counselors' conceptualizations of caring in the counseling relationship

Counselors’ Conceptualizations of Caring in the Counseling Relationship

Richard W. Halstead, Linda D. Wagner, Margo Vivero, and Wilma Ferkol

Caring is a concept that has been studied in numerous helping professions but has yet to be researched from a counseling perspective. In this qualitative research study, 13 master’s-level counseling interns were interviewed to better understand their perceptions of caring in the counseling relationship. Results suggest that these interns perceive that supporting desired outcomes, a personal capacity for caring, maintaining therapeutic conditions, mutuality in the counseling relationship, and a dynamic flow of communication are important attributes of the counseling relationship when caring is present. The findings suggest further research that explores the concept of caring in the counseling relationship may be warranted.

he counseling relationship has been identified as a primary element around which theories of counseling converge (Frank, 1961; Goldfried, T 1982; Lambert, 1991; Strupp & Hadley, 1979). According to Lambert

and Cattani-Thompson (1996), next to variables associated with a client’s overall ability to function in a healthy manner, factors related to the counselor4ient relationship are the best predictors of positive outcomes in counseling.

Although the literature strongly supports the importance of developing a positive counselor-client relationship, in hurried and time-limited counseling environments, counselors are often pressured to demonstrate results in a minimal number of sessions (Richardson & Austad, 1991). This pressure can result in counselors focusing more on the technical aspects of service delivery rather than on the quality of the counseling relationship (Glick, Showstack, Cohen, & Klar, 1989; Newman & Bricklin, 1991; Richardson & Austad, 1991).

For some helping professions (e.g., nursing, education, and occupational therapy), practicing from a caring perspective has been a means through which clients and families can achieve maximum well-being in increasingly pressured work environments. This is accomplished by fostering within the helping professional an understanding of caring that enhances the quality of interaction between the caregiver and receiver (Benner & Wrubel, 1989; Knowlden, 1998; Watson, 1988).

Although caring alone is not sufficient to ensure effective practice, there is literature to suggest that there are clear benefits when clinically compe- tent professionals integrate caring into their practice (Benner & Wrubel, 1989;

Richard W . Halstead, Margo Vivero, and Wilma Ferkol, Department of Counselor Education, Saint Joseph College; Linda D. Wagner, Department of Nursing, Southern Connecticut State University. Correspondence concerning this article should be addressed to Richard W . Halstead, Department of Counselor Education, Saint Joseph College, 1678 Asylum Avenue, West Hartford, CT 0611 7 (e-mail: rhalsteadQsjc.edu).

34 Counseling and Values. October 2002 =Volume 47

Freedberg, 1993; Noddings, 1984, 1992; Peloquin, 1993; Roach, 1987; Swanson, 1993; Watson, 1988). A report by Tresolini and The Pew-Fetzer Task Force (1994) strongly advocates for relationship-centered care in which “the caring relationship between practitioner and client is modeled by the nurturing environment that . . . practitioners themselves create through the quality of their relationships” (p. 40).

The counseling literature has neither addressed the concept of caring nor the role it holds in orienting the counselor in professional practice. The purpose of this study was to explore how beginning counselors, who had no formal introduction to theories of caring, conceptualized caring within the context of the counseling relationship.

Review of Literature

Early works from philosophers such as Buber (1958), Heidegger (1962), and Mayeroff (1971) laid the groundwork for the development of the concept of caring as it relates to clinical practice. Buber’s classic work, I and Thou, explored the experience and mutuality that exist in the meeting of two individuals. Buber was one of the first to base principles of therapy on caring and fairness in human relationships. He framed the therapeutic process as one that takes place within that space cocreated between the client and counselor. Heidegger viewed caring as a universal phenomenon that influences the ways in which people think, feel, and behave in relation to one another. In his reflective and thought-provoking essay, Mayeroff articulated a defi- nition of caring as helping the other to grow through giving meaning and order to life. These philosophical perspectives served as a foundation for helping professionals to examine what occurs between two people when the desire is to promote healing beyond the tasks associated with specific treatment regimens (Wagner, 1997).

The concept of caring has been the focus of study for professionals in the disciplines of education (Noddings, 1984, 1992), social work (Freedberg, 1993), occupational therapy (Peloquin, 1993), and most notably, nursing (Benner & Wrubel, 1989; Knowlden, 1998; Roach, 1987; Swanson, 1993; Watson, 1988). These writers have sought to better understand the human relationship aspects of professional interactions. Their discussions have focused on defining caring as more than “being nice” to conceptualizing it as a primary element in reaching a deeper level in the interpersonal relationship between the student and teacher or nurse and patient. In the field of nursing for example, Watson’s development of a transpersonal care theory views the nurse as a coparticipant in the human care process. The two individuals in the caring transaction bring with them unique life histories such that both are influenced and affected by the nature of the relationship. This encounter entails ”protection, enhancement, and preservation of the person’s humanity, which helps to restore inner harmony and potential healing” (Watson, 1988, p. 58). The premise of transpersonal caring is that an indi-

Counseling and Values rn October 2002 rn Volume 47 35

vidual moves toward a higher sense of self and harmony in a moment- to-moment human encounter between two people.

Caring, expressed as joining another person’s world, does not reside in a set of practices; rather, it is a dynamic process that engages the client and moves him or her forward in a positive direction through a knowledge base and relationship that connotes a willingness and desire to achieve a greater understanding. In a research study involving practicing nurses, Minick (1995) found that the participants who used a caring approach in practice had a heightened awareness of the individual presenting to them. Caring practitioners were able to move beyond skill and technique and weave in caring and concern in such a way that they noticed subtle clues and were able to identify issues and concerns earlier in treatment.

As the concept of caring continues to be researched and to evolve in various helping disciplines, there are core elements on which most people agree. Caring is always personal, involves commitment, and occurs within a specific context in which the practitioner and client become connected (Benner & Wrubel, 1989; Knowlden, 1998; Watson, 1988). This connection ”has energy and vitality that demands something be done to act upon those feelings” (Bevis, 1981, p. 58). The relationship is mutually satisfying to both giver and receiver, and growth is experienced by both (Marck, 1990; Mayeroff, 1971). Although recognition of caring by the “cared for” is a necessary element in the caring relation, it need not be equally reciprocated (Noddings, 1984). Similarly, contextual therapists believe that reciprocity is imperative in the practitioner- client relationship but acknowledge that it is not symmetrical. For example, Boszormenyi-Nagy and Krasner (1986) have suggested that there are moments when the counselor and client experience a genuine meeting, but the degree of investment and the level of expectations are not thought to be the same for both individuals.

The endeavor to reach a better understanding of how counselors create and maintain a strong counseling relationship has led to examining various qualities of counselor capacity, skill, character, and presence (Gelso & Carter, 1994; Horvath & Greenberg, 1986; Horvath & Symonds, 1991). Jennings and Skovholt (1999) interviewed 10 peer-nominated outstanding therapists and identified characteristics in the cognitive, emotional, and relational areas that well-regarded practitioners possess. Their findings suggest that there is a blend of all three domains used by these therapists when working with clients. Within the field of counseling, however, caring has yet to be defined and addressed.

Given the extensive use of the construct of empathy in the counseling literature, one may confuse it with the concept of caring. Duan and Hill (1996), in providing their extensive review of the literature on empathy, have suggested that divergent perspectives regarding empathy are prob- lematic. Depending on the theoretical perspective from which empathy is being viewed, it may mean a personal trait or ability to feel with another (Sawyer, 1975), a situation-specific cognitive-affective state (Batson & Coke,

36 Counseling and Values October 2002 =Volume 47

1981; Rogers, 1953, or a multiphased experiential process (Barrett-Lennard, 1981). ”Unfortunately, when the same term is used to reflect divergent constructs, it leads to confusion in the literature” ( k a n & Hill, 1996, p. 263). It is, therefore, important that one not extend the meaning of empathy beyond how it has been defined in the literature, that is, as an important element of emotional understanding that the counselor attempts to convey to the client and foster within the context of the counseling relationship. According to Boszormenyi-Nagy and Krasner (1986), “Expressing empathy for people’s feelings is an important part of caring, but it is a method rather than a goal” (p. 397). Caring, on the other hand, is thought to encompass a broader frame of professional motivation. Professional caring is a form of interpersonal communication whereby one applies the content and principles of a specified knowledge area (e.g., counseling) within the context of a professional relationship for the purpose of rendering a service designed to improve the human condition (Knowlden, 1998). This study was developed to answer the following research question: How

do counseling interns conceptualize caring within the context of the counseling relationship? A synthesis of previous research on caring from various disciplines as well as current literature from the field of counseling was used as the framework for this study.

Method

A qualitative methodology was chosen for this investigation in order to understand the construct in question from the participant’s frame of refer- ence. Grounded theory serves as a means for understanding the realities of the participants and how they define and experience their world (Bowers, 1988). Grounded theory “focuses on processes that exist within the individual or groups of individuals rather than on social structure” and is used “to ex- plain a given social situation by identifying the core and subsidiary processes operating in it” (Baker, Wuest, & Stem, 1992, p. 1357). From this perspective, one seeks to understand behavior as the participants understand it, learn about their world, and learn their interpretation of self in the interaction. As a result, the emerging theory is grounded in the data.

Approval for the study was obtained from a research review committee at the college. Informed consent, confidentiality, and anonymity were ensured. All participants signed research consent forms. Interviews were coded, and tapes destroyed at the end of the study.

Participants

Participants included 13 female master’s-level graduate students from a pri- vate college located in the northeastern section of the United States. Twelve of the participants were of European American descent, and 1 was of Asian descent. Participants ranged in age from 25-53 years, with a mean age of 37. Each of the participants had completed a 100-hour practicum, and each was

Counseling and Values October 2002 =Volume 47 37

in either the first or second semester of a 600-hour internship. Participants used the following theoretical approaches to counsehg: cognitive-behavioral, client-centered, humanistic, and object-relations theory.

Procedure

This research study followed the standard grounded theory methodology of simultaneously collecting data and analyzing data. The process begins with the first interview and uses theoretical sampling, a constant comparative method of coding to arrive at acore theme and data collection until saturation occurs (Lincoln & Guba, 1985; Strauss & Corbin, 1998). The method of theoretical sampling for data collection was used to elicit information-rich cases for in-depth study in order to obtain as much information as possible (Lincoln & Guba, 1985;Patton, 1990). An initial convenience sample included students at the internship level who had been chosen based on their academic performance in their graduate studies and their site supervisors’ evaluations during practim. As the study progressed, additional students were included to broaden the data emerging from the interviews.

Individual interviews were arranged at the participant’s convenience and were audiotaped. Prior to collecting data, participants were informed that they were being asked to participate in a study that would address elements of the counseling relationship, the approximate amount of time the interview would take, and that the resulting data would be coded to assure anonymity of responses. During the introduction to the study, participants were neither informed of the interview questions nor the fact that the primary element of interest to the researchers was participants’ conceptualizations of caring.

A preliminary interview with a set of open-ended questions was conducted with the first participant. As key issues and themes emerged in successive interviews, additional questions were added to the interview protocol as consistent with grounded theory research. This method of data collection allows for richer responses grounded in the participant’s experience as opposed to being constrained by the researcher’s perspective (Bogdan & Biklin, 1982). All participants had an opportunity to respond to questions addressing the following five areas of interest: elements of the counseling relationship perceived to be of greatest importance, the nature of the bond between counselor and client, the concept of caring, the role of caring in the counseling relationship, and the communication of caring within the counseling relationship. At the end of each interview, the participants were de- briefed, and the purpose of the study was revealed and discussed in detail.

Data Analysis

Data analysis involved using interview transcripts to organize content, analyze units that contained information relevant to the research focus, synthesize meaning, and search for patterns that conveyed how participants conceptualized caring. We used a constant comparative method (Wilson,

38 Counseling and Values October 2002 mVolume 47

1989) to analyze the data. Categories developed as codes were clustered and constantly compared with one another to assure mutual exclusivity and saturation of data. Categories were then reviewed in order to arrive at a final integrative scheme (Wilson, 1989). Throughout all phases of data analysis, we maintained methodological rigor by adherence to the authenticity criteria outlined by Lincoln and Guba (1985), including peer-debriefing activities and member checking with the participants. This process yielded results that were theoretically linked to caring in the counseling relationship.

Results

Caring as Supporting Desired Outcomes The central theme that emerged from the data analysis was that participants framed caring as a primary element that supported the desired outcomes of counseling. Throughout the interviews, participants repeatedly stated that being able to see client change and growth was of the utmost importance. Planning with the client to create goals, focusing on a positive outcome, and client well-being were talked about over and over. It was clear from participants' reports that their commitment to the client was important and that the graduate students were as much participants in the counseling process as the client was.

One of the student interns discussed an adolescent group that she co-led in a school setting. She talked about her involvement in caring as follows:

It was allowing those students the freedom, to give those kids what they really needed and wanted to do, plus a pathway for me to care for them. It was beautiful. It allowed me to show them that I was invested in what they wanted to do. That I really cared and that I was willing, and that the school was willing, and the administration was willing and everybody was willing to really go out on a limb and do what was needed to help them reach the goal that they, themselves, had set.

Inherent in the counseling encounter are the counselor's and client's beliefs that a goal or outcome will be achieved. These counseling interns perceived that when the counselor is invested in a participatory way, a caring relationship develops that further enhances and supports accomplishment of those goals. The specific components of the caring relationship that emerged included a personal capacity for caring, maintaining therapeutic conditions, mutuality in the counseling relationship, and a dynamic flow of the caring relationship.

Personal Capacity for Caring

Participants expressed that caring was a major component of the counseling relationship and that an expression of caring rested within one's personal capacity to engage another in a caring manner. One intern stated, "I think that the types of people hopefully that are in counseling. . . would be caring individuals that are really there, that care to see somebody become

Counseling and Values October 2002 Volume 47 39

what they want to become.” In reflecting about the presence of caring in the counseling relationship, another participant stated,

The counselor has to show that they can care about the client not as part of the job but as a person. You must see the client as a person and understand what they are going through and share and express that they care about the person instead of just seeing this as doing a job.

Participants described personal qualities, such as compassion, empathy, and being committed, and stated that counseling was a humanistic profession. This quality of having a capacity for caring was seen as a component of the counselor‘s relationship with the client. The essence of one’s humanity laid the groundwork for the encounter. One student remarked, “The skills in counseling are important and they are something that you must have, but it is your humanness that forms the bond.“

Just as important as the counselor’s ability to recognize his or her own humanness was the ability to recognize the humanity in another. One student’s comment aptly reflects this thought of human capacity when she stated, ”I think we care with our entire self.” Another intern com- mented that it was important “to care about the humanity of a person, people’s paths in life, their humanness, their sufferings and their joys.”

Maintenance of Therapeutic Conditions

The analysis of data showed that when caring was present, the knowledge base of counseling and the skills needed to work with the client in the counseling relationship cannot be separated from one another. The students described aspects of “being with” the client (relationship) blending into “doing with” the client (problem-specific content) as important elements that help maintain a caring therapeutic frame.

Students indicated that caring was communicated in the counseling environment through respect, listening, presence, and body language. There was common agreement that it was essential to establish trust at the outset. The students talked about “tough love” and being able to set limits or confront the client. They were concerned about the client’s safety as well as how the counselor presented that concern. They talked about keeping the client’s story straight, being on time to a session, and returning phone calls as means of conveying caring within the therapeutic context. One student recounted an experience in which the client actually confronted her on whether or not she was caring. The student recalled,

At one point she looked at me as I was trying to be distant enough in my responses. But at one point she looked at me and said, “Do you care about this? The response that you gave me, I feel like you don‘t care!” And I thanked that client that she came back to me like that because you know here you are in a certain sense trying to go by the book so that you don’t screw up.

40 Counseling and Values rn October 2002 rn Volume 47

Many times the counseling interns experienced difficulty in trying to ar- ticulate how they saw caring present in the counseling relationship, but they had an intuitive sense of what it was. One student reflected,

If I feel there is a block, I move to a place of stepping up the caring, which I can’t really put into words, but it is just sort of like a place that I can naturally go when I feel that they just need a little extra something.

Often, the students were able to gain a better sense of caring in the counseling relationship as they discussed and articulated negative examples in which caring was not present. This was especially true when participants were asked if they had ever been in environments that either supported or hindered caring. In instances when caring was not present, the students felt that the focus was not on the client, actions taken by administrators did not match their words, and the staff were just putting in time to accrue billable hours.

The interns described a noncaring relationship as one that is much more task and skill focused as opposed to one in which the counselor is connected to individual clients and what those clients need. The result is that it would be difficult to achieve designated goals and it would be a frustrating encounter for both parties. It would also raise concern from the client’s perspective as to whether or not the counselor was really interested in the client.

Another aspect of conditions was the client’s responses to an expression of caring. Again, the students identified caring as contextual. For some clients, closeness is valued, whereas for others, distance is more acceptable. There was some sense that in cases in which caring had been absent from clients’ lives, caring actions from the counselor may not be understood by the client and may, at times, be perceived negatively, depending on the client’s situation. There was an overwhelming sense, however, that students thought that the client would outwardly demonstrate when he or she recognized that a caring relationship was present.

Mutuality in the Counseling Relationship

When the students discussed desired outcomes, the theme of mutuality was expressed. As the students talked about the client’s outcomes and growth, there was a sense of reciprocity. They reported a feeling of being satisfied with being able to help someone, “a giving and taking from each other“ in the process. They made comments such as “being part of their [the clients’] journey and their path,” “the commitment to walk with the person in their pain, is a heart-felt kind of thing,” and ”really feeling a part of how they view the world.” Participants’ responses clearly express that empathy, as defined by Sawyer (1975) and Rogers (1957)) is present in this aspect of the caring relationship. There was also, however, an extension beyond maintaining a connection with the client’s world. Students expressed that they had to be aware not only of the client’s feelings but their feelings as well. As one student summarized,

Counseling and Values October 2002 volume 47 41

And every professional hopefully gets something. I think that’s a great feeling-to feel like you’re really with somebody, there’s chemistry going, working together. You feel that they can really share deep things with you and I think it is such a privilege, I think it’s such a spiritual thing to be present to that.

The counseling interns who participated in this study had a strong sense of commitment and concern for their clients. Their responses demonstrated genuine warmth and desire to establish relationships based on connection.

Dynamic Flow of the Caring Relationship

The final theme that emerged from the data was coded ”dynamic flow of relationship.” The term attests to the fact that the participants viewed the counseling relationship as one in which there is “sensitivity to the rhythmic patterning of relating” (Smith, 1999, p. 23). The interns were asked during their interviews if caring was different during various phases of the counseling relationship. The majority of students stated that caring was expressed differently, both as the relationship developed and as the sessions progressed. Initially, they described a “surface” level of caring that was present and would deepen as one learned more about the client. This initial form of caring was expressed as caring simply because they were human. During this initial phase, they talked more about different skills or techniques that the counselor might use in forming the relationship.

Throughout the interviews, there was a sense that as the students reflected on the concept of caring, they described a process whereby the quality of that flow of communication between counselor and client enhanced the counseling relationship and client outcomes. As the counselor becomes better acquainted with the client through this communication process, a greater commitment evolves, allowing caring to be manifested differently. The students valued the connection that was created and that allowed for the recognition of their own humanity and the humanity of the client.

Discussion

Caring is a universal phenomenon (Heidegger, 1962) that has been studied across several disciplines as a means of framing the best that the professional relationship has to offer. This qualitative research study explored the concept of caring in the counseling profession from the perspective of 13 counseling interns. As the research interviews progressed, participants were able to ar- ticulate ways in which caring served to positively influence their work with clients. Participants used the concept of caring as a means for describing how they viewed themselves as counselors, and they did so in ways that were similar to the ways that members of other helping professions, in which caring plays a more prominent role in professional identity and practice, did.

A model constructed from the findings of this study is presented in Figure 1. The model illustrates how participation in a caring transaction allows for a

42 Counseling and Values October 2002 aVolurne 47

Dynamic Flow of the Caring Relationship

Compassion Empathy Connection

Reciprocity !

-... Client

-.-.- ._._._. Maintenance of Thersoeutic Conditions

Trust Respect Listening Presence

\. Verbal Content Non-Verbal Content ,

-. -. - .- ._. -, -, -. -. -. -, -.-. -.-. ’.. Dynamic Flow of the Caring Relationship

FIGURE 1

in Counseling Conceptualizations of Caring as Supporting Desired Outcomes

process of relating that can be defined as dynamic (Smith, 1999, p. 23). In- herent in this process of dynamic flow of a caring relationship are specific elements that must also be present. These elements include a personal capacity for caring, a sense of mutuality in the counseling relationship, and maintenance of therapeutic conditions. These elements, as shown in Figure 1 by intersecting broken circles, constitute the essence of a caring relationship in counseling, in which growth and supporting desired outcomes are valued, as expressed by participants.

Participants’ conceptualizations of caring were consistent with those derived by other theorists who have studied caring. For instance, one element the participants in this study thought to be important was a personal capacity to care. In Swanson’s (1999) meta-analysis on caring in nursing, the capacity to care was identified as the first level of caring knowledge, based not in order of importance but in order of level of assumption on the part of the researchers. Of 130 publica- tions reviewed for Swanson’s research, 21 of these studies found that the health professional is compassionate, empathic, knowledgeable, confident, and reflective. Similarly, Jennings and Skovholt (1999) found that in their study of 10 outstanding therapists, participants also seemed to be sensitive, caring, and reflective practitioners who were concerned about the human condition. The participants in this study expressed that it was the universal human capacity for caring (Heidegger, 1962) that drew them into the counseling profession.

Counseling and Values October 2002 mVolurne 47 43

The theme labeled ”maintenance of therapeutic conditions” was found to be consistent with those elements that, from a nursing perspective, focused on “what affects caring, enhances caring interactions, or inhibits the occur- rence of caring” (Swanson, 1999, p. 36). The participants identified conditions they believed necessary for maintaining a therapeutic frame. These conditions included interpersonal qualities (e.g., trust, respect, presence) as well as more technically oriented abilities (e.g., listening skills). This may suggest that, in the study of caring in counseling, the technical content of counseling practice and the relationship with the client are important factors that could be explored as complementary parts of a unified whole. In addition to elements of the counseling relationship (e.g., knowledge and counseling skill), participants in this study also saw organizational expectations as factors that had an impact on the nature and quality of the counseling relationship. Participants were easily able to discriminate a caring work environment from a noncaring work environment and the role those conditions played in the ability to foster a caring therapeutic relationship.

Also emerging from the interview data was the theme ”mutuality in the counseling relationship.” This component of professional caring centered on the shared relational space that participants conceptualized as the experience of being with a client when caring was present. Participants discussed the concern, connection, and reciprocity thought to be communicated between the counselor and client in a caring relationship. This conceptualization is consistent with certain principles of communication theory (Watzlawick, Bavelas, &Jackson, 1967). These theorists described the concept of mutuality as a complementary form of communication that can exist when there is a difference in power and status within the relationship. Watzlawick et al. suggested that individuals who do not have equal presentation status (e.g., teacher-student, doctor-patient, counselor-client) enter into a complementary relationship that is characterized by communication focused on a mutual concern and that has a content and a relationship aspect to it. In a relational dyad, one can expect to find these two modes of communication existing side by side and complementing each other in every message given and received, thus establishing a sense of mutuality for both parties.

In summary, participants in this study articulated aspects of counseling practice that foster professional caring, and they believed that caring was a dynamic element of the counselor-client relationship that changed over time. A dynamic flow of relating, as characterized by a sensing of where to place focus and attention as well as being sensitive to self and other, develops over time within a caring relationship (Smith, 1999). This idea is consistent with Jennings and Skovholt’s (1999) discussion of the relational domain described by outstanding therapists. They referred to the art of timing and pacing as the therapeutic relationship develops over time. Inherent in this dynamic process is the ability of the counselor to possess not only the knowledge required for practice but also the ability to blend it with relational components that develop over time (Jennings & Skovholt, 1999).

44 Counseling and Values rn October 2002 mVolume 47

Limitations

There are several limitations that must be kept in mind when evaluating the results offered in this study. First, a qualitative method designed for building grounded theory was used. Although this methodology was ap- propriate for the nature of this study, one must not generalize results beyond the research participant group. Again, the intent of purposeful sampling is to obtain information-rich cases as opposed to a sample that is represen- tative of all counselors (Patton, 1990). As Lincoln and Guba (1985) stated, “It [sampling] is based on informational, not statistical considerations. Its purpose is to maximize information, not facilitate generalization” (p. 202). A second limitation is that the group of participants consisted of novice counselors with internship experience only. There is no way of determining from this study whether experienced counselors who work full-time and carry full caseloads would respond in a manner similar to participants in this study. Third, participants in this study were all female and predomi- nantly Caucasian. This lack of gender, racial, and ethnic diversity offers no insight into how, or even if, counselors who are male or of a different ethnic and/or racial background would conceptualize caring as being a component of the counseling relationship.

Conclusion

According to the research literature in other disciplines, such as nursing and education, caring fosters an experience of human connection that is meaningful to both the individual who is providing the care and the individual who is receiving it (Marck, 1990; Mayeroff, 1971; Noddings, 1984, 1992). The participants in this study were able to conceptualize caring in a manner that was consistent with how caring has been extensively described in other helping professions. Several avenues for further research of caring in the counseling relationship can be suggested. First, given the limited scope of experience and background possessed by the participants interviewed for this study, there should be replicated investigation involving more experienced counselors with more diverse backgrounds, including gender and race. Doing so would serve to answer questions regarding whether or not caring is experienced by broader segments of the counseling profession. Second, there have been some indications from research conducted in the field of nursing that the caring encounter serves to reduce job stress and burnout (Benner & Wrubel, 1989). This area of research may also prove fruitful for counselors. A third area of caring research yet to be explored in counseling is that of clients’ perceptions of counselor caring and the role that it may play in relationship development and the efficacy of counseling interventions.

The vaIue of human connection has long guided the professional practice of care providers in their interactions with clients. This study offers initial evidence that, within the group of beginning counselor participants,

Counseling and Values October 2002 volume 47 45

conceptualizations of caring played a role in how they viewed themselves as professionals, influenced the approaches they used in working with their clients, and served as a standard for assessing the environmental context within which they conducted their practice. Professional caring, defined as a process that uses the purposeful application of technical knowledge interwoven with the important elements of the counseling relationship, may serve as a construct that helps beginning counselors establish a philosophical base for professional counseling practice.

References

Baker, C., Wuest, J., & Stern, P. (1992). Method slurring: The grounded theory/phenomenol-

Barrett-Lennard, G. T. (1981). The empathy cycle. British Journal of Medical Psychology, 66,3-14. Batson, C. D., & Coke, J. (1981). Empathy. A source of altruistic motivation for helping. In

J. Rushton & R. Sorrentino (Eds.), Altruism and helping behavior (pp. 167-187). Hillsdale, NJ: Erlbaum.

Benner, P., & Wrubel, J. (1989). The primacy of caring: Stress and coping in health and illness. Menlo Park, CA: Addison Wesley.

Bevis, E. 0. (1981). Caring: A life force. In M. M. Leininger (Ed.), Caring: An essential human need. Proceedings of three national caring conferences (pp. 49-59). Thorofare, NJ: Slack.

Bogdan, R. C., & Biklin, S. (1982). Qualitative research for education: An introduction to theory and methods. Boston: Allyn & Bacon.

Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give and take. Bristol, PA: Brunner/Mazel. Bowers, B. (1988). Grounded theory. In 8. Sarter (Ed.), Paths to innovative research methods in

Buber, M. (1958). I and thou (W. Kaufman, Trans.). New York Scribners. Duan, C., & Hill, C. (1996). The current state of empathy research. Journal of Counseling Psy-

Frank, J. D. (1961). Persuasion and healing. Baltimore: Johns Hopkins University Press. Freedberg, S. (1993). The feminine ethic of care and the professionalization of social work.

Social Work, 38, 535-540. Gelso, C. J., & Carter, J. A. (1994). Components of the psychotherapy relationship: Their

interaction and unfolding during treatment. Journal of Counseling Psychology, 41,296-306. Glick, I. D., Showstack, J. A., Cohen, C., & Klar, H. M. (1989). Between patient and doctor:

Improving the quality of care for serious mental illness. Bulletin of the Menninger Clinic,

ogy example. Journal of Advanced Nursing, 17, 1355-1360.

nursing (pp. 33-59 ). New York NLN Press.

chology, 43, 261-274.

53, 193-202. Goldfried, M. (1982). Converging themes in psychotherapy. New York: Springer. Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). London: Routledge

& Kegan Paul. Horvath, A., & Greenberg, L. (1986). The development of the Working Alliance Inventory.

In L. Greenberg & W. Pinsoff (Eds.), The psychotherapeutic process: A research handbook (pp. 529-556). New York Guilford.

Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139-149.

Jennings, L., & Skovholt, T. (1999). The cognitive, emotional and relational characteristics of master therapists. Journal of Counseling Psychology, 46, 3-11.

Knowlden, V. (1998). The communication of caring in nursing. Indianapolis, IN: Center Nursing Press.

Lambert, M. J. (1991). Introduction to psychotherapy research. In L. E. Beutler & M. Cargo (Eds.), Psychotherapy research: An international review of programmatic studies (pp. 1-23). Washington, DC: American Psychological Association.

46 Counseling and Values October 2002 =Volume 47

Lambert, M. J., & Cattani-Thompson, K. (1996). Current findings regarding the effectiveness of counseling: Implications for practice. journal of Counseling b Development, 74,601-608.

Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage. Marck, P. (1990). Therapeutic reciprocity: A caring phenomenon. Advances in Nursing Science,

Mayeroff, M. (1971). On caring. New York Harper & Row. Minick, P. (1995). The power of human caring: Early recognition of patient problems. Schol-

arly Inquiry for Nursing Practice: A n International journal, 9, 303-317. Newman, R., & Bricklin, I? M. (1991). Parameters of managing mental health care: Legal, ethi-

cal, and professional guidelines. Professional Psychology: Research and Practice, 22, 26-35. Noddings, N. (1984). Caring: A feminine approach to ethics. Berkeley, CA: University of Cali-

fornia Press. Noddings, N. (1992). The challenge to care in schools: A n alternative approach to education. New

York Teachers College Press. Patton, M. Q. (1990). Qualitative evaluation and research method. (2nd ed.). Newbury Park, CA:

Sage. Peloquin, S. (1993). The patient-therapist relationship: Beliefs that shape care. American lour-

nal of Occupational Therapy, 47,935-942. Richardson, L. M., & Austad, C. S. (1991). Realities of mental health practice in managed

care settings. Professional Psychology: Research and Practice, 22, 52-59. Roach, M. S. (1987). The human act of caring: A blueprint for the health professions. Toronto,

Canada: Canadian Hospital Association. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change.

journal of Counseling Psychology, 21, 95-103. Sawyer, F. H. (1975). A conceptual analysis of empathy. Annuals of Psychoanalysis, 3,3747. Smith, M. (1999). Caring and the science of unitary human beings. Advances in Nursing Sci-

Straws, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for devel-

Strupp, H., & Hadley, S. (1979). Specific versus nonspecific factors in psychotherapy: A con-

Swanson, K. (1993). Nursing as informed caring for the well-being of others. Image, 25,352-357. Swanson, K. (1999). What is known about caring in nursing science. In A. Hinshaw, S. Feetham,

& J. Shaver (Eds.), Handbook of clinical nursing research (pp. 31-60). Thousand Oaks, CA: Sage.

Tresolini, C. P., & The Pew-Fezter Task Force. (1994). Health professions education and relationship-centered care. San Francisco: Pew Health Professions Commission.

Wagner, L. (1997). Caring and leadership in female undergraduate nursing students: A group process experience. Unpublished doctoral dissertation, University of Hartford, Hartford, CT.

Watson, J. (1988). Nursing: Human science nnd human care. New York: NLN Press. Watzlawick, P., Bavelas, J., &Jackson, D. (1967). Pragmatics of human communication: A study

of interactional patterns, pathologies, and paradoxes. New York: Norton. Wilson, H. (1989). Research in nursing. Redwood City, CA: Addison-Wesley.

23(1), 49-59.

ence, 21(4), 14-28.

oping grounded theory (2nd ed.). Thousand Oaks, C A Sage.

trolled study of outcome. Archives of General Psychiatry, 36, 1125-1136.

Counseling and Values October 2002 mVolume 47 47

counselors' conceptualizations of caring in the counseling relationship

Documents