Relationship between the Therapist and Client - Assignment Example

Relationship between the Therapist and Client Before going into the details of my personal example as a therapist during a therapy session, it is important to explain how important it is for a therapist to develop a healthy relationship with the client in order to fasten up the recovery process. Corey (2009 p.150) states that, “The relationship is important in itself because the quality of this person-to-person encounter in the therapeutic situation is the stimulus for positive change.” Therapists must know the fact their personal and professional ethics and values make a lot of impact upon their relationship with the client (Casement, 1984). The basic thing needed to nourish the therapist-client relationship is respect. The therapist must respect the patient in whatever the state he is in. He should be honest and straightforward. He must also take patient’s informed consent about the treatment. Informed Consent is about having the capable patient take part in making decisions about his healthcare and treatment process (Wear, 1992). The therapist has to guide some ethical principles in his practice to be able to hold the client. Rainbow (2002) describes that these ethical principles include: Beneficence This principle is based on the values and standards that guide the physician to make a decision that is in the favor of the patient with the intention of doing good to him (Yoder-wise, 2003) Least Harm When a physician has to make a choice out of options neither of which is beneficial for the patient, then he has to choose the option that will do least harm to the patient. Respect for Autonomy This is about granting the patient the authority to make decisions about his healthcare since he is the one who is most informed about his life style, routine, body, and his comfort zone. Justice This principle states that physicians make ethical decisions that are fair to the patient and all those who are involved in the treatment process. The decisions should be made on logical bases. Deontology Physicians should stick to their responsibilities when they are facing a dilemma in making ethical decisions. This will help them to make consistent decisions while adhering to their ethical obligations. Utilitarianism This theory helps the physician to make choices whose consequences are better for the patient. He will make a decision that will yield greatest benefit to all involved. Casuist This theory enables the physicians to make decision about an ethical dilemma by comparing it to similar dilemmas and their consequences that might have happened in the past. All of the above mentioned principles and theories help in developing strong bond between the therapist and the client. When the client knows that the therapist will protect his privacy, respect his autonomy, and will make ethical decisions about his health, he will naturally want to share all his health related problems with the therapist and will want to participate in the decision-making process. This fastens up the recovery process and guarantees patient compliance with the treatment. Transference Transference is a therapeutic process in which the patient transfers his feelings to the therapist, the feelings which arise because of inappropriate relationships in the past and which can help the therapist in understanding the patient’s present condition (Bauer, 1994). It is known as a very important part of psychoanalytic treatment in which the patient transfers his attitudes and feelings linked with some significant others, to the therapist, and the patient in turn gains an insight into the present distortions in his life by looking at past disturbances in the relationships which may have remained hidden or inactive in his memory. How I used transference in my therapy session? In the therapy session, I had to deal with a young boy, Mike, aged 17. He was an aggressive boy and very argumentative in nature. After several sessions with him, I found a certain behavioral pattern. I found him feeling insecure, maybe because I am sort of an authoritative therapist. I tried to sort out if he responded to all authority figures the same way and why exactly he responded so. Sometimes, he reacted so differently and sweet that I could sense that he is not responding in the actual way he feels but is trying to please me to get praise. This difference and extremities in reactions made me get an idea that there was something wrong in his relationships because he was behaving with me just like he had been behaving with a significant other. The challenge for me was to find out what the problem was. I found out that he had an authoritative father who had been influencing his life. The unconscious and conscious memories of his authoritative father made him react in the same way as he had been reacting toward him. It had become his second nature to show aggressiveness and irritability toward all authoritative figures. Sometimes he acted artificially sweet giving an idea that he wanted praise, the praise which he had longed to get from his father. The transference relationship that he had developed with me helped me figure out the distortion in his relationship with a significant person in his life. Counter-transference Counter-transference involves the intuition, feelings, attitude and behavior that the therapist shows in reaction to the client’s experiences. The stimulation in the therapist’s mood, for example the excitement, curiosity, anger or sympathy, whatever arouses in the therapist is what we call counter-transference. The therapist must be well tuned to recognize this stimulation within him and must be able to figure out if this stimulation is coming from the client or is arising from within. How I used counter-transference in my therapy session? While I was having therapy sessions with Mike, I found out a behavioral pattern within myself which I would call counter-transference. Every time I talked to him, I felt a certain urge to make him quiet and tell him that guys his age are all immature and behave childish. Every now and then I wanted to supply him with answers and fill him in with the information he was lacking. I got it in his eyes that he knew my reaction. As a matter of fact, I do not think that counter-transference is something that the therapist should be ashamed of. I believe that counter-transference is the patient’s creation and it tells the therapist about the patient’s personality. I knew that I did not get agitated easily and this guy was constantly agitating me which meant that the guy was agitating. I inferred from this counter-transference that the guy needed to talk about his past and his relationship with significant others which led me to transference, which I have described in the previous section. What he aroused within me were feelings of agitation which told me of his personality and his problems. I also believe that therapists must also be able to distinguish between counter-transference and own permanent behavioral patterns. Since I knew that I am not naturally agitated or easily irritated, I automatically inferred from this that the feelings that Mike aroused within me were counter-transference and not my natural behavior. Therefore, it was proved that I as a therapist did not need therapy, and Mike did. Working with Silence Silence is also a mode of communication during psychotherapy sessions. It is actually a very powerful intervention technique and is either overlooked or overused. A new analyst may be silent because he has very little information to start with. Modern day analysts do not like to go through prepared notes about the patients that may cause biased opinions. They, instead, give the patient a chance to talk about themselves in order to build an unbiased relationship with them. In this case, silence becomes a vital choice and not so harmful because it gives the patient enough space or room to describe himself. Silence, however, becomes inappropriate when it is used as a response to unrecognized counter-transference or a tragic event that has ever occurred with the patient. How I worked with silence during my therapy session? During my therapy sessions with Mike, I found out that I needed to do my own therapy regarding working with silence. My friends were observing me during the sessions, and they told me that I at times left Mike silent and was not able to change the topic or carry on the topic to remove the silence. I need to improve myself in this scenario. Sometimes, I use silence as a tool to let the client talk about his experiences, but this intervention became long enough to irritate the client and he went into persecutory silence which I was not able to break. Moreover, when Mike was telling me about his father’s death, I found myself dumbfounded on Mike’s and his family’s suffering and I found myself not being able to compose myself. This is where I confused my own feelings with counter-transference. My silence was not counter-transference here; instead, it was my personal behavior because I know that whenever I hear anything tragic, I feel myself cocooning inside a shell. I could see that Mike was irritated at my silence and was asking when the session would be over which was a clear signal that he wanted to end the session or at least change the subject. I must also work upon understanding non-verbal clues from the clients who may be afraid to convey their feelings onto me directly. The Frame (350 words) The frame includes the “therapeutic setting and boundaries” (Grohol, 2004) in which the session is taking place. It includes the place or room where the session is held, the setting of the room, the seating arrangement, the distance between the therapist and the client, the time of meeting, the duration of meeting, any distractions coming from within or outside of the room, the mode of payment, and etcetera. Any distraction in this frame leads to distraction in the therapy. An ideal frame includes a single time payment, a single location where the client has to come for sessions, a set time and duration of sessions, a soundproof room where there is no chance of distraction from the outside, and a guarantee of privacy and confidentiality. How I used the frame during my therapy session? I used a proper frame during my therapy sessions with Mike to make him feel comfortable with me. One thing that I do not appreciate is that I was having some colleagues watching when I conducted the session whom I allowed because I wanted an input from their side about how conducted the sessions. I believe that their presence was a bit distracting and I could see Mike holding some sentences with himself due to their presence. So, I think that the session could have been much more successful without their presence even when their feedback was very valuable because I came to know about my strengths and weaknesses. However, I will make sure the next time that there is no distraction in the room and no noise coming from outside so that the client feels at comfort and does not hesitate in talking everything out. I kept the distance between Mike and me proper enough so that I could hear him comfortably and he did not have to talk loud in order to make himself clear. Also, the chairs were not too far apart so that Mike could get an idea that I was totally interested in whatever he spoke and was not trying to avoid him. This made him feel that I was eager to listen to him and he felt valued and respected, which is a great input that any therapist can give during a therapy session. Holding the Client Holding the client during a therapy session is as important as listening to him attentively. Holding may mean composing him verbally or physically as need be. It is hard to draw boundaries or make the client aware of his boundaries if he needs a physical assurance. For example, if a client wants to hug the therapist before leaving, it is a matter of sensitivity if the genders are opposite. If the therapist responds with a hug, then many follow-up responses are needed in next sessions to balance out the hug. So, it is hard for the therapist to decide how much to hold on and in what way. However, it is very important to hold the client verbally when he is in a difficult situation like when he remembers a tragic event or is fearful of something that can happen in future to him. How I held the client during the therapy session? Mike was, at times, very vulnerable when he talked about his future and shared his fears with me. Although I found myself not very good at working with silence, yet I was very good at holding the client at many times. For example, Mike talked about his loneliness that had followed after the death of his father and he started shivering. I found myself holding his hand and soothing him through verbal and non-verbal gestures. I wanted him to compose himself. Also, when he showed anger upon something, I tried to cool him down by patting his shoulder and smiling at him to give him an idea that the matter is not important enough to get angry at. This would calm him down a bit. I believe that touch is one of the most valuable non-verbal modes of communication. Zur and Nordmarken (2011) state that “when a client initiates or requests touch, the therapists must use his or her clinical judgment to ascertain whether providing or withholding touch is ethical and clinically advantageous in each therapeutic situation.” In our culture, touching the same gender is a taboo because of homophobic concepts; therefore, whenever Mike wanted a physical reassurance like a gentle hug, it was very hard for me to decide whether it would be within ethical boundaries or not. However, I found myself dealing with the situation very efficiently, and Mike was also not very demanding in this context. Conclusion The relationship between the therapist and his client is very important for a fastened recovery. A bad relationship will end nowhere while a healthy relationship will become a fruitful and delightful journey for both the therapist and the client. However, to build a good relationship, the therapist needs to have many personal, professional and ethical values and principles so that the patient feels comfortable in developing an honest and a trustworthy relationship with him. During the therapy sessions with my client, Mike, I found him transferring his emotions and feelings to me, and this transference led me to the root cause of his problem. I felt counter-transference many a times when I felt agitated. I was not very good at working with silence. However, I put my best efforts in orienting the most suitable frame that I could offer to the client to comfort him. I was also very good at holding him in difficult and sensitive situations. To sum up, my therapy sessions were very successful and I learnt my strengths and weaknesses which I will definitely consider in my future sessions. References Bauer, GP 1994, Essential Papers on Transference Analysis, Aronson, London. Casement, P 1984, On learning from the Patient, Routledge, London. Corey, G 2009, ‘Relationship between therapist and client’, Theory and Practice of Counseling and Psychotherapy, 8th ed., Cengage Learning, USA. Grohol, John M 2004, ‘Types of therapies’, PsychCentral, viewed, 2 December 2011, . Rainbow, C 2002, Descriptions of Ethical Theories and Principles, 2011, . Wear, S 1992, Informed Consent: Patient Autonomy and Physician Beneficence within Clinical Medicine, Springer, USA. Yoder-wise, PS 2003, ‘Ethical principles’, Leading and Managing in Nursing, Elsevier Health Sciences, USA. Zur, O & Nordmarken, N 2011, ‘To touch or not to touch: exploring the myth of prohibition on touch in psychotherapy and counseling: clinical, ethical & legal considerations’, Zur Institute, viewed 3 December 2011, . Read More