The Importance of the Therapeutic Relationship in Counselling and Therapy: challenges and opportunities.
Research suggests that the therapeutic relationship is as important as any interventions are in relation to the effectiveness of counselling and therapy (Cooper, 2004; Kuyken et al. 2011). This means that not only is therapy about you experiencing various interventions in order to understand yourself, your life and your relationships better, but therapy is also about experiencing a secure and supportive relationship from the therapist.
A good therapeutic relationship between you and the therapist has many components. Carl Rogers (1951), a leading thinker and practitioner in person-centred therapeutic approaches, has argued that an effective therapeutic relationship involves you experiencing unconditional positive regard and empathy from your therapist. For Rogers (1951), the therapeutic relationship is so key because this can make you feel able to be yourself, to take down any defences and to trust that what you say will be accepted by the therapist. For Mearns and Thorne (2012), a good therapeutic relationship should involve there being no power differential between yourself and the therapist. This seems key, given that the World in which we live has many power differentials according to ‘race’/ethnicity, gender, class, sexuality and so on (Spalek, 2008).
A positive therapeutic relationship can be life-changing because this may be the first time ever that you have experienced complete acceptance from another person. A lot of research shows that humans are relational beings, meaning that we place a high value upon how others relate to us and how we feel they perceive us (Rogers, 1951; Bowlby, 1988). If a person has been brought up in an environment that is critical towards them, an environment that feels unsafe for them, then they may feel discomfort and even distress because they have been unable to develop into the person that perhaps aligns more closely to their inner values (Rogers, 1951). A good therapeutic relationship between therapist and client enables a person to better learn about themselves and to gain the courage to lead the life that is more closely suited to who they really are. This can take time, and so it is important to let the therapeutic relationship grow and develop. Perhaps in this solutions focussed environment that we live in, where short-term therapies are often funded, it is important to give time for the effects of therapy to be experienced, by giving time for the therapeutic relationship to work.
The therapeutic relationship is not, however, without challenge. Therapists often have to decide when and how they are going to intervene. You may want your therapist to sit and listen to everything that you want to say, and this is of course right. However, being in a therapeutic relationship also means that the therapist will be reflecting your statements back to you and also will be asking you questions and will be asking you to elaborate further. The therapist will be making decisions about how and when to intervene so that you get the most out of your counselling session. Sometimes you may find the therapist’s intervention as helpful, directing you to explore an area of your life in more detail in order for you to come to a deeper understanding of this. Sometimes, however, you may find the therapist’s intervention as challenging and even annoying, because the therapist is raising your awareness of issues and experiences that maybe you would prefer to avoid. According to the trans-theoretical model (TTM) of change, developed by Prochaska and Norcross (2010), there are six different stages of psycho-behavioural change – pre-contemplation, contemplation, preparation, action, maintenance and termination. This means that on some aspects of your life you may be at pre-contemplation stage, and so you may be unaware of these aspects. A good therapeutic relationship enables your therapist to help raise your awareness of these issues, in order for you to move from the pre-contemplation to contemplation stage of change. At the contemplation stage of change, you are aware of the issues and can explore how you might prepare to address these (Prochaska and Norcross, 2010). Thus, the therapeutic relationship can help you to move between the different stages of psycho-behavioural change, in order to empower you to challenge and even change those parts of your life that you want changing.
A good therapeutic relationship involves building trust between yourself and the therapist. Trust is not an easy thing to develop, and if we draw upon research from contexts outside of therapy, this can help shed important light into the challenges of building a trusting relationship with your therapist. Trust involves placing faith in another person, that they will behave in a way that you believe they will. Trust develops out of experience, in our interactions with other people (Goldsmith, 2005). If you have been brought up within an environment where you have learnt not to trust others, or if you have experienced a violation of trust, developing trust for your therapist will take time. Initially, perhaps you can develop contingent trust towards the therapist. Contingent trust involves building trust through engaging in trust-building activities with your therapist. Here, the therapist needs to demonstrate their trustworthiness to you. This might involve, for example, the therapist saying that they are genuinely interested in listening to your experiences, and for you to experience this as them genuinely listening, with their full attention. This might involve the therapist saying that they will be available for a session with you at a certain time and place, and for them to be there at the time they said they would be. Contingent trust can later become implicit trust, which is a more advanced type of trust that can be found in committed, stable relationships (Goldsmith, 2005). Perhaps after a number of sessions with your therapist, you can develop implicit trust for them, and maybe experiencing this is therapeutic. Trust towards the therapist can also be enhanced by checking out what ethical guidelines they follow, and for you to have clear understanding about confidentiality, and where the limits of confidentiality lie.
Clearly, there are many different aspects to a positive therapeutic relationship. Like all relationships, the therapeutic relationship can take time to build and grow. It seems crucial to therapeutic effectiveness and so this aspect to therapy is an important one to reflect upon.