It is essential in any helping relationship to have an anticipation for change. In the counselling relationship it presents as Hope. An optimism that something will develop in order to bring about constructive change in the personality of the client in order for them to be able to facilitate positive change in their lives.
As with all processes there may be small events that bring about the necessary transformation. In the therapeutic relationship (alliance), it has been observed that it is often the seemingly unremarkable things, such as the core qualities of the counsellor, which bring about the strongest alliance and therefore, the most change. Qualities that have been identified as: Empathy, a sense of Genuineness and Unconditional Positive Regard for the client. According to Horvath and Luborsky (1993) it is reasonably well documented across a variety of therapies, that a positive correlation does exist between good alliance and successful therapy outcome.
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It is important to note that early critical writers were inclined to see the therapeutic alliance more as facilitative rather than directly responsible for change (Horvath, 2006). In 1950, a new perspective on the nature of the therapeutic relationship emerged. This perspective was voiced most powerfully by Carl Rogers. In order to bring about constructive personality change, Rogers (1956) identified what he referred to as the 6 conditions. According to his years of experience, these conditions are essential and sufficient in order to facilitate the process of personality change (Rogers, 1956). His six conditions include for the therapist to be congruent or integrated (genuine), to experience unconditional positive regard, and an empathic understanding for the client. Rogers concludes that outside of these core conditions, none other is necessary in order for change to develop.
It is interesting to note how intertwined these three conditions are. One cannot possibly experience and display empathy without some level of genuineness. Similarly, one cannot feel unconditional positive regard without first having some level of empathy. It all sounds quite simple: be the best care-giving person one can be, be comfortable with the person one is, and in doing so one will facilitate change in another. Yet, anyone who has attempted this, will admit that it is not the most natural state for humans to be in. It requires a greater understanding of the core conditions, a desire to want to exhibit these characteristics, and being able to not only apply them to clients but to the counsellor as well. Therefore, in exploring this area of helping, it is of paramount importance to study these conditions in order to bring about change. Firstly, as people; and secondly, as counsellors.
None of the conditions in the counselling relationship can be meaningful unless they are real. Genuineness is at the heart of every true relationship. In daily relationships, genuineness is displayed by the people whom we feel are not hiding from us or themselves. They wear no masks and are comfortable with who they are and what they are feeling. This in turn makes the recipient comfortable and allows them to be open and honest with that person and more importantly, with themselves. This does not change very much in the counseling setting. A congruent counselor is one who is what he is, during the encounter with the client (Rogers, 1967). The genuine counselor allows the client to meet the true person, not the professional with the paperwork. This includes admitting things to himself or the client that is not observed as ideal psychotherapy. It is also essential to note what genuineness does not imply: The therapist must not burden the client with a running commentary of what the therapist is feeling and thinking. He can, of course, voice appropriately any persistent emotions triggered by what the client is saying or doing.
Being genuine is not an easy task. It involves being aware of one’s own flow of experience and being comfortable with sharing with the client. Sometimes it involves vulnerability from the counsellor’s side which in turn can deepen the relationship. It is a fearsome and fearless exchange between client and counselor and when integrated into the relationship, can create very deep levels of understanding. Appropriately opening the door for unconditional positive regard…
Standal coined this phrase in 1954. It was adopted by Rogers and means that there are no conditions of acceptance (Rogers 1967). More than that, it refers to the counsellor’s belief that the client possesses all the resources necessary for change without the need to change him or herself. Unconditional Positive Regard (UPR) is often misunderstood as meaning to be ‘nice’ to the client (Mearns and Thorne, 1988). To be ‘nice’ is a social ‘mask’ people wear to hide their deeper feelings. Being ‘nice’ all the time will only serve to confuse the client and to foster a false sense of security. It is superficial whereas UPR is most efficient when it arises from a place of depth. Another way of defining UPR is to accept all traits and behaviours in another person without it causing significant harm to oneself. The word ‘significant’ is not added superficially. If one states that another’s behaviour is causing significant harm, then unconditional positive regard cannot exist (Rogers, 1967). In order to display UPR, one needs to be aware of one’s own values, beliefs and standards (Sutton and Stewart, 1997). From there one can evaluate and scrutinise them privately or perhaps confidentially with the help of a supervisor.
The fifth of Rogers’ conditions and the third to be discussed here, is empathy. According to Schafer (1956) relatively little investigation of empathy can be found in the psychoanalytic literature. This is despite constant emphasis on its importance not only in the therapeutic process, but of child development and personal relationships. Consequently, it remains a vague concept, sometimes regarded uncritically as synonymous with intuition or more often, accidentally misunderstood as sympathy. These common misconceptions undermine the importance of usage and association of the concept within the therapeutic alliance.
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It is difficult to pin point empathy in a relationship because it is most often not a single response made by the counsellor. Nor is it captured by a series of responses. Empathy is a more of a process than an observable response (Mearns and Thorne, 1988). It is a process of leaving one’s own frame of reference behind and entering the world of the client. To be with the client in their frame of reference and to respond with empathic responses. Note that these responses in themselves are not empathy. They are the result of sharing the client’s journey. The sharing creates the empathy. Rogers (1967) explains it as experiencing the client’s world “as if” it were happening to the counselor. Yet making sure never to lose the “as if’. To be able to sense accurately what the client is feeling without getting caught up in the turmoil of the experience.
Researchers found it much simpler to work with the empathic response than the empathic process (Carkhuff, 1971). If researchers are to study the process, they not only have to take into account the verbal responses of the counselor and how it is perceived by the client, but also the series of interactions that have led up to that response. Importantly, empathy is not a skill or technique acquired by a counselor. It is a way-of-being-in-relation to the client (Mearns and Thorne, 1988).
Many scientists in the 1970s and 80s have voiced their fact-based opinions regarding the therapeutic alliance and the necessary conditions for successful counselling. Gurman (1977) concluded that there is significant evidence supporting the relationship between the therapeutic conditions and the outcome of the counselling. Orlinsky and Howard (1986) maintained that when the core conditions were met, 50%-80% of the number of findings were significantly positive. These results were confirmed by observations made by clients involved in these therapeutic relationships.
Just as evidence is feeding the notion of these core conditions having a positive effect on the outcome of the therapeutic relationship, there is also evidence to the contrary. When these conditions are limited, it causes the relationship to deteriorate (Kirschenbaum and Jourdan, 2005). A popular criticism of this evidence, is that many studies compare counsellors employing only a minimal level of the conditions with counsellors using none. Critics claim that the minimal use of a skill does not necessarily provide good evidence that the skill works. Patterson (1984) argues this point by claiming that if success in the counselling process is achieved by only using a minimal level of the core conditions, then it serves to demonstrate exactly how effective these conditions are. When Stubbs and Bozarth (1994) conducted research that controlled the ‘minimal use’ bias, they were unable to find one study where the conditions were not sufficient for counselling success.
As a result, psychoanalytic, eclectic and client centered approaches have emphasized the importance of the counselor/therapists’ capacity to perceptively and appropriately understand the inner experience of the client/patient. Consequently, the qualities of Empathy, Genuineness and Unconditional Positive Regard have been highlighted as being essential to the therapeutic alliance and subsequently, a positive outcome to the counselling process.
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