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The Therapeutic Relationship: In Psychoanalysis, Counselling Psychology and Psychotherapy

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Other ways of working within the individual’s ZPD are the use of nonverbal techniques in the therapy such as the use of colours to express feelings, (King 2002) the use of buttons to express how patient’s experience themselves and the therapist, (King 2002), and a circle with 16 segments to indicate the passage of time in the therapy (King 2002 p35). You are here: Home > Reformulation > Spring 2005 [Issue 24] > CAT, the Therapeutic Relationship and Working with People with Learning Disability CAT, the Therapeutic Relationship and Working with People with Learning Disability In the 1950s, Carl Rogers had written a paper entitled ‘ The Necessary and Sufficient Conditions of Therapeutic Personality Change’, published in the Journal of Consulting Psychology. This introduced the idea that the therapeutic relationship is key, and three of the conditions – congruence, unconditional positive regard and empathy, which have subsequently become known as the ‘core conditions’ – have come to be accepted by practitioners of all modalities as vital to establishing this relationship. It was interesting to see how Claire’s perception of me developed. At the beginning of therapy she selected a large brown button for herself as a reflection of her sad mood. For me she chose a similar sized pale blue button, which for her was a happy, good colour. It was as if in her mind she held all the bad, difficult feelings and, by contrast, I held all the good, happy feelings.(King 2002, illustration 6, p78) Towards the end of therapy, using colours, we found that she could hold lots of different feelings towards me and that these feelings could be mixed. (King 2002, illustration12, p85) She seemed more aware of the complexity of our relationship, seeing each of us more as whole people. Thorne, B. (2000) Person-Centred Counselling, Therapeutic and Spiritual Dimensions. Whurr Publications.

The therapeutic alliance is very important in Relationship Psychology, this is where you make a contract with your clients. Ensuring you make sure that the time, the place and the cost are discussed, and the client is motivated and responsible. Many counsellors from my experience don’t do this properly, this can be very damaging from the get go. The transferential/countertransferential relationship refers to the idea that we may remind a client of someone from their past, or vice versa, and the related feelings from the past may be transferred to the present, so affecting the therapeutic relationship. If this happens, it is important to explore the issue in supervision. Bender, M. (1993) The unoffered chair: the history of therapeutic disdain towards people with a learning difficulty. Clinical Psychology Forum, 54, 7-12. Humour also had a role in promoting the person-to-person relationship. With Michael we used buttons in each session to help him express his feelings and experience. Each time at the beginning of the session when he opened the tin of buttons he would comment “what no biscuits then.” It was a moment we both enjoyed. A Qualitative Study of Cognitive Analytic Therapy as Experienced by Clients with Learning DisabilitiesIn relationship psychology, The Five Relationships states that to achieve an “Intersubjective Relationship”in counselling requires all three components to be met; The Intersubjective Relationship Several scales have been developed to assess the patient-professional relationship in therapy, including the Working Alliance Inventory (WAI), [11] the Barrett-Lennard Relationship Inventory, [12] and the California Psychotherapy Alliance Scales (CALPAS). [13] The Scale To Assess Relationships (STAR) was specifically developed to measure the therapeutic relationship in community psychiatry, or within care in the community settings. [14] See also [ edit ] Ryle, A., 2005. Article Review - Subjective Consciousness Explained. Reformulation, Spring, pp.18-19. The person-to-person relationship draws on the work of Martin Buber regarding ‘I–Thou’ (as opposed to ‘I–It’) relationships – i.e. the development of a real emotional connection (which makes counselling a unique profession, differentiating it even from other caring professions).

Symington, N. (1992) Countertransference with Mentally Clients. In Waitman,A. and Conboy-Hill, S. (Eds) Psychotherapy and Mental Handicap. Sage Publications

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It is necessary to remember that this sort of relationship has a seductive potential. Clarkson (1995 p160) writes “If having moved into true person-to-person relationship one stays too long, then it actually becomes abusive – a replacement for intimate relationship for both the psychotherapist and the client.” The time-limited structure of CAT helped us to keep our feet on the ground, allowing us to enter a person-to-person relationship but always mindful of the ending. For example if cancellation is not discussed up front and your client fails to follow a policy in place, and then you tried to charge your client for the missed session, the therapeutic alliance could fall apart and your client may never return.

In many ways working with people with learning disability is just like working with anyone else. However issues of woundedness, weakness, limitation, difference and vulnerability (alongside the need for appropriate independence and autonomy) are particularly strong. The challenge is to find a way of establishing and maintaining authentic, life enhancing relatedness (Safran 1993) in the face of these issues. Cognitive Analytic Therapy in People with Learning Disabilities: an Investigation into the Common Reciprocal Roles Found Within this Client Group Psaila, C.L. and Crowley, V., 2006. Cognitive Analytic Therapy in People with Learning Disabilities: an Investigation into the Common Reciprocal Roles Found Within this Client Group. Reformulation, Winter, pp.5-11. Ryle, A. (1991) Cognitive Analytic Therapy. Active Participation in Change. John Wiley and Sons Ltd. As individuals, as psychotherapists and as a society, it is healthier to learn to connect with people with learning disability and the pain that they bear for us, and the gifts that they bring us, than it is to distance ourselves or destroy. In wishing to conceal or get rid of disability we deny or destroy an essential part of our humanity. Living in a society which places such a high premium on achievements, possessions and the perfect looks of the adverts, it may be hard to be in touch with the imperfections which are part and parcel of the human condition. Connecting with disability brings us more in touch with the whole of ourselves, allowing us, if we will, to accept the strengths and weaknesses of our full humanity.Counselling and psychotherapy rely, to a great extent on building a human connection with clients, where a deep level of trust is established, this transcends any modality, this is seen to a great extent in the work of Carl Rogers. Therapist unconditional positive regard: The therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted or denied.

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