The Therapeutic Relationship

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The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client. Many clients come to see therapists as the ‘good enough other’ the idea that at some level they emotionally take on the therapist as a ‘parent figure’ to support them during the personal growth that hopefully takes place during therapy, Clarkson described this as ;

The Therapeutic Relationship by Clarkson - AbeBooks The Therapeutic Relationship by Clarkson - AbeBooks

This is harder to define in absolute terms; it can include an expansion of consciousness, which can be spiritual or healing. Gelso, C.J. & Samstag, L.W. (2008). A Tripartite Model of the Therapeutic Relationship. Handbook of Counseling Psychology (4th ed.). (pp. 267-280).This text provides coverage of the uses and abuses of the therapeutic relationship in counselling, psychology, psychotherapy and related fields. It provides a framework for integration, pluralism or deepening singularity with reference to five kinds of therapeutic relationship potentially available in every kind of counselling or psychodynamic work. Perhaps one way of describing it is the feeling you have after going to a concert you enjoyed or a really special evening with friends. A feeling of spiritual connection which was described by Clarkson herself as;

The therapeutic relationship, 2nd ed. - APA PsycNet

Counselling and psychotherapy rely, to a great extent on building a human connection with clients, where a deep level of trust is established, this transcends any modality, this is seen to a great extent in the work of Carl Rogers. This strong feeling is sometimes rooted in ‘the presenting past ‘also known as ‘transference’ the idea that the client reminds us of someone from our past and as such we ‘transfer’ those feelings from the past on to the client. The transferential/countertransferential relationship refers to the idea that we may remind a client of someone from their past, or vice versa, and the related feelings from the past may be transferred to the present, so affecting the therapeutic relationship. If this happens, it is important to explore the issue in supervision. The person-to-person relationship is the core or real emotional connection – as opposed to a professional relationship with say your doctor or dentist.As I understand it the working alliance is the basis of the client–therapist relationship that enables both the client and the therapist to work together and would include such things as the contract, the presenting issues and maybe a realisation of both people that in other circumstances they may not be kindred spirits, or even necessarily like each other. There are some synergies here with Coaching practice with a contracting process, and examination of presenting versus underlying issues; it leads to my sense that Coaching has beg, stole and borrowed from therapeutic theory! In the 1950s, Carl Rogers had written a paper entitled ‘ The Necessary and Sufficient Conditions of Therapeutic Personality Change’, published in the Journal of Consulting Psychology. This introduced the idea that the therapeutic relationship is key, and three of the conditions – congruence, unconditional positive regard and empathy, which have subsequently become known as the ‘core conditions’ – have come to be accepted by practitioners of all modalities as vital to establishing this relationship. Here are some of my personal favourites (the authors have been significant 'teachers' for me) on the topic of therapeutic use of self: The concept of therapeutic relationship was described by Freud (1912) as "friendly affectionate feeling" in the form of a positive transference. However, transferences, or more correctly here, the therapist's 'counter-transferences' can also be negative. Today transference (from the client) and counter-transference (from the therapist), is understood as subconsciously associating a person in the present, with a person from a past relationship. For example, you meet a new client who reminds you of a former lover. This would be a counter-transference, in that the therapist is responding to the client with thoughts and feelings attached to a person in a past relationship. Ideally, the therapeutic relationship will start with a positive transference for the therapy to have a good chance of effecting positive therapeutic change.

therapeutic relationships. - APA PsycNet The five therapeutic relationships. - APA PsycNet

This article focuses on a few key frameworks and models of approach that I came across in foundation psychotherapy training and think best illustrate various approaches. Rogers 6 conditions: I have become interested in Petruska Clarkson due to her body of work on human relationships, including the 5 relationship model. When I look at the five aspects of a therapeutic relationship I feel a strong degree of resonance with these principles, and will focus on a couple of particular ones, the working alliance and the reparative/development need aspects. I like the metaphor Clarkson uses in relation to a piano, that some aspects are played more frequently or loudly than others, but they are always potentially there. What do our therapeutic relationships with clients involve? How do we create a safe space for clients to go exploring? What are we doing when we show clients respect and caring, attuned attention or when we challenge them to grow? How is our way of being with clients therapeutic? These questions around ‘doing’ and ‘being’ all relate to the idea of therapeutic use of self which can be defined as: "A therapist’s thoughtful, deliberate effort to use their self as a tool, one which embodies a self-aware therapeutic way of being in the service of clients and the client-therapist relationship" (Finlay, 2022, p. 1).The presentation, entitled “A Global Vision: Taking Gestalt Therapy into the 21st Century”, brought together delegates and presenters from across the globe that reviewed and explored views of Gestalt therapy. Clarkson also co-founded two training organisations, the Metonia Institute and Physis. Most of us have at some time or another met a person for the first time and found ourselves either strongly attracted or repelled by them. Horvath, A. O., Greenberg, L. (1986). The development of the Working Alliance Inventory: A research handbook. In L. Greenberg and W. Pinsoff (Eds.) Psychotherapeutic Processes: A Research Handbook, New York: Guilford Press. One of their underlying aspects of people being relationship seeking and the idea of people having internalised relationship patterns is an interesting one. They bring into play the theories of Stern in child development in how a child creates a sense of repeated similar experiences with primary carers and how this builds a set of self beliefs and behaviours built on this; what they call the core interpersonal scheme. It also brings to mind Transactional Analysis theory on life scripts and “drivers”. They do point out clearly that whilst it is stated sequentially, that these stages often are re-cycled and overlap. In my experience in other work around behaviour change such as the transtheoretical model, this is true of robust, flexible models; they contain a sense of start, middle and end, but have circumnavigated ways through.