Timothy Richardson. OUPI: C3632876 D171 TMA 02 What are the essential elements of an effective counselling relationship?

How does this differ from other kinds of helping relationships? Illustrate your answer with examples.

'The helping relationship is defined as the process of promoting the growth, development, maturity, functioning and coping skills in another person' (http://education2.uvic.ca/Faculty/hfrance/2.htm). The counselling approach on the other hand has been described as being 'designed to help clients to understand and clarify their views of their meaningful, well-informed choices and through resolution of problems of an emotional or interpersonal nature (McLeod 2008 p14). This essay will look at what defines a counselling relationship before discussing what is needed to make that relationship effective. We will then look at what elements are essential in this relationship, drawing comparisons with a number of 'helping' relationships, both for the behaviourist counsellor and the person centred one. Then we will discuss how this compares with other forms of helping relationships, before drawing conclusions about the counselling carried out by 'helping' professionals.

Before discussing what makes a counselling relationship effective, we must first consider what we mean by 'counselling relationship'. It is not an easy thing to define, but there have been several attempts to do so. Glenn Shepard collects some of the definitions in his Notebook article, 'What is counselling' (http://www.ccpa-accp.ca/_documents/NotebookEthics/What%20is %20Counselling%20A%20Search%20for%20a%20Definition.pdf). BCAP (British Association for Counselling and Psychotherapy) defines it thus 'Counselling and psychotherapy are umbrella terms that cover a range of talking therapies. These therapies are delivered by trained practitioners who work with people over a short or long term to help them bring about effective change or enhance their well-being'. Within this definition of course there are several different schools of counselling

Timothy Richardson. OUPI: C3632876 D171 TMA 02 thought, but they all lead towards the same goal, treatment of clients. As we will see below, other professions may 'change or enhance wellbeing' but they are not always the 'trained practitioners' (as far as counselling is concerned) of BCAP's definition.

In order for a counselling relationship to be effective, the client must, by necessity, be the primary driver of the relationship. They must talk and carry out tasks given in their own time and at their own pace. In other helping relationships, this is not always the case, it is often that the 'helper' drives the process as it is they with the skills and training In fact not only might the client not drive this process, but in the case of the paramedic or nurse, the client may not even be conscious! Counselling is often carried out to '...understand and clarify their lifespace, and to learn to reach their self-determined goals...' (McLeod 2008, p14). This definition throws up two separate, but equally relevant points. The first is that counselling is a teaching process, at least according to McLeod. It is to enable the client to 'learn' to help themselves. This stands in contrast to some forms of 'help'. The nurse does not teach the patient to preform a blood pressure test, they merely do it. The second is that unless they have determined their own goals, the counselling will be only of limited use at best. Again this differs from the 'helping relationship'. A nurse, or probation worker, have goals for the client in mind, that of healing or rehabilitation, . E. S. Bordin believed that the setting of goals was one third of the relationship, his so called 'working alliance', later expanded on by P. Clarkson in his 1995 work, 'The Therapeutic Relationship'.

A vital element in the effective counselling relationship is for the counsellor to demonstrate active listening. It is not enough that the counsellor is listening to the client, the client must be aware that they are. While this is carried out in a number of fields of help, and even in business, but is especially important here as the client needs to feel that they are being listened to, and thus driving the relationship and treatment. To return to our nursing example, although the wishes of

Timothy Richardson. OUPI: C3632876 D171 TMA 02 patients are being increasingly listened to, the expertise of the doctor and nurses can supersede the these for clinical reasons. The patient may want more painkillers, but will be denied due to the maximum dose already having been administered. The acronym EARS (Embrace, Appreciate, Respond Show) is an example of one technique amongst many for how to demonstrate active listening. The effect of this 'active listening' is a more subjective matter however, and can depend on the approach the counsellor takes. The person-centred behaviourist believes that a key point of being effective is to show empathy for the client. While empathy is often an important part in helping relationships, it is not essential, a self inflicted injury will be treated the same as the most unfortunate. The behaviourist will use it to show that they are 'conceptualising' the problem, which is the most important step to beginning treatment according to Persons 1993 work'.

We frequently talk of people being 'helped', but we don't use the word 'counselled' as often, there is good reason for this. Counselling is not something that can 'be done' to someone, rather, it is when 'someone who is troubled invites and allows another person to enter into a particular relationship with them' (McLeod 2008 p23). This is not always the case with the 'helping relationship' . In some instances the helping relationship may not be voluntary for the client, to continue the example from earlier, a nurse will treat patients occasionally without them being conscious with no ethical problems whatsoever. Clarkson referred to a counsellor and client entering into a 'Therapeutic Alliance', as the most effective treatment relationship. Without the active compliance of the client, this alliance is doomed to fail.

Another element essential in the effective counselling relationship is trust. The client must believe that they can say anything to their counsellor and that it will be kept confidential. The boundaries between counsellor and client, produced in no less than three documents by BCAP, are there to enable clients to have trust in their counsellor. Because counselling is such a deeply

Timothy Richardson. OUPI: C3632876 D171 TMA 02 personal (and uniquely individual) experience, boundaries help with the understanding of both practitioner and client. This is particularly important for the person-centred counsellor as it evokes the doctor-patient relationship. They do however remain guidelines, others, such as the police, have many of their procedures put down in law, making the difference in this relationship that of the difference between ethics and statute.

When we provide counselling the client must feel able to tell us anything. For this they must believe the counsellor will be non-judgemental. This believe is gained over time, something that other helping relationships don't always allow, patients not in hospital long enough for them to develop this depth of relationship with their helpers. Putting one's own views on another prevents the client being the driver of their own treatment, limiting the effectiveness of the treatment. This is different from the reaction that a priest for instance will have, perhaps telling the confessor that they have committed a sin and must do penance for it. This was the basis of Larson et al's work of 1992, 'Development and Validation of the Counselling Self-Estimate Inventory' and his discussion of personal 'soundness'. McConnaughy's studies show that the attitude and personality of the counsellor are vital in the relationship. Again this differs from the nurse or policeman who's very uniformity is one of their main strengths, whereas for the counsellor it is their uniqueness that form the basis of the relationship.

Counselling within a counselling relationship is almost always carried out by a trained professional and forms the core of their work. Counselling within the helping relationship is often carried out in addition to those roles. If a patient tells a nurse of an emotional problem, the nurse may use some of the skills and techniques of counselling to help that person, but they will not be fully trained in the tools and techniques of professional counsellors. The difficulty of making boundaries between the 'helping' relationship and the one of counselling is that often they overlap,

Timothy Richardson. OUPI: C3632876 D171 TMA 02 sometimes completely. That is not to say that any caring professional has the ability to provide effective counselling, as we have seen above, but that essential elements of the counselling relationship can, indeed must exist. There remains however, a difference between counselling and being a counsellor. (McLeod 2008 p16)This is unlikely to be an effective relationship (as far as the counselling aspect goes) with that being the preview of the trained professional counsellor. By utilising a wide range of techniques, and understanding them in a wider context, the counselling relationship is more effective than the helping one when it comes to 'reach[ing] self-determined goals'. Word count: 1416

What stops us from listening effectively?

There are several things that can stop us from actively listening. One of the main obstacles is personal baggage. That is to say things from our personal life that we should really put aside and not think about when running counselling sessions, but can intrude nevertheless. The second is shown in Section 5 of the DVD, being uninterested in/judgemental of the client. That is to say allowing our personal views to cloud our professionalism. Finally the third thing that can prevent us from listening effectively is assumption. I mean by this assuming that the client has a problem before they've actually really spoken about it and the practitioner has already decided on a course of action and treatment which may later be proved useless, or even harmful.

Timothy Richardson. OUPI: C3632876 D171 TMA 02 References.

Bordin, E. S. (1979) 'The Generalizability of the psychoanalytic concept of working alliance',

Psychotherapy: Theory, Research and Practice, 16, pp252-60.

Clarkson, P. (1995) 'The Therapeutic Relationship', London, Whurr.

Larson et al, (1992) 'Development and Validation of the Counselling Self-Estimate Inventory', Journal of counseling[sic] Psychology, 39, pp105-20.

Persons, J. B. (1993) 'Case conceptualisation in cognitive-behaviour therapy' in Kuehlwein, K. T. and Rosen, H. (eds) (1993)

McConnaughy, E. A. (1987) 'The person of the therapist in therapeutic practice', Psychotherapy, 24, pp.303-314.

McLeod, J. (2008) 'Introduction to Counselling', [Ed D. Langdridge] Maidenhead/Milton Keynes, Open University Press/The Open University.

Websites.

Sheppard, Glenn: http://www.ccpa-accp.ca/_documents/NotebookEthics/What%20is %20Counselling%20A%20Search%20for%20a%20Definition.pdf accessed 21/01/2013

Timothy Richardson. OUPI: C3632876 D171 TMA 02 http://www.bacp.co.uk/ethical_framework/ (accessed 21/01/13)

http://education2.uvic.ca/Faculty/hfrance/2.htm (accessed 21/01/13)