The Counseling Interview
December 1, 2010
The Therapeutic Alliance
The therapeutic alliance is an aspect of therapy that emphasizes the collaborative nature of the partnership between counselor and client. Therapist and patient each bring characteristics that affect the strength and success of the therapeutic relationship. Without a positive working relationship between counselor and client, there is unlikely to be any treatment progress. Though some therapies rely more heavily on the use of technique and taking a more directive and guiding stance during the treatment process, four therapies understand the therapeutic alliance as being crucial in achieving positive treatment outcomes for the client and is the center that these philosophies revolve around.
Existential therapy emerged as an effort to help people resolve the dilemmas associated with contemporary life such as isolation, alienation, and meaninglessness. There are a few key concepts behind the philosophy of existential therapy that connects it to other therapies but also a few concepts that distinguish it from most therapies. The significance of existential therapy is that it alters the widely accepted association of therapy with the use of technique. Instead it defines its therapeutic process on the understanding of what it means to be human (Corey,2008). Traditional existentialism looks for a balance between recognizing the limits and dimensions of human existence while also realizing and bringing to the fore front the possibilities and opportunities of a fulfilling life. Existentialism views life as the idea that the significance of our existence is not written in stone but that we continuously re create ourselves through our life’s experiences and endeavors.
Some of the key concepts behind existential therapy include for one that people have the capacity for self awareness (Jordan, 2003). The more the person becomes aware of himself and his life, the greater the possibilities in achieving personal freedom. Existentialists believe and are aware that people are free to choose and decide in life and because of this fact view individuals as playing a large role in shaping their own destinies (Corey, 2008). This philosophy states that a major problem within many of us is that we have looked for direction, answers, proper values, and beliefs from the important figures in life instead of searching within and trusting ourselves to finding our own answers in life, hence giving in to conform to others expectations.
Clients in existential therapy are encouraged to seriously view their own perspective of their own individual world. The therapist challenges them to take responsibility for how they choose to be in the world and to subsequently take action on the basis of the insights they develop during the therapeutic process (Barber, et al, 2000) . In existential therapy clients are expected to be active in the therapeutic process and during therapy sessions actively explore and direct what fears, guilt’s, and anxieties they and the therapist discuss (Corey,2008). Through this process of therapy, clients explore alternative possibilities for making their ideal view of existence become reality.
Like existentialism, gestalt therapy is an approach that views the individual as being understood through the context of their life long relationship with the environment. Founded by Fredrick Perls, gestalt therapy originated with a more confrontational and dramatic style. Then evolved to the more contemporary model of therapy which includes a more supportive and an increased kindness and compassionate stance towards clients (Barber, et al, 2000). The initial goal within gestalt therapy is for clients to gain awareness of what they are experiencing now and how their actions are causing these experiences (Corey, 2008). This therapy skips over conventional analysis and places more emphasis on the clients awareness of their environment.
Gestalt therapy assumes that individuals have the capacity to self regulate when they are aware of what is happening to and around them. Through therapy, the gestalt approach provides a therapeutic setting in which clients have an opportunity for their awareness to be supported and restored. The gestalt theory of change states that the more we work at becoming who or what we are not, the more we remain in the same state (Corey, 2008). Through holism, the gestalt philosophy views the world as a solid and unified whole in which cannot be seen as individual and separate parts (Jordan, 2003). This view is also related to the client and subsequently shapes the therapists stance that the whole person is more important than placing any superior value on any one aspect of the person.
One of the main contributions of gestalt therapy is its emphasis for the client on learning to appreciate and fully experience the present moment and view focusing on the past or the future as a way of avoiding coming to terms with the present (Jordan, 2003). As the client invests their energies towards dwelling on the past or creating a fantasy for the future, this creates a mist that fogs up and clouds the thoughts of the client and causes the power of the present to be left unseen. Gestalt therapy attends to the basic goal of assisting the client in attaining greater awareness and with this awareness helping the client in making choices (Corey, 2008).
The postmodern approach to therapy encompasses different approaches to therapeutic process. First, social constructionism theory has a critical stance towards everyday knowledge. It challenges conventional knowledge that historically has guided our understanding of the world and cautions us to view the world beyond what it appears to be. Constructionism believes that the language and concepts we use are historically and culturally specific and that our ways of thinking are not much different from other ways of thinking. They believe that knowledge if formed through social interactions and what we consider to be truth are a product of our daily interactions with people in daily life (Corey, 2008). This awareness brings about the realization that there is not a set or exact right way to live and that all experiences of reality are unique and equally real. Finally, through social constructions that are viewed to affect social life and not be abstractions from it, we realize that knowledge and social action go together.
Solution focused brief therapy is another aspect of the postmodern approach and shifts the focus from problem solving to a more complete focus on solutions (Corey, 2008). SFBT is different from traditional therapies in that it completely throws away the concept of the past in favor of awareness of the future and present. Therapists focus on what is possible and have very little interest in gaining an understanding of the problem itself (Scaturo, 2010) . They have a view that gathering information about the problem is not needed to solve it and within SFBT, clients choose the goals in which they want to accomplish and little attention is given to diagnosis, history taking, or exploring the problem.
Narrative therapy is another aspect of the postmodern approach and in this approach the therapist develops a collaborative stance between client and therapist in which the therapist takes a special interest in listening respectfully to the clients stories (Corey, 2008). At the same time and through the clients stories, the therapist listens for a time in the clients life when they were more resourceful, uses questions as a way to engage clients and help them in their exploration, and avoid diagnosis and labeling on the premise of a specific problem (Matin, Garske, & Davis, 2000). Then to assist the client in putting into perspective exactly what influence the problem has had on their lives so the client can separate themselves from the dominant stories that have shaped their lives to this point for new stories for which the client has more conscious control and proactive influence (Corey,2008).
Through person centered therapies like existentialism, gestaltism, or the various approaches to postmodernism, the client is the main advocate for change in their own lives. The therapists’ role in these approaches is one of collaborator in which the therapist provides the atmosphere and positive attention and the client is in the driver’s seat with full control and decision making capacities that will ultimately direct their lives on to a more desirable and fulfilling path.
In this section of my essay I will explore therapies that rely more heavily on the techniques and formal training of the therapist in directing and guiding the client to positive treatment outcomes.
Psychoanalytic therapy was founded by Sigmund Freud and is the key behind many therapeutic approaches that we see today. According to Freud, our behavior is determined by irrational forces, unconscious motivations, and biological and instinctual drives as these evolve through psychosexual stages in the first 6 years of life (Corey, 2008). One of the main ideas behind psychoanalytic theory is the structure of the personality which included the id, ego, and super ego as three separate distinctions of the human personality (Scaturo, 2010). Freud believed that the mind was divided between the conscious, an awareness of ourselves and our surroundings, and the unconscious, which is an aspect of thought that exists below our level of conscious awareness (Matin, Garske, & Davis, 2000).
Other key concepts include anxiety, which is a feeling of dread that results from repressed feelings, memories, desires, and experience that emerge to the surface of consciousness and creates difficulty for the individual(Corey, 2008). Ego defense mechanisms, which has several different aspects, help the individual cope with anxiety and prevent the individual from becoming psychologically distressed and overwhelmed (Scaturo, 2010). Two goals of psychoanalytic therapy are to make unconscious thought emerge in the conscious and to strengthen the ego so that behavior is based more on reality then on unconscious instincts and irrational guilt. In this therapy, successful results are obtained by significant modification of the clients personality and character structure.
In psychoanalytic therapy the therapist engage in very little self disclosure and maintain a sense of neutrality to bring about a transference relationship in which the client then makes projections onto them( Corey, 2008). The transference relationship is one of the foundational building blocks of psychoanalysis and along with specific techniques, like free association, where the client is encouraged to say whatever comes to mind regardless of what it may be. In free association, the process is used to open the door to unconscious wishes, fantasies, conflicts, and motivations (Matin, Garske, & Davis, 2000). Through interpretation, the therapist points out, explains, and teaches the client the meaning of behavior that is manifested through dreams, free association, resistances, and the therapeutic relationship itself (Corey, 2008).
Cognitive Behavior therapy also relies heavily on the technique implemented and fostered by the therapist. Under CBT fall different approaches which include Albert Ellis’s rational emotive behavior therapy (REBT), Aaron Beck’s cognitive therapy (CT), and Donald Meichbaums cognitive behavior therapy (CBT) (Corey, 2008). In REBT, this therapy starts with clients distorted feelings and intensely explores these feelings in connection with thoughts and behaviors (Scaturo, 2010). Therapists in REBT make sure that they are creative in their use of methods while making sure that they tailor the techniques utilized to the unique needs of each client (Maclaren, 2008).
This therapy is often highly directive, persuasive, confrontational, and usually focuses on the teaching role of the therapist. Unlike REBT, cognitive therapy places more emphasis on helping clients discover and identify their misconceptions for themselves (Maclaren, 2008). While Ellis views the therapist largely as a teacher and does not think that a warm personal relationship is required with clients, Beck stresses that the quality of the therapeutic alliance is crucial to the application of cognitive therapy (Corey, 2008).
Person Centered approaches are continuing to emerge as a more collaborative way for client and therapist to build a relationship of trust. Through the therapeutic alliance that is formed, clients tend to open up more and tend to respond more positively to treatment. This is the idea that person centered therapies like existentialism, gestaltism, or postmodern approaches attempt to encourage and foster for their methods of treatment. They believe that the client is central to the therapeutic process and the client is the main source and director of change. Technique based therapies like psychoanalytic or cognitive behavior therapies are the foundation of the therapeutic process and have proven to be effective for a multitude of psychological problems and distortions of reality.
Whether it’s heavily technique laden or proactively person centered, talking therapies continue to grow and expand as our knowledge of the human condition of existence evolves and our understanding of the human psyche becomes more focused through our process of trial and error.
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