Rules and Principles of Establishing Interpersonal Relationships in Psychotherapy - Essay Example

?Drawing the Line Between the Professional and the Personal in Therapy Establishing interpersonal relationships entails several factors that can benefit or negatively affect the connection especially in its early stages. In my opinion, personal relationships may have more leeway for adversarial situations than professional ones because boundaries are less defined in personal relationships. However, there are professional relationships that have strong tendencies to include personal rapport due to the nature of its service. One example is in therapy. This essay will attempt to draw the somewhat blurry line between the professional therapeutic relationship and the personal connection of the therapist and the client, as sometimes, conflicting interpretations ensue during therapy. It will also emphasize the importance of reflective practice in therapy. In therapy, the therapist and the client share a close relationship that may transcend the professional link because the client is made vulnerable to the influence of the therapist. However, one rule in therapy is for a therapist to be objective even as he tries to extract personal information from the client (Pervin, Cervone & John, 2005). I believe that when a therapist is successful in making the client open up, he has made a breakthrough that will be crucial in the healing process. However, since the trust of the client is gained, it is possible that the client may develop certain emotional attachments to the therapist and yearn for more than what the professional relationship offers. Jorgenson, Hirsch & Wahl (1997) explain that the importance of maintaining boundaries stems from the nature of the relationship wherein the professional possesses the special expertise or knowledge that the client needs. The fact that the possession of knowledge or skill of the professional, coupled with the client’s vulnerability creates an imbalance of power in the relationship. In order for the professional relationship to progress, its integrity must be maintained at all times. Behaviours should be regulated to be appropriate under any circumstance. However, variations in the approaches to therapy, treatment modalities, ideologies, goals and theoretical or moral perspectives can lead to a wide spectrum of views on the appropriateness or inappropriateness of behaviours. Consequently boundaries may still be mapped to prevent any inappropriateness. One is the professional’s personal moral code for his or her own definition of acceptable boundaries which he could tactfully share with the client. Boundaries may be adjusted according to the client’s age or health or therapy employed (Jorgenson et al, 1997). For example, an aging client with a heart condition may be in need of a more nurturing therapist who can extend his or her sessions to accommodate the client’s airing of personal gripes. Another boundary-setting body is the code of conduct or rules and regulations provided by the organization of which the professional is a member and must abide by (Jorgenson et al., 1997). The British Acupuncture Council Code of Professional Conduct (2004) sets ethical boundaries in therapist-client relationships. Inappropriate relationships that are of a romantic or sexual nature or those that involve business opportunities or financial issues are firmly discouraged. If the therapist is aware that the professional relationship is put at risk with certain inappropriate advances by the client then the therapist must discourage it or end the professional relationship if necessary (p.9). The danger of getting personally involved with the client is affecting the treatment by having emotions getting in the way and at certain times, not being able to deliver the professional service expected for successful treatment. For example, if the therapist is emotionally involved with the client and needs to do a session that may involve pain, if the client decides not to pursue with it even if it was already agreed upon, then the therapist may yield to client’s decision, against his better judgment. It is important to set clear boundaries of the professional relationship from the beginning, however, it may not be as easy as it seems. I believe that the therapist himself must set basic rules such as keeping strict appointment schedules in the official venue of the therapy and limiting personal contacts to relate to the therapy itself. This means, the client can only see the therapist regarding the nature of her case and at the schedule and venue set by the therapist. Phone calls should also be limited to issues related to the therapy and should be limited to working hours, interceded by the therapist’s secretary or receptionist, if possible. Jorgenson et al. (1997) enumerate the possible negotiations between therapists and clients such as appointment times, fees, length of sessions, telephone protocol, and vacation times. These negotiated elements of the relationship constitute boundaries. It takes a true professional to be able to set boundaries clearly and stand by them. Corey (2005) describes the professional therapist as adept and very patient in coaxing the client to unearth information that is pertinent to therapy. The ability to listen and be alert and sensitive to what the client tries to communicate (verbally or non-verbally) is crucial to his valid interpretations about the client. He must also possess maturity and maintain his professional objectivity especially when the client undergoes “transference” of remembered feelings towards a significant person in her life to the therapist. A deep level of trust must have been established between the therapist and the client to be able to achieve this feat (Corey, 2005). Carl Rogers, a noted psychologist who espoused humanistic views in therapy, believes that a warm and caring therapist should be imbued with attributes such as congruence, unconditional positive regard and accurate empathic understanding in addition to a high level of maturity (Corey, 2005). The intimacy of details shared during therapy can easily make clients vulnerable to being attracted to the therapist due to the skill of being able to derive such personal information while still maintaining a professional demeanor. The client may think that the therapist is one trustworthy individual who accepts her as she is and is not pushed away regardless of how bad her case is. This fact may cause ‘transference’ of feelings the client originally had for one person who may have caused her strong emotions in the past to her therapist (Corey, 2005). On the other hand, the therapist may also develop certain feelings for the client. This is termed ‘countertransference’. The concept of countertransference was first introduced by Freud in 1910. He noted that there are some factors in the patient that can influence the analyst’s unconscious feelings and these can interfere with the treatment. However, more contemporary therapists see such therapist’s reactions to patients may also have diagnostic and therapeutic relevance which can contribute rather than inhibit treatment (Bethan et al., 2005). Other factors that may affect the professional relationship are the therapist’s own biases and stereotypes. Some examples are gender, sexual orientation or cultural stereotypes attached to some clients. Steele (1997) explains that stereotype threat is an external factor that greatly affects an individual’s confidence about his own abilities due to his identification with the domain and the resulting image it projects about him. For example, a Black American woman may be stereotyped as inferior to a Caucasian woman in terms of competencies and personality. It is likely that this client shirks away from situations that may expose her to stereotype threats for fear of being labelled negatively, thus further diminishing her already low self-esteem. It is also possible that she has grown immune to such stereotypes that it defines her “self-fulfilling prophecies” to be manifested (Rist, 2000). The therapist should project to the client that he is non-judgmental and the therapy sessions are stereotype threat-free. Maintaining a warm and sincere disposition will help the therapist eventually gain the client’s trust. At the same time, such biases and stereotypes may alter the professional boundaries of the therapist. For example, in believing the stereotype that Black teenagers may pose as threats to his safety, his boundary may include not accepting them as clients for fear of his security. The therapist should be able to rise above such stereotypes if he is after the best interests of his clients, no matter what background they come from. Therapists should be reflective in their practice. Schon (1983) was particularly influential in contributing to the understanding of reflective practice He defines reflection to “involve thoughtfully considering one's own experiences in applying knowledge to practice while being coached by professionals in the discipline” (p.26). Schon’s theory outlines two different types of reflection that occur at different time phases: reflection on action (p. 278) and reflection in action (p. 62). ‘Reflection in action’ is often referred to the colloquial phrase as ‘thinking on your feet’ a term used to being able to assess ourselves within a situation, making appropriate changes and still keeping a steady flow in the process. For reflection in action, vigilance is essential so as not to slip into a misinterpretation by the client. Reflection on action is when reflection occurs after the event. This is where the practitioner makes a deliberate and conscious attempt to act and reflect upon a situation and how it should be handled in the future (Loughran 1996, p.6). It appears that David Kolb’s learning theory is of a very similar nature to Schon’s. The reflection-on-action could well be equated with the abstract conceptualisation formulated by Kolb and the reflection-in-action with the second stage of reflective observation. David Kolb’s learning theory consists of four stages: experiences, reflective observations, abstract conceptualisation and finally the active experimentation leading to new experiences thereby completing the cycle is a generalised learning theory (Kolb, 1984). Therapy sessions are the same. The therapist is in a constant state of alertness in gaining information and insight about the client while providing the necessary service expected of him. The whole session becomes a learning and reflective experience altogether. After the session, the therapist reflects on whether what he has done was the right thing to do for the client or not. Reflection As a therapist, I believe in reflective practice. Since my profession involves serving people in settings that encourage close personal contact, I need to reflect on all my actions all the time. I need to be aware of transferences that may be developing that I may be unwittingly encourage because I enjoy them. It is but human to enjoy the attention and admiration of others. Being friends with clients is not a bad thing. However, if they step out of bounds, then I need to step back and alert them of my boundaries. For instance, a client keeps calling me regarding personal problems or begins to borrow money or some things from me, or manifested interest in beginning a romantic relationship with me, then I have to be firm in reminding him/her that we are friends but our professional relationship overrides the friendship and that we must stay within our boundaries as therapist and client. I should likewise be discerning about my own biases and counter-transferences. Did I endorse the stereotype my client was tagged with? Was my behaviour rude to a man I perceived to be obnoxious? Am I being paranoid about clients perceived to be flirting with me that it affects my work? I know that in keeping an open mind and in letting the therapy session unfold, I will learn more about the client and how to deal with him or her while maintaining my professional demeanour. Conclusion Boundaries are what define the limits of a relationship, whether they are personal or professional. As a therapist, sometimes, boundaries may be blurred due to the nature of the situation of a professional therapist dealing with personal issues of the client. It is important to have empathy for clients for their own problems but it is also crucial to maintain a professional stance in order to achieve the goals of therapy. Aside from voicing out one’s professional boundaries, a therapist should be reflective of his own actions in both the therapy session and outside it. The therapist should keep in mind the client’s best interest which is his or her success in the healing process. At the same time, he should always maintain his professionalism. References Bethan, E., Heim, A.K., Conklin,C.Z.& Westen, D. (2005) Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation. Am J Psychiatry 162:890-898, British Acupuncture Council (2004) Code of Professional Conduct. London. Corey, G. (2005) Theory and Practice of Counseling and Psychotherapy, 7th ed. Brooks/Cole, a division of Thomson Learning Inc. Jorgenson, L.M., Hirsch, A.B. & Wahl, K.M. (1997) Fiduciary Duty and Boundaries: Acting in the Client's Best Interest, Behavioural Sciences and the Law, Vol. 15, 49±62 Kolb D. (1984) Experiential Learning: Experience as the Source of Learning And Development. Englewood Cliffs, NJ: Prentice-Hall, Inc; Loughran, J.J. (1996) Developing reflective practice: learning about teaching and learning through modeling. Routledge. Pervin, Cervone & John (2005) Personality: Theory & Research, 9th Edition Wiley Rist, R.C. (2000). HER classic: Student social class and teacher expectations: The self- fulfilling prophecy in ghetto education. Harvard Educational Review, 70 (3), 257-301. Schon, D. A. (1983)The reflective practitioner: how professionals think in action. New York: Basic Books Steele, C.M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52 (6), 613-629. Read More