Key Issues for Counselling in Action

Windy Dryden, Andrew Reeves, Windy Dryden, Andrew Reeves

• Publisher: SAGE Publications Ltd
• Year: 2008
• Print ISBN: 9781412946995, 9781412946988
• eBook ISBN: 9781446243596
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Effective counselling is based on a strong working relationship between counsellor and client. Building and maintaining this therapeutic alliance, demands both skill and an ability to negotiate challenges which arise during the counselling process.

Key Issues for Counselling in Action prepares new practitioners for face-to-face work with clients by looking at what is required at each stage of the process and examining issues which practitioners most frequently need to deal with along the way. The topics covered are relevant to all counsellors, regardless of theoretical orientation.

The book explores the everyday issues counsellors face when:

- getting started

- making an assessment

- working at relational depth

- setting goals, and

- ending the relationship

Advice is also given on more difficult challenges, such as dealing with:

- reluctant clients

- stuckness

- client dependency, and

- unplanned endings.

Key Issues for Counselling in Action is a bestselling text which has been used to train many thousands of counsellors as well as supporting their continuing professional development. This second edition has been completely re-written and includes new material on the use of touch, self-care, culture and counselling evaluation.

Windy Dryden is Professor of Psychotherapeutic Studies, Professional and Community Education (PACE) at Goldsmiths College, University of London.

Andrew Reeves is a University Counsellor at the University of Liverpool Counselling Service and Editor of the journal, Counselling & Psychotherapy Research.

1

The Therapeutic Alliance as an Integrating Framework

Windy Dryden

In this chapter I will briefly consider a perspective on the therapeutic alliance in counselling which, I hope, will serve as a framework in which the material presented in the rest of this book can be placed. The following chapters all focus on a key issue of counselling practice which deals with a different point in the counselling process. The view that asserts that counselling is a process which unfolds over time is, in my opinion, a crucial one. Counsellors are faced with different challenges at the beginning of counselling from those they face during the middle and ending stages of this helping endeavour. Effective counsellors, then, in my view, are those who are flexible and skilful enough to modify their interventions according to the particular stage in which they and their clients are working (see Chapter 9). Effective counsellors also can vary their style of intervention according to the different needs of different clients (see Chapter 9).

The Four Components of the Therapeutic Alliance

It is important to place the chapters that follow into a framework which views counselling from a broad perspective. I have chosen to outline briefly one such perspective which considers the work of counsellors to involve the initiation, maintenance and ending of the alliance that exists between them and their clients. Bordin (1979) has written an important paper showing how the old psychoanalytic concept of the working alliance between counsellor and client (here referred to as the therapeutic alliance) can be broadened and divided into interrelated components. He argued that the therapeutic alliance can be broken down into three such components: bonds, goals and tasks. I have argued elsewhere (Dryden, 2006) that a fourth component – ‘views’ – should be incorporated into an expanded version of Bordin’s model and it is this expanded model that I will present here.

Bonds

When the bond between counsellor and client, i.e. their interpersonal connectedness, becomes a focus for consideration, certain counselling concepts become salient. The first, and perhaps the one that has received most attention in the literature, concerns the interpersonal attitudes of the counsellor and their impact on the client. Such work has its roots in the person-centred tradition, e.g. Mearns & Thorne (2007), but has a wider relevance. This work has shown that when the counsellor (a) demonstrates an empathic understanding of the client’s concerns; (b) is genuine in the therapeutic encounter; and (c) shows unconditional acceptance of the client as a person, and when the client experiences the presence of these counsellor-offered conditions, then the client tends to move to a position of greater psychological growth. Early arguments that such communicated (and perceived) counsellor attitudes were necessary and sufficient for client development have subsequently given way to the view that these attitudes are therapeutic under most but not all conditions. Indeed, it is interesting to compare the views of Mearns & Thorne (2007) with those of Trower et al. (1988) on this point. For Mearns & Thorne, such counsellor attitudes form the backbone of their book on person-centred counselling and the skilful communication of these attitudes constitutes the basic work of person-centred counsellors. For Trower et al., who write on cognitive-behavioural counselling, these attitudes are important in that they set the stage for the strategic and technical work that is to follow.

From a therapeutic alliance perspective, a more complex picture emerges that is in keeping with the present research position (Beutler et al., 2004). This position states that these counsellor attitudes are often important for most but not all clients. Here the task of the counsellor is to emphasise certain attitudes with some clients and to de-emphasise other attitudes with other clients in order to establish the most productive and idiosyncratic therapeutic bond with each individual client.

The second area that is relevant to our discussion of the therapeutic bond places more attention on the client’s feelings and attitudes towards the counsellor. Here such concepts as the client’s trust in the counsellor (see Chapter 6), feelings of safety in the relationship (see Chapter 4), and degree of faith in the counsellor as a persuasive change agent become salient. While the focus of understanding how to best promote such client feelings and attitudes has been on constructive counsellor qualities and interventions, it is now recognised that clients bring with them to the counselling endeavour pre-formed tendencies in these areas which have a powerful impact on the counselling process (Moras & Strupp, 1982). Thus it may be that when a client has little trust in other people, finds them threatening to be with and has little or no faith in counselling as a vehicle for personal change, then the phenomenon of ‘client reluctance’ is encountered (see Chapter 10). This is particularly so when, in addition, the client has, in some way, been coerced into seeking counselling ‘help’.

The third area relevant to the therapeutic bond concerns work that has been done on the interpersonal styles of both client and counsellor. Here the focus is more interactive than in the previous two areas. The line of reasoning that has emerged from such work is that the counselling bond can be enhanced when the ‘fit’ between the interpersonal styles of counsellor and client is good and threatened when such a fit is poor. An example of a productive fit between counsellor and client, at least in the early stages of the relationship, would be when the counsellor’s style is ‘dominant-friendly’ and the client’s style is ‘submissive-friendly’. An example of an unproductive fit would be when the counsellor’s style is ‘passive-neutral’ and the client’s is ‘submissive-hostile’. The implications from such work are that the counsellor’s initial task is to modify his or her interpersonal style to complement the client’s style in order to initiate the therapeutic alliance. Once such an alliance has been firmly established, the counsellor can begin to consider ways of slowly changing his or her style in the service of initiating client change. The important point here is that initial bonds which may be counter-therapeutic in the longer term for client development may have to be established to get the relationship off the ground. This theme is explored in Chapters 9 and 13.

Another implication of this work is that clients who have a critical/hostile style of interaction are more difficult to engage in counselling at the outset than clients who are appreciative/friendly. While the danger here is that clients who are critical and hostile get blamed for prematurely dropping out of counselling, the real implications of such a viewpoint concern alerting counsellors to very early signs of threat to the development of a productive alliance and encouraging them to focus on this in as constructive a way as possible. Indeed, it has been shown that ignoring such threats does little to promote a constructive counselling relationship (Foreman & Marmar, 1985).

Another slightly different way of looking at the counsellor–client interactive bond has emerged from social psychology, e.g. Dorn (1984). Here the focus has been on clients’expectations for counsellor participation and counsellors’ use of a power base, particularly in the early stage of counselling.

When clients show a preference for counsellor formality and demonstrations of expertise, then counsellors who seek to meet such expectations at least initially are more successful at initiating a productive therapeutic alliance than counsellors who try to encourage the clients to work in a relationship characterised by counsellor informality and friendliness. Clients who have such expectations seem to benefit more at the outset when counsellors use a power base consonant with these expectations. In this case, this means emphasising one’s credibility as an expert and using a formal style of interaction. However, using such a power base may well have an impeding effect on clients who expect their counsellor to be more informal in style and to emphasise personal rather than professional qualities. With such clients, counsellors need to emphasise a power base characterised by informality, attractiveness and trustworthiness.

The point here is that counsellors who can appropriately vary their style of interaction, and the power base in which such styles are rooted, are more likely to be more successful at initiating a therapeutic alliance than counsellors who use only one style of interaction and a single power base and expect their clients to adjust accordingly. The theme of counsellor variation is taken up in a slightly different way in Chapter 9.

The final area which is relevant to the bond between counsellor and client relates to the concepts of transference and countertransference. Although these concepts have been derived from psychoanalytic approaches to counselling and psychotherapy (see Jacobs, 2004) and their very mention has a negative effect on many non-analytically-oriented counsellors, my position is that it is the phenomena to which the terms point that are more crucial than the use of terms themselves. The terms point to the fact that both clients and counsellors bring to the counselling relationship tendencies to perceive, feel and act towards another person which are influenced by their prior interaction with significant others. These tendencies can and often do have a profound influence on the development and maintenance of the therapeutic alliance. Working with transference in counselling is explored in Chapter 11 and the issue of countertransference is discussed in Chapter 18

It should not be forgotten that the development, maintenance and ending of the therapeutic bond (as with the other components of the therapeutic alliance to be considered) are influenced by the gender and racial composition of the counsellor–client pairing (see Chapter 20) and I refer the reader to other books in this series for a full discussion of these issues (Chaplin, 1999; d’Ardenne and Mahtani, 1999).

Bordin’s (1979) point about the importance of bonds in the therapeutic alliance is that the effectiveness of counselling and psychotherapy depends, to a large extent, on the development and maintenance of a productive bond between counsellor and client. I would like to stress here, as I have done earlier, that while the distinguishing feature of the bond in its early stages is one where there is a comfortable fit between counsellor and client, productive change is more often predicated upon the resolution of manageable conflict in the bond than it is on the perpetuation of early feelings of comfort in that relationship (see Chapters 2–5). Although it has to be said that some clients do benefit considerably from counselling relationships which are characterised by an enduring sense of comfort. Yet in most counselling relationships counsellors need to introduce dissonant elements (challenges) into the relationship so that clients can be encouraged to make changes in their style of acting, feeling and thinking.

Such dissonant elements or challenges, when constructive, need to be introduced in the context of a relationship based on solid foundations, that is, solid enough to survive the challenges thus introduced. The challenge may indeed be introduced by the client, and Bordin makes the important point that from wherever the challenge originates the therapeutic alliance may indeed be strengthened by the successful resolution of a threat to its existence. It is where such a solid foundation in the relationship is absent that challenge has the greatest potential for therapeutic harm for the client (and in some instances, the counsellor). This issue of challenge and the resolution of conflict that it engenders is prevalent in Chapters 6–9 in Part 2 of the book.

Views

The second component of the expanded model of the therapeutic alliance is called ‘views’ (Dryden, 2006). These concern the views held by you and your client on such relevant issues as:

• The nature of clients’ psychological problems. For example, are clients’ problems determined largely by their childhood, their underlying beliefs, poor housing conditions or discrepancies between their ideal self and actual self, to name but a few?
• How can clients’ problems best be addressed. For example, are clients’ problems best tackled by challenging their underlying beliefs, offering them a safe space to talk with an empathic counsellor or encouraging them to live in the present?
• The practical aspects of counselling. For example, how long should counselling last, how often should sessions occur, what are the fees to be paid and what is the cancellation policy?
• Counsellors’ views are influenced by their counselling approach. Counsellors’ attempts to understand their clients are likely to be influenced, at least in part, by the constructs put forward by the approach in which they have been or are being trained. This is also the case when we consider counsellors’ attempts to help their clients. Different approaches to counselling emphasise different constructs and may use different language to describe similar constructs. Most books on counselling approaches make clear which constructs are used by the approach when understanding and helping clients.
• Clients have views about counselling too. As noted above, clients are also likely to come to counselling with some idea of what determines their problems and the nature of the help that their counsellor will be providing them. If we consider the latter issue, for example, these ideas may be well informed and accurate, as in the case of a person who has read about a particular counselling approach, has sought a practitioner of that approach because she (in this case) has resonated with it and has a clear idea of what to expect. On the other hand, this idea may be inaccurate, as in the case of a person who expects advice from a practitioner who is very unlikely to give it, e.g. a person-centred counsellor.
• Effective counselling occurs when the client’s views are similar to the counsellor’s. Therapeutic alliance theory holds that when clients’ views are similar to their counsellor’s on the above issues, then counselling is more likely to be effective than when such views are different. When they are different, these differences need to be acknowledged and openly discussed.

The outcome of such discussion may be for the relationship to proceed because (a) the client has adjusted to or is prepared, for a while, to work on the basis of the counsellor’s view; (b) the counsellor has adjusted to the client’s view (it is interesting here to speculate how often counsellors do this); or (c) the client and counsellor have negotiated a new shared conceptualisation of the client’s problem which is different from their previous initial attempts at understanding (this is an important but poorly understood topic awaiting future empirical enquiry). If the counsellor and client cannot come to some sort of shared understanding on this issue, the counsellor may, at this point, refer the client to a counsellor who will offer a conceptualisation of the client’s problem more acceptable to the client.

Goals

The third component of the therapeutic alliance – goals – pertains to the objectives bot...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• List of Contributors
• Preface
• Acknowledgements
• 1. The Therapeutic Alliance as an Integrating Framework
• Part 1: Initiating the Therapeutic Alliance
• Part 2: Deepening the Therapeutic Alliance
• Part 3: Dealing with Threats to the Therapeutic Alliance
• Part 4: Ending the Therapeutic Alliance
• Part 5: Issues for the Counsellor
• Index