What impact has the relational approach had on personal therapists - Essay Example

?What impact has the relational approach, (as described in 'Beyond Empathy' and Mearns and Cooper's 'Working at Relational Depth had on personal therapists? Introduction Relational needs are about achieving a good quality of emotional and psychological life and an active sense of one’s self- in relationships. Relational counseling is a process of broadening i.e. enabling a client to become aware of new ways of living, of being. On the other hand it involves a narrowing – a realization of which choices are actually possible and can be developed. How often is someone with psychological problems described as ‘withdrawn’ i.e. uninvolved with others? They are experiencing long-standing problems which interfere with their quality of life, and that is reflected in the way they deal with relationships. Earlier psychotherapy tended to be based upon a model based upon quantitative research or would be a symptom-based medical model with ‘patients’ rather than clients. A relational psychology approach is one which challenges some of these long held ideas used in more established types of therapy. Its main idea is that people need to establish authentic relationships and failure to do this ( sometimes referred to as disconnection) is the major source of psychological difficulties. The relational counselor must be able to develop as a reflexive practitioner, capable of reflecting on the client, on themselves as therapist and the therapeutic process that builds between them and their clients. Although the counselors involved are skilled practitioners, this type of therapy is not the usual doctor /patient relationship where one is the expert and the other merely an empty vessel to be filled with a suitable medication. Instead there must be dual input, a much more co-operative situation, which may take some adjustment of attitudes for those who began their counseling careers using more traditional methods. The History of Relational Psychotherapy As long ago as 1964 Gendlin described two factors needed for change. Firstly such a change must involve more than a cognitive understanding of the problem. There must a true connection with feelings. Such change is most often experienced with in an ongoing relationship. In the case of changes within a therapeutic situation the client needs to engage both with their own feelings and also with the therapist. The reflective presence of a therapist can assist the client to become more aware of the feelings they are going through. The weakness of such an approach could be, if care is not taken, is that the client becomes dependent and attached to the therapist, rather than moving on into other relationships with those in his world outside the therapeutic environment. Various theorists over time have come up with different descriptions of the various relational needs of mankind as they see them, but there is a great deal of overlap between the various schools of thought. Some for instance stress the needs for such attachments and links during childhood, but in the majority of cases there is agreement that such relational needs last lifelong. Needs will be individual to each person – someone who lost his father at an early age for instance may spend considerable effort even into adulthood seeking a father figure. The anonymous article ‘The psychology of relationships: relational needs’ ( 2006) mentions the work of Kohut and his twinning theory i.e. that we seek out someone we see as being similar to ourselves - someone who delights in what we delight in, someone with whom to share life’s experiences, someone to share with. Kohut also describes what he calls idealization – the need to have someone in our lives who is somehow bigger than we are – someone to be relied on when the going gets tough. In childhood that person is often a parent, in adult life it could be a partner or friend or even God himself. The Purpose of Relational Therapy The objective of the relational therapist is to work with clients in order that they can develop an understanding of themselves and so enable the fostering and growth of relationships. They will then be better able to experience a feeling of psychological well being. In some cases the therapeutic relationship and the well being that results becomes a model for a client to use as a prototype for other necessary relationships. As described by Miller ( 2005) they become able to take actions in relationships. They develop a better knowledge of themselves, but also gain insight into the other person involved. This engenders an increase in self esteem and also increases the demand for creating more relational connections. This possibility of a therapy session becoming a model relationship can involve very careful distinctions. In order to keep things on a professional basis such things as the length of sessions, about 50 minutes, and their timing (at a fixed time each week) and in a particular place, in this case at the health centre, need to be carefully maintained. While making a client feel welcome with a friendly greeting, it is also necessary to show in some way that this is to be a professional relationship. Also it is useful if, although therapy may be long term, a fixed number of sessions are stated after the initial meeting, so that the client realises that this is a temporary situation and after a time they must move on. Relational therapy is not so much about quickly fixing a particular problem as providing a basis for reaching a life long solution. The first session can be described as exploratory with both sides getting to know each other and necessary boundaries being set and any necessary paperwork being completed . If this is a private, rather than a National Health or charity session, then payment arrangements have to be made. This session isn’t so much about therapy as exploring a way to move forward into a therapeutic process. A history of such things as childhood, a persons level of education, relationships - romantic and otherwise things, the person’s career and their current living situation as your childhood, education, relationships (family, romantic, friends), your current living situation and your career. Confidentiality must be respected and the client must be assured of this. In a situation where the counselor is supervised some information will be passed on, but the client needs to know that if this is done their right to confidentiality will still be protected. The session will involve questioning on the part of the therapist - either asked directly, or perhaps in the form of a facial expression or a ‘Mm’ all of which can lead the client of further enquiry into his self , his feelings and needs. Such questioning does not demand particular answers , expected by the therapist or not, but allows the client to discover and reveal something new. It also involves acceptance that that client is trying his best in his present condition - a form of respect for him as an individual. This includes giving him time and the chance to ask any questions he has and the therapist doing their best to provide correct and suitable answers. It must be realized that the client is emotionally vulnerable. They may have previously experienced broken relationships and disrespect and now they are being encouraged to form new relationships or mend old ones. The ideas they have formed through their previous relational experiences colour the assumptions they make about any future relationships. This means that they have developed methods which keep them out of true relationships. Instead they must learn new techniques. Erskine states ( undated) that ‘ truly empathic therapists’ are those who are skilled inquirers, who are attuned sensitively to clients, and involved in an appropriate way in the process of therapy.   Instead of being asked to pay attention to their feelings of poor self esteem - which could lead to further lack of self-esteem – the client is encouraged to think about how they feel about their lack of self esteem. From this they can move on to what can be done to right matters. If there is lack of success in doing this it is more likely that the counselor has failed, than the client according to D.W. Winnicott who stated in 1956 ‘every failed analysis is a failure not of the patient but of the analyst.’ Mearns and Cooper These two represent the British Person Centred Approach to Counselling, as in their 2005 work, ‘Working in Relational Depth in Counseling and Psychotherapy.’, although Melanie Klein, who most often worked with children, is usually the person credited with being the founder ( although Austrian born) of the British based school of person centred relationship therapy, as in ‘Love , hate and reparation’. This was very different from the Freudian school that had prevailed up until that point, as in the work of Anna Freud. Klein believed that positive relationships, as in that between a mother and her infant child, are essentially part of self preservation. Mearns and Cooper state that each individual evaluates himself according to his relationships. (Page 1, 2005) It is known that the building of relationships is helpful to psychological well being, but even Mearns and Cooper ( 2005, page 15 ) had to admit :- ‘We still know very little about the actual processes and dynamics that take place between therapist and client, and how these might lead to significant therapeutic change.’. On page 2 they surmise that because relationships cause difficulties it is also through building relationships that healing can be achieved. It is through interactions with others that clients find and become themselves. Yet in an earlier work ( Mearns and Thorne ,1999) the authors asserted that what leads to therapeutic changes is the way in which a therapist provides an antidote to lack of self esteem when they offer empathy, rather than sympathy and are accepting of the person as they are. Parton ( 2006) pointed out that Mearns and Cooper did not describe conditions of worth. They are not trying to push a certain point of view as much as sharing their own experiences, including their doubts and uncertainties as well as their combined insights. These therapists have a great deal of clinical experience and the knowledge that accompanies such experience , but also are able to express their compassion fro those with whom they work. Other therapies In 1992 Norcross and Newman stated that no single therapy or group of therapies had been found to be innately more helpful. In all of them the client must be bought to the point where they can answer questions such as ‘What exactly do I want from a relationship?’ and ‘What is it that will make me feel that someone cares about me?’ and of course ‘What can I do about my relationships?’ For instance they must come to the point where they realise the importance of communication – a partner cannot mind read – only by open discussion can one person come to really know what the other requires of their relationship. Only then can a period of negotiation be developed as to how each can meet the other’s needs. Those seeking relational therapy can on occasions be quite self centred – even if they realise what they are missing, they may need to be bought to the point where they realise that other people, or a particular other person, may also have such needs. In 2002 a task force from the American Psychological Association reviewed the data available to them on the therapeutic relationship and its link with the outcomes of therapy. They concluded, as quoted by Mearns and Cooper ( page 2) that:- The therapy relationship ….makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment. This means that from whatever point of view the therapist comes from – whether working as a cognitive behaviourist or uses interpersonal therapy or any other method, it is the quality of the relationship with the therapist that is the most important factor i.e. talking with someone who both listens and understands them. This involves such things as the level of empathy achieved, the amount of co-operation between therapist and client and an agreement between client and therapist as to the goals they want to reach. Erskine Erskine (1998) speaks about various relational needs present in everyone from infancy onwards. He, together with Rebecca Trautman, ( 1996) expanded upon the relational needs as described earlier by Kohut. A person needs to establish a relationship with the other person involved. When this does not happen or is disrupted needs are not met. There needs to be empathy or attunement i.e. a two way process of being aware of how the other person is feeling and why they act as they do. It also involves letting the other person know that they are understood. This may be communicated by word, but also by facial and body language, and simply by presence. The therapist needs to be capable of withdrawing himself from his own experience and instead focus upon the needs of their client. There is a need to feel of value, an affirmation. If someone’s needs or ideas are constantly ignored or devalued the relationship becomes invalid. This facet of human relational needs includes the innate demand for affirmation of our particular relational needs affirmed and the acceptance of these as being normal and natural. A relationship must be stable and have continuity. As small children we rely on others as dependable and protective beings – this need continues throughout life in various forms. The majority of people would prefer for instance to have a steady job, rather than one which might or might not be available next day. Also preferred by the majority of adults is a stable romantic relationship rather than a series of ‘one night stands.’ This could be described as the need for security in relationships. In some cases a person may be seeking something that it is impossible to obtain, the healing of a relationship that has now passed – a better relationship with someone who has died for instance, or with a lover who has moved on.. They must learn ways to cope with this – perhaps by writing a letter to the person, even if it is impossible for that person to read it. Another need stated by Erskine is for confirmation of one’s personal experience. A client may fantasise, but even then the fantasy will express needs, hopes and conflicts. Such expressions must be accepted as valid. By a very careful sharing of certain personal experiences the therapist confirms what the client is experiencing. Self – definition, Erskine says, is the need to express, and have appreciated, one’s uniqueness as an individual. It can be expressed by such things as describing ones likes and dislikes or hobbies and preferences. The more someone feels they are just like others the more insistent is the need for such self-definition. This is the other side of the need for twinning as described earlier by Kohut. There is a need to make an impact on someone - to make a difference – so if someone says ‘ You’ve cheered me up today ‘ an impact has been made. The therapist’s response is important - if they are obviously moved when a client is sad then impact has been made. This can be described as the need to give love, as in the article ‘The psychology of relationships: Relational needs’ ( 2006) If someone else initiates we feel valued, as when someone is invited out to tea, or even welcomed to a session by the therapist moving physically towards them in greeting. Conclusion Erskine stresses the needs of an individual, though these are often based upon the need for relationships . The British writers on the other hand, Mearns and Cooper, lay emphasis on the healing of relationships , but these are but two sides of one therapeutic tablet. Relational Centred Counselling is an important part of professional counseling work both within and outside of organisations such as the National Health Service. Its success can be supported by research and draws upon a number of contemporary developments in psychoanalytic theories. Of the greatest importance to this type of counseling is the therapeutic relationship – the co-created relationship which must involve both client and therapist as partners in the therapeutic process. Coping with difficult emotions and ideas can be difficult for some people to cope with, and to share with people we know. This is where professional counseling may help. What is paramount must be the therapeutic intent. Both therapist and client must make a commitment to the client’s growth and eventual healing. It seems obvious that relationships are important to us all. Erskine stresses relational needs and Mearns and Cooper stress the person involved in the relationships. These are differing aspects of the same therapeutic process. Any situation that enables stronger and better relationships must be a good thing. For those undergoing psychotherapy and counselling involvement is needed. The client must feel that the therapist is really interested in them and their future wellbeing. The therapist must be able to use the client's individual knowledge in order to see the world, including their particular problems and needs through eyes. This involvement may include such things as accepting his needs as being valid and worthy of attention. The psychotherapist's focus on the relational needs of their client can bring about change, but Erskine reminds his readers that this kind of therapeutic therapist/client relationship, if it is top be successful, can neither be standardized or prescribed. Therapists may be working with people who have similar problems, even come from very similar backgrounds, but it must be remembered that they are individuals and the relationships between therapist and client must be an individual one. REFERENCES AMERICAN PSYCHOLOGICAL ASSOCIATION , 2002, quoted by MEARNS,D & COOPER, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage.( page 2) ERSKINE, R., Beyond Empathy: A Therapy of Contact-in-Relationship, Available from http://www.integrativetherapy.com/en/articles.php?id=39 ( accessed 12th January 2011 ERSKINE, R., 1998, Attunement and involvement: therapeutic responses to relational needs, International Journal of Psychotherapy, Vol. 3 No. 3, Available from http://www.integrativetherapy.com/en/articles.php?id=31, ( accessed 11th January 2011) ERSKINE ,R. AND TRAUTMAN, R., Methods of an Integrative Psychotherapy. Transactional Analysis Journal, 1996 Vol 26, No 4, October GENDLIN, E.T.,A theory of personality change. ( 1964/1973) In MAHRER, A. and PEARSON, L. Creative Developments in Psychotherapy. New York: Jason KLEIN, M. and RIVIERE, J., Love , Hate and Reparation, 1964, London and New York, Norton Library KOHUT,H., The analysis of the self. , 1971, New York: International Universities Press. MEARNS,D & COOPER, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage. MEARNS, D. & THORNE, B. (1999) Person-Centred Counselling in Action. 2nd edition. London: Sage. NORCROSS J. & NEWMAN, C. (1992). Psychotherapy integration: Setting the context. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 3-46). New York: Basic. PARTON, C. ( 2006), ‘Focusing’ and ‘Working at relational depth’ – why do they help?, paper presented at 7th World Conference for Person-Centered and Experiential Psychotherapy and Counselling. July 12-16 2006, Potsdam, Germany., available from http://www.dwelling.me.uk/Focusing%20and%20relational%20depth.htm ( accessed 11th January 2011) THE PSYCHOLOGY OF RELATIONSHIPS : REALATIONAL NEEDS, Relationships Explained, 2006 , available from http://www.relationships-explained.com/pages/Relational-needs.html, ( accessed 14th January 2011) WINNICOTT,D., Clinical Varieties of Transference, 1955-56, as quoted by Robbons , D.W. WINNICOTT, 1999, Available from http://mythosandlogos.com/Winnicott.html ( accessed 14th January 2011 Read More