeutic Relationship and Process

Susanne Slay-Westbrook

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eBook - ePub

Respect-Focused Therapy

Honoring Clients through the Therapeutic Relationship and Process

Susanne Slay-Westbrook

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About This Book

Therapists have a unique opportunity and responsibility to provide a respectful environment for their clients, yet respect has not received adequate attention in the psychotherapy community and related research. Respect-Focused Therapy: Honoring Clients Through the Therapeutic Relationship and Process sets forth the formulation of respect-focused therapy (RFT), a new approach to psychotherapy that addresses the quality of the client–therapist relationship and therapeutic process. This volume treats respect as a combination of action, attitude and open-mindedness, urging therapists to recognize their own biases and beliefs and be willing to suspend them for the benefit of their clients. Using Martin Buber's "I-Thou" relationship as a conceptual model, Slay-Westbrook provides core principles of respect and demonstrates how to incorporate these into the therapeutic relationship to best foster a healing environment.

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Setting the Stage

The “I-Thou” Therapeutic Relationship

Respect is basic and essential to any positive human interaction. We all need and seek it. And yet, respect seems often to be lacking in a deeply harmful way in our world, our homes, our workplaces, and our communities. This phenomenon is often overlooked in therapy. We, who are in the mental health field, need to take a harder, more deliberate look at how we can best facilitate our clients establish the awareness and skills necessary to get it back.
We find examples of the lack of respect in the everyday lives of many of our clients, such as apathy in communication and listening skills in many relationships, serious disregard for the feelings of others, meanness in speech, or violent communication, as well as violent actions and abuse. The connections among these various levels of disrespectful behavior often seem to be understudied and therefore not addressed fully. In this chapter, we focus on these connections and the patterns they create to better understand the powerful strength of intervention respect can have as well as the danger and malignancy disrespect, unrecognized and untreated, imposes.
Respect is not only a noun but is also, and more powerfully, an active verb, requiring an intentional action of some sort. It can be as small as making eye contact with a pleasant smile or greeting or not interrupting someone speaking—simply good manners or polite behavior, as many think it to be. But it can be so much more, exceeding form or cordiality, becoming as deep as being tolerant and accepting of others’ behavior or understanding of varying human perspectives, such as sexual or cultural differences. Regardless, respect can serve as a healing agent, making every human interaction work more effectively.
Respect-Focused Therapy (RFT) is not a technique or a theoretical model but rather a foundation on which all modalities and techniques used in therapy are, or should be, grounded to produce sound, effective outcomes. For the remainder of this chapter, I will be considering other theoretical approaches as they relate to RFT, how they are supportive through similarities, as well as how RFT brings additional perspective, unifying all of these approaches through the lens of respect.

The Therapist in the Therapist-Client Relationship

What the therapist brings to the therapist-client relationship is vitally important to the entire process and outcome of therapy. Because of the power disparity between therapist and client, it is easy to slip into the position of judge or parent without intention. Even the smallest biases can get in the way of doing good, effective work, such as regarding physical appearance, dress, hygiene, or language, not to mention parenting or relating styles or what we may consider to be inappropriate behaviors.
Our role as therapists inherently contains a certain power that can be too easily forgotten. We are the helpers, the professionals. We have been trained to be empathetic. We have learned skills and techniques. More importantly, the truth is, or should be, that we really do care, or we probably would not have chosen this field. We genuinely want to help alleviate human pain and suffering. It is with this intention that we go forward with this challenging but rewarding work. But the best intentions can be maligned by the presumption that we are indeed fulfilling this appropriately. This presumption can and does often bypass the focus of respect. The act of helping can then unintentionally create imbalance in power or asymmetry.
To this point, respect can become the equalizer, or as Lawrence-Lightfoot (2000) put it, respect “creates symmetry” (p. 5). One of the core principles of respect I present in this book is that respect in its truest form is not hierarchical; it is lateral and genuine and thereby most effective in creating real change. It is freely given, not demanded or fear based. This directly challenges one of the more widely assumed aspects of respect: that it is reserved for elders or authority. This assumption leaves out a large section of humanity, namely, all of those who do not have power or authority over others, including children.
In undergraduate school, I was required to write a senior-year thesis in psychology. I chose to do a phenomenological study of the nature of helping behavior, particularly as it related to the level of acceptability of the way the help was presented to the persons being helped. The two groups I studied were persons with physical disabilities and persons without obvious disabilities. It was particularly interesting to me that the nondisabled population found it harder to accept help than the disabled population did but just as notable, and perhaps more significantly to the point being made here, is that the factor that made help most acceptable to both groups was the feeling of equality with the helper. Condescension of any form made the help less desirable to those being helped. Being treated or perceived as helpless or inferior in any way most often was the cause of refusal of help.
As therapists, as human beings in this role, we need to remind ourselves always of our humanity, our own frailties, woundedness, triggers, biases, and perceptions of the world at large. The respect we have, or don’t have, for ourselves is critical to how we find and build respect for our clients. Self-care, then, is a mandatory piece of the puzzle in the quality of care that we give to our clients. Our physical and mental well-being contribute heavily to our ability to be fully present and separate in a way that gives us the maximum capacity to openly respect the total uniqueness of the person(s) sitting in front of us. If we genuinely have respect for our unique selves, we are much more available to have it for others. There will be a more in-depth discussion about how to gain and maintain this kind of self-care and real respect for oneself in the last chapter of this book, but from this point forward, please keep in mind that you are key in the entire process and development of RFT.

Mindfulness and Respect

With this self-awareness, it is important to be consistently mindful that the positive aspect of helping is evident when it is acknowledged as truly being helpful in a way that is wanted and balanced. By really listening to our desired path and outcome in therapy, we increase our ability to actually help in a much more significant way.
In recent years, much has been written and researched regarding mindfulness in therapy, as studied through the lenses interpersonal neurobiology and neural integration (Siegal, 2010). Mindfulness is about being fully aware in the present, both of self and others. It also includes “being open minded and avoiding premature closure of possibilities” (Langer, as cited in Siegal, 2010, p. 20) as well as “being aware, on purpose and nonjudgmentally, of what is happening, as it is happening in the present moment” (p. 20). All three definitions complement the meaning of respect as presented in this work, although they stop short of addressing the valued totality of others as well as self.
Allan Schore (2012) states, “Relational-affective processes between patient and therapist are at the core of the change mechanism. Indeed, a large body of basic research in clinical psychology on the therapeutic alliance is supporting a shift from a purely intrapsychic one-person psychology to a relational two-person psychology” (p. 10). I would submit that the work of Carl Rogers, which precedes this work, researched and postulated similar findings and therefore is foundational to it.
Being aware of one’s nervous system status and how this affects and is affected by others’ nervous systems have been covered extensively by the likes of Allan Schore and Dan Siegel, yet very little has been written specifically on the topic of respect as a central agent of change at both non-conscious and conscious levels in the therapeutic process. The practice of mindfulness-based therapy and the practice of RFT share parallels within the brain and might at first seem hard to distinguish, but there are substantial differences. The primary operational difference between the two approaches is that respect takes the affective focus of mindfulness to a new level by providing a cognitive template that seeks to realize that which is positive in self and others. Although this search for the positive might at first seem like a hearkening to Seligman’s positive psychology, RFT is inherently focused on relationships with self and others, whereas positive psychology tends to focus on frame of mind and thus is not generally regarded as being relationally oriented.

Respect Versus Empathy

The etymology of the word respect is respectare or respicere (Latin derivation), meaning “to look again.” To take another look, to reconsider, is to respect. In other words, to respect is to respond in a way that can create affirmation rather than dissent. It requires us to be willing to stand back, take another look, and reconsider that which is around us as well as inside of us. This reconsideration involves both cognitive and emotional processing, which take in the entirety of person, not just the presenting portion that is in front of us. In doing this, we can more effectively connect and build value in ourselves, in others, and in our world.
Empathy is derived from the Greek en patheos, which means “in feeling.” Therefore, empathy is about shared understanding of emotion. This is a critical component in any therapeutic environment, requiring both learned skill and an innate human quality in the therapist. Experience is probably the best teacher of empathic understanding because it is so based in emotive connection, requiring vulnerability. We know that empathy is one of the most highly researched components of psychotherapy, yet still it is debated in terms of being more or less significant in the healing process as compared to specific technique or modality (Patterson, 1984).
Respect, conversely, has been much less researched in our field, even though Marie Jahada, (1958) (as cited by Hymer, 1987) recognized it as being “one of the major criteria for mental health” (p. 6). Dr. Sharon Hymer, one of a few to directly address the role of respect in psychotherapy, went on to say, “There have only been a few investigations of how therapists foster or impede the development of respect in psychotherapy. Respect concerns how we look at our patients and takes into account their uniqueness” (p. 6). Respect can expand the therapist’s understanding of the client’s experiential knowledge based on previous life events.
Furthermore, according to Dr. Ana Maria Rizzuto (1993), “[R]espect is naturally presumed to be a component of the therapeutic relationship. Therapists, however, need to go beyond the everyday understanding of respect and be prepared to provide a dimension that we do not expect to find in other human relations” (p. 277). She emphasized that respect is “the act of noticing with attention” (p. 277).
Respect encompasses empathy, requiring it to exist, yet goes far beyond empathy because it includes cognitive as well as affective understanding. Respect is a comprehensive understanding of a complete individual, including values, beliefs, culture, life experience, and the understanding and interpretation of that experience. Empathy is essential in establishing a connection to be built on, but respect carries that connection deeper and wider. To be clear, respect without empathy would be hollow, mechanical, and academic at best so that both must exist to firmly establish trust as well as connection.

Feminist Psychology

The feminist movement in the 1960s and 1970s had a profound impact on the culture of male dominance and, more significantly, on the empowerment of women. Although it certainly did not eradicate sexism, it did shine a bright light on the darker qualities of unfairness and inequality between the sexes, which opens doors for reevaluation of gender roles and their values in our society. As the feminist movement grew, it found new ground in psychotherapy as therapists found a new voice and determined ways to bring this voice into their work and share it with their clients. This shift in gender role assessment also led the way toward an even larger paradigm shift, which became inclusive of a wider definition of power disparity.
Dr. Laura Brown (2014) summarizes the development in feminist therapy in this way:
Feminist Therapy is a theory that derives its inspiration and its wisdom from an in-depth interrogation of standpoints that are unavailable to dominant cultural simply because they have been relegated to the margins; the standpoints of Euro American women, people of color, lesbian, gay, and bisexual people, gender variant people, poor people, people with disabilities, immigrants and refugees.
This radical stance of listening more to the marginalized, or weaker voice, was not initially well received by mainstream psychology and still is primarily practiced by feminists, although the tenets of inclusion have been more normalized over the decades.
However, Brown goes further by establishing the fact that feminist therapy is not only inclusive of the marginalized but “privileges” or centers focus on the nondominant voice of wisdom.
Feminist therapy does not simply study the “other” in order to offer a neutral perspective on that experience. Rather, what is inherent in Feminist Therapy theory is the radical notion that silenced voices of marginalized people are considered to be the sources of the greatest wisdom.
(Brown, 2014)
The very notion that the persons least recognized become instead most valued by the process indicates an intention to reassess human worth and dignity not based on social norms, as is noted biblically as “the last shall be first and the first last.” Again, respect is utilized to “reconsider” that which might not be apparent in other circumstances. Yet this primary shift in perspective serves to clarify and enrich the very meaning of human experience.

Vulnerability and Shame

Dr. Brene Brown (2013) has recently done interesting research on vulnerability and shame. She defines vulnerability as “uncertainty, risk and emotional exposure” (p. 34). She further says,
Vulnerability is also the cradle of the emotions and exper...

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