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European Association for Counselling

Is Therapeutic Alliance the Foundation of Counselling?

Therapeutic Alliance

The number of counselling therapies available can be confusing when selecting a course for study.
No matter how confused a prospective student may be, what is it like for a client with no prior knowledge? Especially, if they are under stress when seeking help, in what can be their darkest hour.

In reality with all the counselling psychological approaches available how does a client select the correct one?

Do they seek a therapist specialising in Cognitive Behaviour Therapy, Person-Centred Therapy- or a proponent of Transactional Analysis? Let alone – Humanistic; Integrative; Mindfulness; NLP; Gestalt; and the other theories and specialism, that can make up a course of treatment.

All of these components must have one overriding commonality – they must have the foundation of a strong Therapeutic Alliance between the therapist and client.

This is not a new nine-day wonder in mental health care. Carl Rogers wrote about the main elements that had to be in place. Rogers identified a number conditions that must occur during the sessions for positive therapeutic change to take place.

These include the three core conditions:

  1. Congruence
  2. Unconditional positive regard
  3. Empathy.

Combined they prove an unconditional regard for the client

Therapeutic Alliance is without doubt the most important part of Counselling. It is often said that it is the most reliable way of seeing if the process and outcome of Counselling is going to be successful or not.

What is Therapeutic Alliance?

Putting it simply it is the trust between a client and therapist. This empowers the client to have the confidence to freely express their feelings. It enables the client and the therapist to work together for the benefit of the client. It is that bond that helps a client have total faith in their counsellor. The course of treatment may be difficult but the client still believes that the counsellor has their well-being at heart. This is not an instant feeling. It can take many months to develop, but it can be established at the first meeting and developed as time goes by.

Research has endorsed the three identifiers suggested by Rogers.

To establish and develop the Therapeutic Alliance the Counsellor must be able to help a client relax and feel comfortable. This is a new situation for the client plus a strange environment. Possibly the client is feeling even more stress than normal because they are meeting their counsellor for the first time. Which is why the counsellor must show a quiet but confident persona. Encouraging the client talk about themselves, using open-ended questions. The counsellor must be careful to not challenge the client. Showing empathy and support for the client and their situation.

It is the role of the counsellor to be consistent. They must promote a sense of collaboration so the client feels supported. Even if the counsellor has experienced many similar situations the client feels their feelings are unique. The counsellor must actively listen to develop empathy. Therapeutic Alliance and outcome is the bedrock of the client and counsellor relationship.

Freud provided a clear description of this in his journal – ‘Outline of Psychoanalysis’.

The analytic physician and the patient’s weakened ego, basing themselves on the real external world, have to band themselves together into a party against the enemies, the instinctual demands of the ID and the conscientious demands of the super-ego. We form a pact between therapist and client. The sick ego promises us the most complete candour promises. That is, to put at our disposal all the material which its self-perception yields.

We assure the patient of the strictest privacy and discretion. Placing at his service our experience in interpreting material that is influenced by the unconscious. Our knowledge is to make up for his ignorance and to give his ego back its mastery over lost provinces of his mental life. This pact makes up the analytic situation”.

[Encyclopedia.com: Freud began writing this work in Vienna in 1938 composed of three sections. The “Outline” opens with a description of the psychic apparatus, its spatial organization and differentiation into agencies.]

The Counsellor must also prove knowledge of and respect for diversity and multiculturalism. Possessing an understanding and appreciation of the client’s culture can play an important role. Providing the Counsellor in the professions treatments and interventions a route to follow.

Information on the impact and outcome of Therapeutic Alliance can be found in books, articles and scientific papers.

Empathy shown during the course, is an essential part of the healing process. Empathy is not only communicated orally but with an increase in eye contact; posture; tone of voice and listening skills. They enable the counsellor to press home the elements of the programme that are beneficial to each unique client. It is important for the counsellor to realise to not only think of the therapeutic alliance but also in the ways they show empathy as an influence on treatment results.

There is a danger that if the counsellor launches into their favourite method, without first discussing with the client their concerns and hopes, they will be met with resistance. This resistance can create an outstanding chance that any hope of a successful conclusion being reached is diminished by their own self-importance and lack of understanding.

The failure of many people in a given conversation is to be thinking of what they are going to say next and not actively listening to the other person in the conversation usually the client. This leads to another building block being removed from the desired structure. A counsellor should always actively listen to a client. Live by the rule that you have two ears and one mouth and they should be used in the same ratio!

In doing so the counsellor will allow the client to take the session where they want to go. This may be difficult to achieve and it may well demand some creative thinking during the course on behalf of the Counsellor. But what must be considered , is the goal of the client. This is more important than the counsellor taking the lead.

Barriers to Therapeutic Alliances

No matter how skilled a counsellor or how much empathy they display to a client, they will hit barriers, this can lead to frustration. This is the time when a counsellor despite the frustration and belief that they offered of their best need to analyse if they have really uncovered the client’s point of view or ask have they assumed knowledge.

Barriers can also appear because of the pace the consultation. Every client is different even those who present the same or similar problems. The counsellor needs to be solution focused . But if they go too fast the client, who is problem focused, may think that the problem is being taken away from them. Unlike the counsellor who feels frustrated the client is more likely to throw in the towel and stop the sessions. The counsellor must never forget that the client is in charge not the other way around. The client has probably stated the goals they want to achieve. Sometimes what appears small to the counsellor can be massive in the eyes of the client.

Positivity Plays a Role

There is a temptation in any session to be continually talking about the problems. It can be very useful every now and again to swing the discussions around. Have the client discuss things that have gone right in their lives. Perhaps something that today is working out well no matter how small. Taking this positive approach can become a springboard for helping the client change their mind-set.

This article has discussed the need and process for building a Therapeutic Alliance. How that alliance is the foundation on which a counselling session is based. Any experienced therapist will say that it is the most important and powerful factor in the healing process.

It can be a clients’ experience that they feel an improvement from making the appointment to the first visit. Many feel more empowered by the time they meet their therapist for the first time. This is quite natural for the problem they want help with has taken control of their lives. Yet the action of making an appointment and arriving at the rooms of the therapist shows that they took control. They feel they already have taken a positive step towards the change they want.

However the therapist knows that there are many factors that could have happened to help the client continue to take positive steps and just as many negative factors that can and probably will arise.
Professional counsellors seek to be trained to the highest levels in order help every client who crosses their threshold.

Building a Therapeutic Alliance is the foundation

Author David Dutch

Author David Dutch

therapeutic alliance

picture by Twitter.com