Relationships in Counseling and the Counselor's Life

Jeffrey A. Kottler, Richard S. Balkin

• Publisher: American Counseling Association
• Year: 2016
• Print ISBN: 9781556203602
• eBook ISBN: 9781119375449
• Edition: 1
• Topic: Education
• Subtopic: Professional Development

In this engaging book, Jeffrey Kottler and Richard Balkin address common misconceptions about what works in counseling and offer suggestions for building constructive counseling relationships and facilitating positive counseling outcomes. Key aspects of the client–counselor relationship are supported by interesting examples and stories integrated with clinically useful research on counseling results. Part 1 reviews basic assumptions about the nature of helping relationships and examines how and why they can empower client change efforts. Part 2 describes practical approaches to encourage client trust and growth, including chapters on the cultural and environmental context of relationships; the ways in which counseling is used to treat trauma; how exchanging stories solidifies and fortifies counseling relationships; and using creative and innovative
techniques to enhance relationships. Part 3 discusses the influence of relationships on counselors' personal lives and explores how counselors are affected by their work, process disappointments and failures, and deal with personal conflicts.

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Part 1
Some Operating Assumptions About Relationships in Counseling

Chapter 1
What Do We Know, or Think We Know, About How Counseling Works?

Let's acknowledge at the outset that there are decades of empirical research, not to mention practitioner anecdotes, to support the power, influence, and efficacy of counseling. This is true across a number of theoretical orientations, clinician styles, contexts, clinical specialties, diagnostic issues, and client problems. However, in spite of the confidence we might feel in the power of our profession to improve the quality of people's lives, as well as to address their most challenging difficulties, we are by no means all in agreement as to why it works.

In this initial overview of what we know, or at least what we believe may be the case, we review some of the consensual assumptions and common precepts about what most consistently produces the most satisfying outcomes—for both clients and their counselors.

First, a Little History

Much of the interest in the counseling relationship began with Sigmund Freud's (1933/1916–1917) early work, which was followed by many of his colleagues and disciples, investigating the mechanisms of the so-called alliance that takes place in all therapeutic work. Luborsky (1976) distinguished between two different phases in this process; the first includes the supportive and caring “holding environment,” and the second involves the client's own commitment and investment in the process. Bordin (1979) considerably expanded these ideas from a psychodynamic perspective to one that was far more encompassing and integrative. This model, which has now become known as the “working alliance,” consists of three distinct but related features: (1) agreement on goals between counselor and client, (2) collaboration on the structure and content of the sessions together, and (3) respectful and intimate bonds that develop in the relationship. It is this third dimension of relational connection that Carl Rogers (1957) researched throughout his career, emphasizing the warmth, affection, trust, authenticity, and congruence that he found so critical in his work. Complementing Bordin's work were other theorists (e.g., de Shazer, 1985; Haley, 1963; Satir, 1983) who advanced more relational strategies, spawning specializations in marriage, couples, and family counseling. Essential to these theorists was the notion that what is occurring between two people is more important than what is occurring within each person (Bateson, 1972).

All of this is part of the foundational heritage of counseling as a profession. In one sense, it is what helped distinguish counseling from other allied mental health specialties such as social work, psychology, and psychiatry; that is, we have always been (and, we hope, always be) relationally oriented in our approach. Rogers (1980), perhaps more than any other thinker, defined the anthem of the counseling profession when describing the nature of empathy as both the ability and the willingness to understand others' thoughts and feelings from their own unique point of view. He believed this could only legitimately take place when the counselor was able to enter into the private perceptual world of clients, thus enabling the counselor to sense meanings about which clients may not be fully aware.

Empathy has its origins as part of the biological and social basis for human existence. This ability likely evolved as a way for members of a community to literally feel one another's pain and provide assistance as needed. Cozolino (2006) described empathy as more like a hypothesis than an actual sensation: “Shuttling back and forth between my head and what I imagine to be in yours, I generate hypotheses about your inner state based on my own thoughts and inner experiences” (p. 231). He posited that it is our shared neural circuitry that allows us to create models of others' internal states and make assumptions based on this resonance. Using the metaphor of cellular physiology, Cozolino suggested that just as neurons have synapses between them, so too are there social synapses in the spaces between client and counselor, or any other individuals. We communicate across those spaces in such a way that they alter brain chemistry in the same way that cellular structures and compositions are changed as a result of interneuron interactions. So-called mirror neurons, in particular, allow us to feel what others feel—as if it is our own experience. This remarkable ability, as we discuss later, is one reason stories have such a profound effect on people's lives, regardless of their form. When we are watching a film, television show, opera, play; listening to song lyrics; or reading a novel, we enter into the fictional world and fully imagine ourselves living in this alternative universe that provides vicarious experiences without danger or actual threat (Gottschall, 2012; Kottler, 2014).

The Counseling Relationship and the Era of Accountability: Two Opposing Forces?

For any of us who has been in the field for a while, we may remember a time before the strict oversight of managed care and the sometimes rigid parameters of prescribed “manualized” treatments designed to provide greater accountability. This was an era when counselors and therapists were actually allowed to determine for themselves, and their cases, exactly how often sessions should be conducted, how long they should last, and what should be the focus of treatment. Although there were some abuses of this system, it was a time of greater professional freedom in which counselors and therapists determined what was in the best interests of their clients.

In recent years, two terms related to greater accountability in counseling frequently have been used: empirically supported treatments (ESTs) and evidence-based practice (EBP). ESTs refer to specific techniques and strategies that reduce symptoms based on empirically controlled studies. EBP, on the other hand, refers to any evidence that affects client outcomes (Laska, Gurman, & Wampold, 2014). The issue of evidence, therefore, is the primary concern because there is ample support to conclude that the role of the relationship in client outcome is indeed quite substantial. In addition, “evidence” can take many different forms beyond quantitatively measured dependent variables, such as the anecdotal evidence that emerges from personal and professional experience.

Many of us might agree that that there have been times when the obsession with empirically supported interventions for specific presenting complaints has been taken a bit too far. Wampold (2001) has been particularly critical of the role ESTs have garnered in counseling practice and estimated that techniques account for less than 1% of actual client outcomes. Nevertheless, all of us today are expected to provide some evidence that what we are doing is helpful to others. To understand what we know and what we think we know, it might be helpful to explain how we got to this point.

Hansen, Speciale, and Lemberger (2014) provided a historical retrospective on the debate between ESTs and the role of the relationship in counseling. ESTs have roots in the biological premise of behavior espoused by Freud and behaviorism as exemplified by B. F. Skinner and others. As you are probably well aware, our profession has been fighting for respectability as a scientifically supported discipline that is grounded in research. Although humanistic ideologies, exemplified in the work of Carl Rogers, Abraham Maslow, Victor Frankl, and others, provided a counterpoint to the influences of behaviorism and psychoanalysis, the medical model also exerted a lot of pressure on nonmedical practitioners to utilize their Diagnostic and Statistical Manual of Mental Disorders ([DSM] American Psychiatric Association, 1952), which emphasizes ESTs for specific diagnostic entities and configurations of symptoms.

The DSM, originally published in 1952, was developed by psychiatrists in collaboration with the pharmaceutical industry. Although the latest incarnation of this “bible” invites input from other helping professionals—notably, psychologists—it is still heavily shaped by the medical profession, which treats conditions such as depression, anxiety, and other emotional disorders essentially as diseases ([DSM, 5th ed.; DSM-5] American Psychiatric Association, 2013). There has also been a noted preference for any therapeutic approach, such as cognitive–behavior therapy (CBT), that can be “manualized” and empirically tested. Needless to say, relational factors, which are often both indistinct and difficult to measure, have been relegated to categories of “nonspecific” or “common” factors.

Components of Successful Counseling Relationships

Debates and arguments, if not an actual war, have been waged among therapeutic practitioners regarding which approach or model is best. This has been going on for decades, with some arguing that the best way to help people is by focusing on their internal beliefs, or their innermost feelings, or their dreams, or their past unresolved conflicts, or their behavior, or the social constructions of the larger culture, and so on. At one time, these debates may have been useful, but we are pleased to report that more recent efforts have focused on what all (or most) successful counseling efforts have in common. In other words, instead of trying to figure out which single theoretical model is best for all clients, in every context and situation, regardless of their complaints, social environment, family configuration, and cultural background, attention has now turned toward those features that seem relatively universal across the spectrum of variables. The key question now is, “What are the common factors in counseling approaches that seem to be most important and useful?” Once these significant variables have been identified, the corollary question explores just how relatively important each of these factors might be. In the language of researchers, this is described as the “percentage of variance.”

Identification of Common Factors

Many years ago, Jerome Frank (1971) published a seminal book about the nature of persuasion and influence within helping encounters. He viewed the various therapeutic approaches as “cults” in the sense that each had a rigid ideology that seemed impervious to compromise. Rather than necessarily accepting that what their proponents insisted was operative as a therapeutic ingredient in each conceptual framework, Frank settled on what he considered to be universal features of healing, such as the client's expectations, the counseling relationship, and the importance of faith in the process. Since that time, a number of other researchers (e.g., Duncan, 2014; Lambert, 1986, 2013; Norcross, 2011; Wampold, 2001) have investigated these common factors. In one early review (Grencavage & Norcross, 1990), five recurring themes were identified that are still considered important today: (1) what the client brings to sessions in terms of motivation, beliefs, personal characteristics, and expectations; (2) the counselor's personal characteristics; (3) the ways sessions are specifically structured to meet clients' needs and interests; (4) the change processes that are emphasized and accessed; and, finally, (5) the quality and kind of relationship that is established and maintained. In subsequent studies and reviews, this last feature—the relationship—has been found to be just as important as any technique that may be used.

Of course, it isn't any kind of relationship that is considered helpful to clients but rather the sort that has some particular qualities. Although certain clients may need or prefer more or less structure, as well as a number of other facets, it consistently has been found that the best helping relationships have a high degree of perceived and experienced empathy—clients feel understood, respected, and cared for by their counselors. Clients feel that there is a true partnership in terms of collaboration on their goals. In addition, the best relationships provide opportunities for ongoing sharing of input and feedback so that constant adjustments can be made as the process, stage, and needs inevitably evolve.

We will save you the trouble of wading through the overwhelming evidence, supported by countless research studies, that clearly demonstrates the importance of th...

Table of contents

• Cover
• Title Page
• Copyright
• Preface
• Acknowledgments
• About the Authors
• Part 1: Some Operating Assumptions About Relationships in Counseling
• Part 2: Relational Strategies and Interventions
• Part 3: Relationships in the Counselor's Life
• References
• Index
• Technical Support
• End User License Agreement