The Importance of Empathy and Congruence in the Counselling Relationship - Case Study Example

Why are empathy and congruence important in the counselling relationship? A strong positive alliance and relationship between patient and therapist has been widely identified as the ideal setting for an improved outcome in a psychological therapeutic process. It was Carl Rogers who have argued that congruence and empathy are core conditions that counselors must strive to achieve in order to achieve successful therapy particularly in person-centred counseling. (cited in Palmer 2000, p. 177) Congruence For the client-centred therapist, being in touch with his inner feeling should be ongoing and that it can be communicated as well. Ideally, this allows the client-therapist relationship to grow and become more real. These are the principles that characterise congruence. According to Stephen Palmer, “congruence involves the counselor being self-aware and open.” (p. 178) It supposedly has two dimensions: First, the counselor must be wholly and genuinely themselves within the therapeutic relationship, being alert to the presence and movement of their thoughts, feelings and perceptions; and, second, this genuine presence extend itself to the client. (p. 178) Although person-centred counselors don’t seek to provide their clients with an example to imitate, the congruence of the counselor is likely to inspire an increase congruence in the patient as well. This is particularly significant because incongruence, wrote Colin Feltham, is one of the characteristics of emotional disharmony. (p. 63) In addition, congruence in the counselor offers the client the genuine reaction of another person “whose integrity can be trusted, and whose professionalism has ensured that as far as possible that [reflection] is not discoloured by the counsellor’s own need system.” (Mearns and Thorne 1999, p. 87) What this tells us is that congruence empowers a therapist because it allows for a deep, real, vibrant and vital self of the counselor in his interaction with the client and that it has a great potency in the his quest for transformation. As a result, congruence allows for the thoughts and behaviours of the therapist and the client to correspond. As a result, both the patient and the therapist will be more genuine because the therapist dared to be more real. Carl Rogers (1971) has been one of the leading advocates of congruence. In an account, he elaborated on how congruence is applied in his practice: I express anger, and affection, and annoyance and all kinds of things, as well as being very responsive to hurt. Hurt arouses in me feelings of really wanting to be emphatic so that a lot of therapeutic attitudes that I’ve stressed, I think, are very real parts of me, and of many therapists, and so they need expression as well, but other feelings, too, have equal validity. (cited in Frick, p. 89) Empathy In Carl Rogers’s definition, which has guided most of the research in this area, is that “empathy is the therapist’s sensitive ability and willingness to understand the client’s thoughts, feelings, and struggles from the client’s point of view – in other words, entering the private, perceptual world of the other.” (cited in Koocher, Norcross and Hill 2005, p. 204) From here, the basis of its positive effect on the outcome is that it serves as a foundation of a positive relationship that is a corrective emotional experience, promoting the exploration and the creation of meaning while supporting the clients’ active self-healing efforts at the same time. When empathy is at its best, Eisner (2000) wrote, the two individuals are participating in a process comparable to that of a couple dancing, with the client leading and the therapist following. (p. 97) The idea that empathy is a prosocial motive that operates against people’s powerful egoistic motives is helpful to understand its potency. Because of empathy, the client know that he is understood and for the counselor to check their understanding. This is the same as saying, “This is how I sense it is for you. Have I got it right?” David Howe identified four stages in how empathy could be achieved and applied in the clinical setting: 1. Observation and identification: The patient’s gestures, expressions and speech communicate to us the vital expression of what he is feeling and thinking. There is accurate perception of the other’s behaviour and an accurate understanding of the meanings of the other person’s messages. 2. Incorporation: Having gained a picture of the other, much of it at preconscious level, we can absorb and assimilate the details into our ego. 3. Reverberation: the counselor resonates with the other’s experience and feels an experience of his own, that is real for him, but which has arisen in reverberation to the condition of the other. (p. 77) 4. Detachment: Here the professional observer withdraws, and regains the psychic distance necessary for objective analysis. From the therapist’s viewpoint, empathy is a special way of knowing. Here the therapist tries to get to know someone else’s inner world. Knowing, wrote Feltham, in this context, means, that the therapist’s inner phenomenological world and state of mind, which he can indeed directly perceive, are as similar as possible, or more, almost identical to the client’s. (p. 65) Case Study Eisner referred to a case study – a transcript - taken from an unpublished article by Rogers concerning a woman who has difficulty dealing with her dependence on her daughter and her inability to let go: The half hour session is initiated by the therapist offering her the opportunity to express what’s on her mind and informing her that he hopes both can “get to know each other deeply as possible” In the interview, the patient displays guilt and anger, and also experiences a “lot of empty places” when the daughter is not around. (p. 97) The case study have shown how the therapist accepted the client’s problem as presented but allows the issue to move from something external to a more internal focus such as how she feels about herself. Here, the therapist made no mental status evaluation or attempt to obtain any particular history. Instead, what he did was to attempt to see the world from the client’s point of view. This is where empathy comes in. The congruence came in his attempts to show that the client has feelings too. In the above example, one could see that the congruence-empathy model is significantly different from the psychodynamic and cognitive-based therapies in the sense that the patient is not offered specific interpretations or given directions. Criticisms There are critics who argue that using a higher level of congruence and empathy in the treatment is tantamount to selling psychotherapy short and reducing it to a level of a mere loving relationship. (Thorne 2003, p. 67) In this regard, particularly for the critics, it is helpful to point out that the relationship between a therapist and his client, marked as it is by the involvement of the therapist’s total responsiveness, constitutes not a cheapening but an elevation of psychotherapy to an altogether different plane of experience. The congruence-empathy principle offer unique ways to reduce tension and personal threat, thereby increasing opportunities for understanding to the point that individuals may be willing to risk changing their perspectives and positions. The success of the combination congruence and empathy has been documented by Koocher, Norcross and Hill. To quote: Across 20 studies, 34% found a positive relation between therapist congruence and treatment outcome, and 66% found nonsignificant associations. The percentage of positive studies increased to 68% when congruence was tested in concert with empathy… supporting the notion that the facilitative conditions work together and cannot be easily separated. (p. 204) The empirical evidence tells us a significant percentage in impact of the congruence and empathy and more so when they are combined. This variable underscores a new collaborative social communication dimension to the treatment and, as a result, provides new ways of looking and addressing issues in the field. Conclusion Empathy and congruence underscores the focus on the counsellor’s development rather that that of the client’s directly. These two variables are two of the cornerstones of a counsellor’s capacity to be confident and competent in his or her practice and as mentioned previously each is fundamental to the success of the other. With these, the counselor can use more and more of himself in relationship with his client. According Jerry Bozarth empathy and congruence is the perfect combination that supports the therapist-patient relationship with his notion of idiosyncratic empathy reactions. (cited in Mearns, Geldard & Thorne, p. 62) In essence, this idea recognises that the way a counselor would react emphatically to what a client is experiencing would likely be quite individual to that counselor and that if he trusts himself he can give the client whatever his reaction is in that moment with the knowledge that her own blocks are not distorting the reflection. All in all, one must remember that the relationship between the client and the therapist is the axis on which person-centred therapy progresses. If the therapeutic process is to unfold, the client, either consciously or unconsciously, must feel the conditions of congruence and empathy because these factors alone in a person-centred counseling are sufficient to achieve positive outcome. References Eisner, D 2000, The Death of Psychotherapy: From Freud to Alien Abductions, Greenwood Publishing Group. Koocher, G Norcross, J and Hill, S 2005, Psychologists Desk Reference. Oxford University Press. Howe, D 1993, On Being a Client: Understanding the Process of Counselling and Psychotherapy. London: SAGE. Mearns, D Geldard, MR and Thorne, B 1999, Person-centred Counselling in Action. London: Sage. Palmer, S 2000, Introduction to Counselling and Psychotherapy: The Essential Guide. London: SAGE. Rogers, C 1971, "Interview with Dr. Carl Rogers," in W.B. Frick (ed.), Humanistic Psychology: Interviews with Maslow, Murphy and Rogers. Columbus OH: Charles Merrill, p. 86-115. Thorne, B 2003, Carl Rogers. SAGE. Read More