Friday, April 5, 2019

Critically discuss the function of structure within the therapeutic relationship Essay Example for Free

critically discuss the function of structure within the healing(predicate) family EssayExtensive literature shows no significant differences in cure motors among therapeutic approaches, provided yet, these approaches differ to departing degrees in regards to values, techniques and speech pattern on structure. This then poses an equivalence paradox with clearly non-equivalent techniques. The explanation for this commonality in therapeutic out watch over between therapeutic approaches is the leaf node- healer relationship also cutn as the therapeutic alliance. The therapeutic alliance is a much encompassing term for the underlying interpersonal interactions and the collaborative nature of the partnership between a therapist and a client. Meta analytic research studies show that the therapeutic relationship counts for . 21 in core group size, while in combinations with technical focus, the effect size is . 76. While not equally as in effect(p) as technique alone with an effect size of . 55, it is significant in its contributions to therapeutic outcome and has been worthy the focus on how it develops over time and the subsequent development of a generic structure to exhibit and maintain across all theoretical approaches.This essay go forth aim to look for this partnership and the needed steps or requirements on the part of the therapist in rules of order to establish it and the flairs client p characters and goals atomic number 18 incorporated into treatment, in other words, structure required for the establishment and maintenance of the relationship as there is research evidence to support the establishment of this alliance early for stronger therapeutic outcome. Generally, guide with clients ordinarily have a preparatory phase a first phone call perhaps, and introduction on some(prenominal) parts to the tasks and goals ahead.A arrayning phase that involves the face-to-face meet up, sign greeting an chalk out of the therapists agen da, contracting, negotiating and setting and summary of goals. A middle phase the therapist is concerned with facilitating eruditeness and channelise congruent with therapeutic goals and assumptions about change. The ending phase also involves process goals in order to seek resolution of client issues, consolidate learning and change and evaluate therapeutic outcome.Theres evidence to show that therapeutic alliance needs to be formed within the first lead sessions for a good therapeutic outcome. Regardless of the therapeutic approach, there is evidence that certain generic dexteritys argon important and required for the establishment of a structure within therapeutic alliance. These generic attainments include canonical communication skills, but also more complex skills which the therapist needs.They can be learnt and practiced as techniques but the therapeutic use of them with the client depends not only on the communication skill but on the attitude and intention of the thera pist, an inside energy of sorts, that comes from commitment to catch the person from their frame of reference and the therapists internal supervision, awargonness and self-review. The adjacent macro and micro skills ensure the therapist emphases the importance of inner work alongside their practice. 1) Making Psychological contactThis is an intangible personal process that changes from moment to moment, a mental exchange of energy between human beings. It is dependent on the skills, experience, attitudes and emotions that each brings to the situation and it presents itself on a spectrum. It ranges from clients who make no contact at all to those who invade the therapists personal place and on the other side, the therapists exponent to make contact could be influenced by how they grasp new clients and other factors such as culture, class, race, gender, age and sexual orientation.The therapists experience of initial interpersonal contact can be developed by self-reflection. Impa rtial witnessing The observation of inner processes without judgement. sentience of how others experience the therapists psychological contact e. g. Is it warm or cool, intrusive or up submit etc? And finally, skills of greeting appropriately and starting the interaction with particular adjustments made after fear is paid to and sensitiveness of culture, age, gender etc. 2) Effecting Intake and AssessmentIn an interview or a formal assessment, detail skills ar needed. They include Asking for information It is imperative that the client is made to understand the purpose of the questions and what will happen with the records. Purpose stating What the therapist wants to happen and must happen. This attend tos to set the scene of openness to clients so that they know the therapists intentions or purpose and also to experience the therapist as congruent.Preference stating What the therapist would like to happenwith an element of choice for the client. penetrative when to say no t o a client and crafty how to communicate this congruently, respectfully and empathically. 3) Introducing tape recording This is something therapists approach with trepidation and technical skill and appropriate equipment is required to execute. The therapist requires self-assurance and conviction to obtain permission from the client and it needs to be part of the initial contract. 4) Contracting and clarifying therapyNegotiating a contract with a client requires particularly the quadruple skills of active listening, paraphrasing, reflecting feelings, summarizing, asking questions, purpose and preference stating, a balance between assertion and flexibility. 5) Beginning to earn a relationship The ability to communicate empathic understanding of the client, to show unconditional respect, and to be comprehend as congruent, requires inner and outer, receptive and responding skills. The client needs to hear that the therapist understands him from his point of view, accepting and not judging him, and is openly present for him and genuine in the role.This openness conveyed by the therapist may vary with the orientation Skills required to communicate this ar 1) Attention giving The non-verbal show of accessibility, receptivity and presence which are all influenced by an inner attitude dependent on the cognizance and sensitivity of the therapist. 2) Observing Knowing what non-verbal and verbal cues to look out for. For example posture, facial expression, tone and volume of voice, responsiveness etc. These clues are sought to begin to understand the clients internal frame of reference.Also, the therapist needs to check out their own body for clues and observe how the client makes them feel. 3) Listening and Hearing. The former is merely the inner sensory bodily function that involves picking up sounds while the latter is the same inner sensory activity aligned with attention giving. When clients feel really listened to, they are encouraged to talk and reveal th emselves. Accurate listening can dish up clients to increase self-awareness and reduce defensiveness and direct focus towards their own demeanor. It provides psychological space and support for clients self-exploration.The use of a combination of the above skills to focus the therapist and client at appropriate points in the interaction. It can be used as a check for understanding, pulling together thoughts, bridge to help client move on, return to something significant and to structure the interaction if the therapist or the client is get lost. 5) Responding or facilitating skills Also known as active listening skills. These demonstrate and communicate empathy and credence and promote exploration. They are sometimes referred to as first level empathy, distinguishing them from deeper empathy.The latter is used when there is deeper understanding of the clients inner world. Using advanced empathy too soon, exposes a risk of inaccuracy and poses too much of a repugn for the clien t. First level empathy consists of paraphrasing and reflecting feelings. Paraphrasing is picking up the meaning of the clients words and having and extended vocabulary to put it back to him reflecting accurately the feeling and meaning in a tentative way to check understanding. It is not parroting and using jargon or over technical terms.Done healthy, it enables clients to hear and understand themselves afresh. Reflecting feelings is signalizeing what the client is feeling often mainly from non-verbals like tone of voice, bodily expression and therapists own bodily resonance. Therapists need to be sensitive to diverse cultural subtleties as inaccurate reflections may neutralize the intensity of the clients feelings. All these skills are the beginning blocks for expression a relationship and for helping clients explore what they want from a therapist and therapy. In the main they are substantiative skills.Skills which continue to build the relationship and develop the interacti on will be considered next. These skills are challenge, both for the client and therapist. Development and maintenance of the therapeutic relationship Moving the client forward As mentioned above, the skills discussed so far can be considered as supportive helping clients feel safe enough to begin to explore themselves and their situation. To move on in the relationship and the interaction requires skills which will challenge the client to explore further to gain new perspective and new modellings and see the world in a different way.How the client will receive the challenge will depend on the relationship which has been make and how it is retained and developed all the supportive skills will still be needed, appropriately interspersed with the challenging ones. Inner skills contend a client requires the inner skill of the therapist in examining their own feelings about challenging others. The therapist needs to know how comfortable they are with challenging a client. This sk ill is should be applied tentatively and timing is crucial.A therapist needs to be able to gauge implicitly and explicitly when and how to challenge a client and which of these interactions are found on theories of counselling and psychotherapy. This skill really requires an inner awareness and careful attention to personal development is required. This is where tape recording and supervision are important in the review and identifications of values, whimseys, thoughts, feelings and sensations guiding the choices made. Outer skills Responsible challenging requires well-practised communication skills.Focusing. The therapist needs to help clients focus, if they are to move forward. Summarizing. As mentioned above, summarizing provides bridges, draws themes together and is used for keeping track. It is a useful skill that requires accurate listening, ability to filter relevant thoughts and feelings and ability to communicate them clearly. Both summarising and focusing provide challen ge to clients Concrete examples. sometimes it can be useful to ask clients for more specific thoughts, experiences and feelings. Communicating deeper empathy.The ability to pick up the real meaning behind the words, thoughts and feelings of the client which are buried, out of reach or implied and which may come to the therapist as a hunch. The skill is to put it into appropriate words when the timing is right. Challenging. Gently confronting clients to change their perspective, see a bigger picture, recognize strengths they are not using, note discrepancies between verbal and non-verbal behaviour or identify behaviour that is destructive to them and others. Self-disclosure.Here there are two types the therapist disclosing departed experience or the disclosure of thoughts and feelings about the clients thoughts or experiences. There are advantages and disadvantages to this. measure and discrimination of content disclosed is important. It could help as a model for the clients and he lp build the relationship or it may be perceived by the client as maladjustment and hence reduce confidence or the increased intimacy may be threatening to them. It is unhelpful at the beginning stages of therapy as the therapist should be concentrating on staying with the clients experience.Disclosure needs a sufficiently inviolable relationship and should be used selectively at the later stages of therapy. Immediacy. Discussing directly and openly what is happening between therapist and client. It involves awareness of whats going on inside the therapist and what is imagined as going on within the client and what is happening between the two. It is quite complex and challenging to do well, but when penalise properly provides client with insight as to how their behaviours affect others.It involves competence in support skills as well as self-involving statements. It requires assertion and is very helpful to build or repair a therapeutic relationship, identify issues with class, a ge, gender, race, sexuality etc and in psychoanalysis and psychodynamic practice, identify transferee and countertransference. All the skills so far require a lot of practice with feedback for development and lead to the final section. Monitoring self within the therapeutic process, paygrade and development of own work.This requires all the previous skills as well as the additional self-management skills which are exploitation a caring acceptance of self, impartially witnessing of internal processes, identifying and using resources to meets learning, emotional, physical needs, ongoing identification and checking of belief and theories, planning ongoing training and personal development, reflecting, review of recordings and supervision, reviewing with clients and asking for feedback from clients Summary Both supporting and challenging skills, regardless of theoretical approach are necessary for the establishment of structure within a therapeutic relationship.This structure and fra mework is important in ensuring that therapists are mindful of what is required to provide a supportive base to establish trust and rapport and then in the later stages more challenging skill are utilize to provide the necessary challenge that is required to guide clients into awareness and positive change. another(prenominal) possibly useful generic skill would be a termination skill to help the therapist during the end phases of therapy help the client consolidate learning and evaluate outcome and prepare for possible regress prevention and management and finally, client autonomy.Theoretical considerations There is no denying that the generic skills discussed above have built around and extended from the conditions identify by Carl Rogers in person centred therapy, to reiterate, they would be the maintenance of an attitude of acceptance or unconditional positive regard, empathic understanding, as well as personal congruence or integration. Being a non-directive therapeutic appro ach that typically places emphasis on the above, supportive skills would be utilized mainly.Challenge skills, less so, but on occasion, as onus is placed on the client directional the therapy. Cognitive behaviour therapy utilizes an active-directive collaborative style. In its very nature, it is quite structured. In reductionist terms, it occurs in the following four stages the assessment, cognitive, behavioural and learning stages. The therapeutic alliance needs to occur in the assessment stage, usually in the first session because quite rapidly after, from the cognitive stage, negative automatic thoughts are identified and challenged.This means, supportive skills and challenge skills are introduced quite rapidly and interwoven up till the learning stage and termination. In Psychoanalytic and psychodynamic approaches, a distinction is made between the real relationship, transference and counter transference and a working alliance. The real relationship would be akin to the therap eutic relationship as delimit earlier and would only be encountered after transference and counter transference because they are considered to be more of a contamination to the real relationship and would need to be worked through and resolved.Meaning the therapist would take a more reticent stance, utilizing mostly support skills initially and challenge skills only during the working alliance, (the conjunctive of the clients reasonable self or ego and the therapists analysing self or ego for the purpose of therapy) towards the later stages of therapy where interpretation of unconscious conflicts, defence mechanisms and resistances take place. Other considerations Having a framework is important in the development and establishment of rapport and therapeutic alliance but there are salient points to factor in.The therapist needs to have a level of awareness of the similarities and differences between them and their potential clients to avoid the traps of varying degrees of gender inequality, ageism, disability and social class discrimination, homophobia and other sexual orientation based discrimination, religion, spiritual, agnostic and atheist discrimination, and also, racial, cultural and ethnical discrimination. Regardless of how well a therapist conceptualizes how to establish therapeutic alliance, lack of knowledge and experience on these socio economic and socio cultural factors could prove counterproductive.

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