Psychodynamic Counselling Research Paper
Birkbeck Student ref: 12816772
25th October 2013.
Exploring the contribution of the working alliance to the development of an effective therapeutic relationship in both Psychodynamic Counselling and CBT
Introduction (300 words approx)
In my essay I shall be exploring my understanding of the working alliance, and effective therapeutic relationship in both Psychodynamic Counselling, and Cognitive Behavioural Therapy. I shall include my experience gained in class and outside of the classroom setting. With situations of when I have demonstrated my understanding of the therapeutic alliance and therapeutic relationship. Since I began studying for this course, I have become more aware of the importance of the therapeutic alliance, and the therapeutic …show more content…
relationship has towards forming a successful therapy relationship which is vital to a positive outcome for the client during Psychodynamic counselling.
Over the past twenty years I have received counselling from various counsellors who practise different theories of counselling. The types of psychotherapy’s I have experience of include, Psychodynamic counselling, Gestalt Therapy, Integrative counselling, Transactional Analysis, Humanistic Counselling, Group Therapy, and Cognitive Behaviour Therapy. I am dyslexic and have dyspraxia, and I have been finding some of the reading quite difficult to follow, although I have been using some of the study skills I have learned from my personal dyslexia tutor, which I continue to see and develop coping strategies.
I believe I have benefitted enormously from receiving the various therapies and have grown into a more confident and less anxious individual. I am aware that I have developed a greater understanding of who I am and how I relate to others; I also continue to develop my self-awareness.
Psychodynamic Theory and practise skills.
The therapeutic alliance begins even before the therapist and client meet each other. Both will be wondering what to expect before they even meet for the first therapy session, they may have feelings and fantasies about each other. My understanding of the working alliance in both Psychodynamic counselling and CBT is being able to develop mutual trust between the client and therapist. It is important for the client to feel safe exploring their feelings in front of their therapist.
I am aware that not just psychodynamic counselling requires the emphasis of establishing a Therapeutic working alliance with clients; it is also other types of psychotherapy theoretical backgrounds which focus on building a therapeutic alliance in the counselling setting. According to Beck (1979) he explains the importance of establishing a therapeutic relationship between the therapist and their clients, as this is an important first step towards successful treatment.
It has been revealed that studies done on psychodynamic counselling and Cognitive behaviour therapy have concluded that the therapeutic alliance has an important aspect of influencing a positive outcome in both therapies. The first time a client meets their therapist they both begin a process of agreement to work together on achieving the client’s needs to make positive changes in their life. According to Bordin (1979) both the client and therapist will work on the components of the working alliance which include goals, tasks and bonds. These components base the foundations for a therapeutic relationship.
A competent therapist will have developed an understanding of their social and emotional intelligence, which should enable him or her to develop a therapeutic relationship with their client. The therapeutic relationship is based on the acceptance, understanding, and empathy towards the client, and should develop a good working alliance and form a trusting bond with the client.
The two components to any psychodynamic therapeutic alliance are the working alliance and the transference. The therapist should have awareness of the issues their client may have been experiencing such as, trauma, sexual orientation, gender identity, bereavement, cultural differences, disability, and addiction.
My experience of having been in Psychodynamic Counselling & the therapeutic alliance and relationship with my counsellors:
Over the past twenty years I have experienced being in therapy with three individual Psychodynamic counsellors at different periods. I am now aware of how important the developing therapeutic alliance and therapeutic relationship was established between me and the therapist. I shall explain how each of the counsellors worked with me in developing the therapeutic alliance and relationship.
The first time I remember receiving psychodynamic counselling was when I visited an LGBT charity called Pace which is based in North London. I found out about Pace through the London Lesbian and Gay centre who gave me their telephone number. I plucked up the courage to call them and asked for an appointment to see a counsellor, and was told there is a six month waiting list. However I decided to give them my details and wait for an appointment. Fortunately I received a call from Pace within five months to inform me that they had a counsellor appointment available for short term psychodynamic counselling lasting for twelve sessions. I remember feeling anxious about visiting the centre and meeting my therapist for the first time, as I had been desperately waiting to talk to someone in confidence about my sexuality, and this was partly due to the fact that I had not spoken to anyone about my sexuality before. According to (Howard, 2006) ‘It is not uncommon for a client who has been on a waiting list for a long time can diminish the impetus to do something about the problem’. I was also aware that I had to wait for some considerable time before getting to see a counsellor, so that added to my anxiety, and during the waiting for counselling I considered not pursuing it, as I found the situation stressful and frustrating. I understand for some potential clients the waiting period to see a counsellor could put them off.
During the period leading up to my first meeting with the counsellor I began to imagine what he or she would look like and how they will react to me, and how I will react to them.
According to Goleman, (2006) The therapists ability to form a therapeutic alliance is based on emotional intelligence and being able to read other people’s emotions, also identify their conflicts and discover what motivates them. Being aware of the client’s insecurities requires a great deal of listening skills and empathy. I believe being able to read the clients emotions and what motivates them is vital in psychotherapy as this allows the therapist to find out how their client functions emotionally and how they behave. During class we have been practising our listening skills, and when I practised being the counsellor I remember allowing my client to talk freely without interrupting them, listening to what was troubling them and reflecting back to them, paraphrasing the key elements back to the client. I believe this is essential for the positive growth and development of the therapeutic relationship.
Transference and counter transference
Unlike cognitive behaviour therapy, psychodynamic counselling involves the understanding and exploration of transference and counter transference. The concept was first used by Freud, and has since become widely used by psychodynamic counsellors. In classic Psychoanalytic therapy the client and therapists relationship is central to the working therapeutic relationship. According to Greenson (1967), ` Psychoanalysis is distinguished from all other therapies by the way it promotes the development of the transference reactions, and how it attempts systematically to analyse the transference phenomena’ (P.151). As Greenson points out in psychoanalysis, as in Psychodynamic counselling the transference phenomena is vital to helping the client and therapist work together collaborating on working on a successful therapeutic outcome for the client. It is important for the therapist to focus on the client’s transference especially during the beginning of the therapeutic relationship, as this will be a key to developing a successful outcome where the client will be able to work with the therapist on trying to solve important personal issues. The therapist should also be aware of their counter transference as this may hinder the development of the therapeutic alliance. The therapist should discuss any negative feelings to their supervisor.
Unlike person centred counselling, cognitive behaviour therapy, and rational emotive behaviour therapy. Psychodynamic counselling focuses the importance of transference and counter transference, on developing a therapeutic relationship. Psychodynamic counselling focuses on what experiences the client has had to cause any distress and by focusing on this the therapist guides their client to working on improving their feelings, thoughts and behaviour.
Counter transference
According to Laplanche and Pontalis, (1973) `over the years counter-transference has come to be understood as a key factor in the therapeutic relationship without which the counsellor can have no hope of understanding or helping her client.’ The therapist should be able to discuss his or her own issues whilst in supervision as failure to deal with the issues will impede on the successful outcome of their clients therapy. If the therapist brings their own insecurities into the counselling session the client is likely to identify this, and be concerned. The counsellor should be aware of their thoughts, feelings and fantasies in response to what their client is discussing, and be prepared to understand and interpret what the meaning is behind their counter transference.
Setting boundaries foundations
Boundaries are put in place during the start of therapy.
Time is one of the boundaries in counselling. The client is informed by the therapist on the length of each session which can be for example 50mins or an hour depending on what is agreed at the start of therapy. It is important that the client is informed that if they fail to show up for a counselling session without giving enough time to cancel the appointment then full fee will be required for the missed session, presuming the client is paying for their therapy. It is also important that the counsellor advises their client that the counselling session should not over run. The counsellor and client are committed to meeting at an agreed time and place this contributes to the working alliance although there may be a time when the counsellor is unable to make an appointment with the client due to illness or some other reason. Winnicott (1965: p166) remarked, his aim as an analyst was `keeping alive, keeping well, keeping awake’. Winnicott shows how important it is for the therapist to be reliable and make sure they stay awake during the counselling session, otherwise these may hinder the development of the therapeutic alliance and relationship, as the client may believe the therapist may not be interested in helping …show more content…
them.
Another boundary can be in the form of a confidentiality agreement which is set between the therapist and their client; this is made so that the client understands that anything discussed during the counselling session is kept confidential between them and information exchanged is not revealed to anyone out of the session. However confidentiality may be broken in circumstances when the client is potentially threatening to cause harm to themselves or others, this is when the counsellor can inform the clients Doctor, Police, or social services.
Therapeutic Relationship
Ruptures in the alliance
CBT Theory and practise skills.
History of CBT
The work of Aaron Beck and Albert Ellis has become the focus of what is known as cognitive behaviour therapy and where the ABC model has evolved.
Contrary to belief In Cognitive Behaviour Therapy the client and counsellor therapeutic alliance and relationship are essential in forming a positive outcome for the client. Cognitive behaviour therapy begins with the alliance in which the therapist and client begin to build a close trusting relationship where the therapist helps their client to identify what is troubling them in their lives. Therapists should collaborate with their clients and function as part of a team. The therapist
Total words below as of 17 nov = 115
Conclusion 300 words.
References:
Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance.
Psychotherapy, Theory, Research and Practice, 16, 252-260
Beck, AT, Rush, AJ, Shaw, BF, & Emery, G. (1979). Cognitive Therapy of Depression . New York:
Guilford Press
Howard, S (2006) Psychodynamic Counselling in a Nutshell. London : Sage
Summers, R.F and Barber, J.P. (2010) The Therapeutic Alliance. In:
Psychodynamic Therapy. London: The Guilford Press.
Clara E. Hill & Sarah Knox (2009) Processing the therapeutic relationship, Psychotherapy Research, 19:1, Greenson (1967) p.151
13-29, http://dx.doi.org/10.1080/10503300802621206
McLoughlin, B. (1995) Observe and Digest Your Own Responses to
Client Material. In: Developing Psychodynamic Counselling. Laplanche and Pontalis, (1973) London: Sage.
Jacobs, M. (2010) p.95 Psychodynamic Counselling in Action
Winnicott, D.W (1965) Studies in the Theory of Emotional Development. London Hogarth
Press.
25th October 2013.
Exploring the contribution of the working alliance to the development of an effective therapeutic relationship in both Psychodynamic Counselling and CBT
Introduction (300 words approx)
In my essay I shall be exploring my understanding of the working alliance, and effective therapeutic relationship in both Psychodynamic Counselling, and Cognitive Behavioural Therapy. I shall include my experience gained in class and outside of the classroom setting. With situations of when I have demonstrated my understanding of the therapeutic alliance and therapeutic relationship. Since I began studying for this course, I have become more aware of the importance of the therapeutic alliance, and the therapeutic …show more content…
relationship has towards forming a successful therapy relationship which is vital to a positive outcome for the client during Psychodynamic counselling.
Over the past twenty years I have received counselling from various counsellors who practise different theories of counselling. The types of psychotherapy’s I have experience of include, Psychodynamic counselling, Gestalt Therapy, Integrative counselling, Transactional Analysis, Humanistic Counselling, Group Therapy, and Cognitive Behaviour Therapy. I am dyslexic and have dyspraxia, and I have been finding some of the reading quite difficult to follow, although I have been using some of the study skills I have learned from my personal dyslexia tutor, which I continue to see and develop coping strategies.
I believe I have benefitted enormously from receiving the various therapies and have grown into a more confident and less anxious individual. I am aware that I have developed a greater understanding of who I am and how I relate to others; I also continue to develop my self-awareness.
Psychodynamic Theory and practise skills.
The therapeutic alliance begins even before the therapist and client meet each other. Both will be wondering what to expect before they even meet for the first therapy session, they may have feelings and fantasies about each other. My understanding of the working alliance in both Psychodynamic counselling and CBT is being able to develop mutual trust between the client and therapist. It is important for the client to feel safe exploring their feelings in front of their therapist.
I am aware that not just psychodynamic counselling requires the emphasis of establishing a Therapeutic working alliance with clients; it is also other types of psychotherapy theoretical backgrounds which focus on building a therapeutic alliance in the counselling setting. According to Beck (1979) he explains the importance of establishing a therapeutic relationship between the therapist and their clients, as this is an important first step towards successful treatment.
It has been revealed that studies done on psychodynamic counselling and Cognitive behaviour therapy have concluded that the therapeutic alliance has an important aspect of influencing a positive outcome in both therapies. The first time a client meets their therapist they both begin a process of agreement to work together on achieving the client’s needs to make positive changes in their life. According to Bordin (1979) both the client and therapist will work on the components of the working alliance which include goals, tasks and bonds. These components base the foundations for a therapeutic relationship.
A competent therapist will have developed an understanding of their social and emotional intelligence, which should enable him or her to develop a therapeutic relationship with their client. The therapeutic relationship is based on the acceptance, understanding, and empathy towards the client, and should develop a good working alliance and form a trusting bond with the client.
The two components to any psychodynamic therapeutic alliance are the working alliance and the transference. The therapist should have awareness of the issues their client may have been experiencing such as, trauma, sexual orientation, gender identity, bereavement, cultural differences, disability, and addiction.
My experience of having been in Psychodynamic Counselling & the therapeutic alliance and relationship with my counsellors:
Over the past twenty years I have experienced being in therapy with three individual Psychodynamic counsellors at different periods. I am now aware of how important the developing therapeutic alliance and therapeutic relationship was established between me and the therapist. I shall explain how each of the counsellors worked with me in developing the therapeutic alliance and relationship.
The first time I remember receiving psychodynamic counselling was when I visited an LGBT charity called Pace which is based in North London. I found out about Pace through the London Lesbian and Gay centre who gave me their telephone number. I plucked up the courage to call them and asked for an appointment to see a counsellor, and was told there is a six month waiting list. However I decided to give them my details and wait for an appointment. Fortunately I received a call from Pace within five months to inform me that they had a counsellor appointment available for short term psychodynamic counselling lasting for twelve sessions. I remember feeling anxious about visiting the centre and meeting my therapist for the first time, as I had been desperately waiting to talk to someone in confidence about my sexuality, and this was partly due to the fact that I had not spoken to anyone about my sexuality before. According to (Howard, 2006) ‘It is not uncommon for a client who has been on a waiting list for a long time can diminish the impetus to do something about the problem’. I was also aware that I had to wait for some considerable time before getting to see a counsellor, so that added to my anxiety, and during the waiting for counselling I considered not pursuing it, as I found the situation stressful and frustrating. I understand for some potential clients the waiting period to see a counsellor could put them off.
During the period leading up to my first meeting with the counsellor I began to imagine what he or she would look like and how they will react to me, and how I will react to them.
According to Goleman, (2006) The therapists ability to form a therapeutic alliance is based on emotional intelligence and being able to read other people’s emotions, also identify their conflicts and discover what motivates them. Being aware of the client’s insecurities requires a great deal of listening skills and empathy. I believe being able to read the clients emotions and what motivates them is vital in psychotherapy as this allows the therapist to find out how their client functions emotionally and how they behave. During class we have been practising our listening skills, and when I practised being the counsellor I remember allowing my client to talk freely without interrupting them, listening to what was troubling them and reflecting back to them, paraphrasing the key elements back to the client. I believe this is essential for the positive growth and development of the therapeutic relationship.
Transference and counter transference
Unlike cognitive behaviour therapy, psychodynamic counselling involves the understanding and exploration of transference and counter transference. The concept was first used by Freud, and has since become widely used by psychodynamic counsellors. In classic Psychoanalytic therapy the client and therapists relationship is central to the working therapeutic relationship. According to Greenson (1967), ` Psychoanalysis is distinguished from all other therapies by the way it promotes the development of the transference reactions, and how it attempts systematically to analyse the transference phenomena’ (P.151). As Greenson points out in psychoanalysis, as in Psychodynamic counselling the transference phenomena is vital to helping the client and therapist work together collaborating on working on a successful therapeutic outcome for the client. It is important for the therapist to focus on the client’s transference especially during the beginning of the therapeutic relationship, as this will be a key to developing a successful outcome where the client will be able to work with the therapist on trying to solve important personal issues. The therapist should also be aware of their counter transference as this may hinder the development of the therapeutic alliance. The therapist should discuss any negative feelings to their supervisor.
Unlike person centred counselling, cognitive behaviour therapy, and rational emotive behaviour therapy. Psychodynamic counselling focuses the importance of transference and counter transference, on developing a therapeutic relationship. Psychodynamic counselling focuses on what experiences the client has had to cause any distress and by focusing on this the therapist guides their client to working on improving their feelings, thoughts and behaviour.
Counter transference
According to Laplanche and Pontalis, (1973) `over the years counter-transference has come to be understood as a key factor in the therapeutic relationship without which the counsellor can have no hope of understanding or helping her client.’ The therapist should be able to discuss his or her own issues whilst in supervision as failure to deal with the issues will impede on the successful outcome of their clients therapy. If the therapist brings their own insecurities into the counselling session the client is likely to identify this, and be concerned. The counsellor should be aware of their thoughts, feelings and fantasies in response to what their client is discussing, and be prepared to understand and interpret what the meaning is behind their counter transference.
Setting boundaries foundations
Boundaries are put in place during the start of therapy.
Time is one of the boundaries in counselling. The client is informed by the therapist on the length of each session which can be for example 50mins or an hour depending on what is agreed at the start of therapy. It is important that the client is informed that if they fail to show up for a counselling session without giving enough time to cancel the appointment then full fee will be required for the missed session, presuming the client is paying for their therapy. It is also important that the counsellor advises their client that the counselling session should not over run. The counsellor and client are committed to meeting at an agreed time and place this contributes to the working alliance although there may be a time when the counsellor is unable to make an appointment with the client due to illness or some other reason. Winnicott (1965: p166) remarked, his aim as an analyst was `keeping alive, keeping well, keeping awake’. Winnicott shows how important it is for the therapist to be reliable and make sure they stay awake during the counselling session, otherwise these may hinder the development of the therapeutic alliance and relationship, as the client may believe the therapist may not be interested in helping …show more content…
them.
Another boundary can be in the form of a confidentiality agreement which is set between the therapist and their client; this is made so that the client understands that anything discussed during the counselling session is kept confidential between them and information exchanged is not revealed to anyone out of the session. However confidentiality may be broken in circumstances when the client is potentially threatening to cause harm to themselves or others, this is when the counsellor can inform the clients Doctor, Police, or social services.
Therapeutic Relationship
Ruptures in the alliance
CBT Theory and practise skills.
History of CBT
The work of Aaron Beck and Albert Ellis has become the focus of what is known as cognitive behaviour therapy and where the ABC model has evolved.
Contrary to belief In Cognitive Behaviour Therapy the client and counsellor therapeutic alliance and relationship are essential in forming a positive outcome for the client. Cognitive behaviour therapy begins with the alliance in which the therapist and client begin to build a close trusting relationship where the therapist helps their client to identify what is troubling them in their lives. Therapists should collaborate with their clients and function as part of a team. The therapist
Total words below as of 17 nov = 115
Conclusion 300 words.
References:
Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance.
Psychotherapy, Theory, Research and Practice, 16, 252-260
Beck, AT, Rush, AJ, Shaw, BF, & Emery, G. (1979). Cognitive Therapy of Depression . New York:
Guilford Press
Howard, S (2006) Psychodynamic Counselling in a Nutshell. London : Sage
Summers, R.F and Barber, J.P. (2010) The Therapeutic Alliance. In:
Psychodynamic Therapy. London: The Guilford Press.
Clara E. Hill & Sarah Knox (2009) Processing the therapeutic relationship, Psychotherapy Research, 19:1, Greenson (1967) p.151
13-29, http://dx.doi.org/10.1080/10503300802621206
McLoughlin, B. (1995) Observe and Digest Your Own Responses to
Client Material. In: Developing Psychodynamic Counselling. Laplanche and Pontalis, (1973) London: Sage.
Jacobs, M. (2010) p.95 Psychodynamic Counselling in Action
Winnicott, D.W (1965) Studies in the Theory of Emotional Development. London Hogarth
Press.