The Nile College

Nursing Bachelor Program

Second lecture

Overview of Counselling RelationshipDr. Ali Farah Ahmed

• The counselling process and relationship has a developmental or cyclical component to it – a beginning, middle and end

• Each stage has different relationship tasks and challenges

• Different theorists place different emphasis on importance of various stages or number of stages

• Shebib characterizes the cycle as one with four phases: Preliminary, Beginning, Action, and Ending

Phase I: Preliminary

• Create the necessary physical and psychological conditions for relationship to begin

• First impressions are critical in any relationship, and clients often come to therapy highly anxious

• Includes physical setting• Also contacts that occur by phone, via a third

person• Need to impart professionalism and warmth

Phase II: Beginning

• Develop rapport• Begin to build trust• Outline purpose / contract• Limit confrontation in this phase, work on

empathy and support

Phase III: Action

• Relationship continues to grow• Therapist more actively confronts and challenges

client– E.g., may push client to see something in a way different

from their typical worldview• Therapist needs to be able to tolerate tension,

potential disappointment as client is sometimes disillusioned with “ideal”

• The maintenance of this relationship may be a corrective experience in and of itself

Phase IV: Ending (Terminating)

• Specific phase, not just a cessation• EXTREMELY important... can undermine

previous work• Emphasis on reviewing, consolidating, saying

goodbye, shifting success to client• A good termination may be another mastery

experience, especially for people who have experienced much loss

Core Conditions

• Carl Rogers (humanist perspective) identified importance of non-judgmental acceptance of clients

• These have been operationalized as three core conditions–Warmth–Empathy –Genuineness

Contracting with Clients

• Important to have an agreement / mutual expectations outlined at beginning

• Lots of misconceptions about therapy• Contract maps out process, responsibilities• Encourages clients to take ownership from

start• The degree to which the contract is formalized

differs depending on the approach (benefits?)

Elements of a Contract

• Definition of objective or purpose of the counselling relationship

• Discussion of roles and expectations of participants

• Discussion of the methods and routines of counselling

• Practical details (time, place, fees, confidentiality)

Transference and Countertransference

• Introduced by Freud – parallel process between how you relate to key figures in your life and how you relate to your therapist

• Conversely, your relationships as a therapist effect how you relate to your clients

• Although transference and countertransference are key in some approaches (psychoanalysis, psychodynamic approach), they are recognized by most theorists

Transference

• Client may infer your reaction or thoughts (e.g., I know what you are thinking...)

• Client may have a greatly exaggerated response compared to what would normally be expected

• ventually come to realization that therapy is not really about you

Countertransference

• Can include intense feelings of attraction or repulsion

• More than just reminding you of someone• Can be increased by having a client with a

similar history / difficulties to yourself• Need to be aware of your own process and

seek consultation as needed• Custody and access example

Content Versus Process

• What is actually said in a session• The meta-communication (how something is

said, nonverbal communication, dynamics, etc.)

• Can reflect some of this back to a client (particularly in certain types of therapy)

• Talking about the process can be as or more important that the content

Termination of Therapy

• Can be a difficult / powerful experience• Sometimes clients deny difficult feelings• Sometimes clients “dump you first”• Sometimes clients regress / go into crisis• Working through a termination with good

preparation and proactive approach can be an extremely positive experience for people

• Can talk about mourning a relationship