the therapist’s use of self

20 Counselling Psychology Review, Vol. 26, No. 3, September 2011© The British Psychological Society – ISSN 0269-6975

Background and research aims

THE FIRST author’s (Joanna) initialemployment in the National HealthService (NHS) involved being an assis-

tant psychologist with people with learningdisabilities. Her then supervisor introducedher to the idea that the therapist’s thoughtsand feelings during therapy could giveinsight into the inner world of the client.This was particularly useful when workingwith people with learning disabilities whooften had communication difficulties.Sinason (1992), for example, wrote passion-ately about these issues. At the time the firstauthor was also training to be a person-centred counsellor, and whilst working withclients, she often ‘picked up feelings in theroom’ and felt that clients found it helpfulwhen she shared these feelings with them. Asthis process seemed very useful for clientsbut also very complex, she wanted to find outhow other therapists dealt with these situa-

tions and the idea for this research was born.Therefore the aim of this research was tofind out from person-centred practitionershow they process their inner experiences intherapy.

Strawbridge and Woolfe (2003) consid-ered the therapist’s use of self as a vital partof the therapeutic relationship. The termscongruence and empathy from within theperson-centred approach and counter-trans-ference from within the psychodynamicapproach have been used to describe thetherapists’ inner experiences during therapyand their use of these with clients. Althoughthis research looks at person-centredprocesses it seemed important to includecounter-transference as, historically, Freud’sintroduction of this term, focused attentionon this area of therapeutic practice.

Heimann (1950) saw counter-transfer-ence as all of the therapist’s internalresponses to the patient. The therapist was

Research Paper

The therapist’s use of self: A closer look atthe processes within congruenceJoanna Omylinska-Thurston & Pamela E. James

Background and research aims: The researcher’s aim was to find out from person-centred practitioners howthey process their inner experiences in the therapeutic relationship. From a theoretical standpoint, it meantcreating a framework of processes and stages within congruence. Methodology: Seven person-centred therapists were interviewed with regard to how they processed and useda strong feeling, thought or sensation that they experienced with a client. Data was gathered using semi-structured interviews. Grounded Theory Approach was used to analyse the data.Results: It was found that the therapists processed their internal experiences in the therapeutic relationshipthrough the stages of Receiving, Processing, Expressing and Confirming.Conclusions: It seems that to be able to use ‘the self’ in the therapeutic relationship counselling psychologistsneed to be present and tuned-in internally to create conditions for receiving thoughts and feelings from clients.According to the therapists participating in this study who used their internal experiences in therapy, itseemed helpful for clients and a key aspect of the therapeutic process. It did require, however, the therapiststo have a high level of self-awareness and internal discipline in order not to ‘act-out’ and misuse power inthe therapeutic relationships. These findings indicate the importance of continuous personal development forpractising counselling psychologistsKeywords: therapist’s use of self; congruence; empathy; therapeutic relationship; countertransference.

Counselling Psychology Review, Vol. 26, No. 3, September 2011 21

encouraged to examine what was going onfor him/her whilst working with the patientand use this knowledge to further under-stand the patient. Racker (1953) differenti-ated complementary or concordantidentifications. Concordant identificationswere seen as empathic responses to thepatient’s thoughts and feelings. Comple-mentary identifications were explained interms of projective identification (Klein,1946) where the client unconsciously stirs upwithin the therapist a powerful experientialstate that complements the client’s imme-diate self-experience. To gain an under-standing of how this process can be usedtherapeutically, Tansey and Burke (1989)introduced a unitary sequence of theprocessing of counter-transference whichincluded a Reception Phase, an InternalProcessing Phase and a CommunicationPhase. The Reception Phase starts as thetherapist begins to experience the inter-actional pressure and an affect signallingcounter-transference, but he needs to beaware of any other interference to his ownmental set. The Internal Processing Phaseinvolves containing this emotional responseand separating from it, in order to observeself and the patient. Then the therapistneeds to listen through his working modelsto gather more information about the inter-actions between patient and therapists andto establish if concordant and complemen-tary identifications are operating. TheCommunication Phase involves non-inter-pretative and transference or counter-trans-ference-based communications, referring tothe therapist’s experience and under-standing of the patient.

Empathy, from a person-centred perspec-tive, involves laying aside one’s own way ofexperiencing reality and perceiving what it islike for the client (Mearns & Thorne, 1988).It includes ongoing effort to stay attuned toa client’s process and being receptive to theclient. According to Cooper (2005) this wayof working often involves experiencing arange of thoughts, feelings and bodily sensa-tions and communicating these experiences

back to clients can bring powerful momentsof connection. The communicating aspect ofempathy links with congruence.

This research investigates congruence.For the purposes of this research, congru-ence relates to the therapist processing andcommunicating her inner experiencing ofthe client in a genuine and authentic way(Klein et al., 2002). This involves the thera-pist’s awareness and integrity and the abilityto communicate this awareness to the client.Congruence has also been named as imme-diacy (Turock, 1980) and transparency(Lietaer, 1993). Lietaer said that the thera-pist should share her feelings with her clientonly when it is in response to the client’sexperience, when it is relevant to the imme-diate concern of the client and if it ispersistent or particularly striking. Tudor andWorrall (1994) identified four requirementsneeded when using congruence: (1) that thetherapist is aware of the flow of feelings andsensations within (self-awareness); (2) thatthe therapist is able to be and to live theseexperiences (self-awareness in action); (3)that the therapist is able and willing tocommunicate that awareness in the imme-diate moment of the relationship with aclient (communication); and (4) that thetherapist evolves coherent and ethicalcriteria for assessing when it may be appro-priate to share that awareness (appropriate-ness). Lietaer (1993) underlined that thedisclosure could provide the client with acorrective emotional experience, as the ther-apist experiencing of her client may substan-tially differ from the client’s distorted view ofhimself.

Greenberg and Geller (2001) putforward a theory of stages within congru-ence, and highlighted the importance oftherapeutic presence as a prerequisite forcongruence. The movement within congru-ence spanned four steps. The first stepinvolves preparing the ground within oneselffor being fully there with the client. Thesecond step involves receptivity and taking inthe fullness of the client’s experience. Thethird step includes inwardly attending and

The therapist’s use of self: A closer look at the processes within congruence

22 Counselling Psychology Review, Vol. 26, No. 3, September 2011

being in contact with how the experienceresonates in the therapist’s own body. Thefourth step is expressing and contact whichinvolves expressing that inner resonance ordirectly connecting with the client. Accord-ing to Greenberg and Geller the experienceof this process involves total absorption; thetherapist trusts that whatever emerges isnecessary for healing to occur. The thera-pist’s movement of attention is guided bywhat is most poignant in the moment.

Linking with the definitions andprocesses within the congruence, the aim ofthis research is to find out how person-centred practitioners process and use theirinner experiences within the therapeuticrelationship.

MethodologyParticipantsSeven therapists were recruited gradually, ona basis of theoretical sampling (McLeod,2001). All therapists were trained as counsel-lors. Six therapists’ core training was in theperson-centred approach. One therapist’score training was in psychodynamic coun-selling but she also drew on the person-centred approach. One therapist describedher orientation as person-centred/phenom-enological/transpersonal. The group con-sisted of six women and one manrepresenting ages 29 to 54 (M=47.4). Alltherapists had been in practice for three to18 years (M=7.85).

Ethical considerationsParticipants were recruited from theresearcher’s place of work in the NHS andthey knew the researcher as a counsellor andtrainee counselling psychologist. All thera-pists also run private therapy practices. Theinclusion criteria included actively using selfin therapy and an interest in exploring thisprocess in more detail. The therapists werenot required to include client data and it wasnot specified if the therapist’s experiencerelated to NHS or private practice. Theresearcher knew the participants from theworkplace and was aware of the limitations

of this for the validity of the results. Theparticipants might have wanted to be helpfulto share experiences that fitted with theresearcher’s agenda. The researcher encour-aged the participants to be themselves andspeak truthfully about their experience. Itwas explained that anything they say wouldnot affect their relationship with theresearcher. Although the researcher knewthe participants through researcher’s placeof work it seemed that a personal connectionwas important for this research. Mearns andMcLeod (1984) pointed out that trust, goodrapport and quality of research relationshipwere of critical importance in the qualitativeresearch and this seemed particularly impor-tant in this project as it involved asking thetherapists about potentially embarrassingand exposing experiences from theirpractice. A number of ethical issues werecarefully considered. All participants volun-teered to take part in this project afterreading the participants’ information letter.It was important to emphasise that they didnot have to agree to taking part and couldwithdraw at any point and that would nothave an impact on the personal connectionswith the researcher. All participantsconsented to being interviewed and audio-recorded. They were reassured about theconfidentiality and anonymity of theiranswers and that all identifiable data wouldbe removed from transcripts. It wasexplained that the recordings of the inter-views would be destroyed once the researchwas completed. Although the researcher wasavailable for any additional post-interviewsessions if needed, the participants had sepa-rate supervision/personal therapy arrange-ments if any issues emerged duringinterviews that needed to be taken totherapy/supervision. Elliott et al. (1999)pointed out that the researcher’s perspectivewill have an impact on the way the researchin carried out and they suggested making abracketing statement to enable readers tointerpret the researcher’s understanding ofthe data. This information has beenincluded from the outset of this research.

Joanna Omylinska-Thurston & Pamela E. James


Ethical approval for this research was gainedfrom COREC (Central Office for ResearchEthics Committees).

Interview procedureInterviews were used to collect the thera-pists’ stories (McLeod, 2001). The therapistswere invited to tell their story of workingwith a client with whom they had a stronginternal experience (intuition, ‘gut’ feeling,thought or bodily sensations) and if and howthey used this experience in the therapeuticrelationship. Pilot studies highlighted theneed for a structure within which the storycould be told, so a flexible structure of open-ended questions was created. The structureincluded briefly introducing the client anddescribing the experience, reflecting on howthe situation affected the therapist and howthey coped with it, how they processed theexperience, how they used it, how the clientresponded and what impact it had ontherapy. To explore the stories further theresearcher also used questions from theInterpersonal Process Recall (IPR) proce-dure which is often utilised in counsellors’training to help trainee counsellors tobecome aware of their inner processesduring their sessions with clients (Kagan,1975). IPR has been validated as apsychotherapy process research method byElliott (1992).

Semi-structured interviews wereconducted and eight accounts collected(within the flow of her story one therapistgave two accounts). The interviews lasted forapproximately one hour (45 to 90 minutes).The interviews were taped and transcribed.

AnalysisThe analysis was guided by the groundedtheory approach (Glaser & Strauss, 1967)and the guidelines outlined by McLeod(2001). The interviews were transcribed.After each interview, every question andresponse was numbered. Any emergingpreliminary themes were noted and consid-ered in the subsequent interviews. After anumber of interviews there was a sense that

certain themes were being repeated. Thiswas taken as an indicator that enough mate-rial has been collected. The first step ofanalysis involved open coding in order togenerate as many as possible alternative cate-gories of meaning units. The categories wereframed in terms of what the therapist werefeeling, thinking or doing. Every categorywas given a name and a code relating to theparagraph of interview it came from, toensure that they were derived from the orig-inal transcript. The next step involved clus-tering categories into a story order andhigher order categories (I). These were thenclustered further into higher order (II). Thefinal stage of analysis included axial codingand identifying themes emerging withinevery higher order category. This stage ofanalysis involved drawing on the work ofGrafanaki and McLeod (2002), Rennie(2004) and Łosiak (1994). Throughout theanalysis constant refinement of the cate-gories and themes was applied. The wholeanalysis was repeated twice for accuracy. Anycategories that were not adequatelygrounded in the transcript were excluded.Furthermore, identified higher order cate-gories, axial codes and main categories werematched with the story of every interview toaddress any discrepancies in the emergingresults. To provide the credibility check(Elliott et al., 1999), the individual storieswere sent to all therapists for comments.

FindingsThe aim of this research was to find out howtherapists used their inner experiences inthe therapeutic relationship to informperson-centred practice. During the processof clustering it was noted that the therapistswere going through a cycle: feeling uncom-fortable/anxious to comfortable with a senseof release.

From the analysis, the processing ofinternal experiences involved going throughstages of (main categories) Receiving,Processing, Expressing and Confirming. The results are summarised in Table 1.



1. RECEIVING(a) The therapist is present, tuned-in and

ready● Tuned-in to physical/emotional

state (6)● Aware of outside influences (4)● Aware of feelings towards the client

and the therapeutic process (8)● Ready to engage in the therapeutic

relationship (5)(b) The therapist experiences significant

discomfort which is:● striking (6)● persistent (4)● out of the therapist’s control (7)● powerful and clear (8)● experienced as bodily sensations (5)● experienced as emotions (4)● experienced as thoughts (6)

(c) The therapist and the therapeuticrelationship are affected● Feeling more vulnerable (6)● Anxiety level is increased (8)● Emotional and physical fatigue (6)● Unsure of what to do (4)● Forced to disengage (5)● Struggling with unwanted

responsibility (5)● Concerned about fitness to practice (6)

2. PROCESSING(a) The therapist is using internal coping

strategies to deal with the discomfort● Distancing/ separating (5)● Reducing tension/anxiety (5)● Support seeking (5)● Wanting to escape/ avoid (4)● Alert watchfulness (8)● Initiating therapeutic activities (4)● Focusing on self (4)● Planning (6)● Reacting to difficult feelings (4)● Minimalising (3)● Wishful thinking (4)

(b) Making sense of her discomfort● Working on her self-awareness (7)● Working on person empathy (7)● Working on relational depth (8)● Process identification (8)● Process direction (5)

(c) Using supervision (4)● Reducing tension/anxiety (2)● Separating feelings (4)● Working on self awareness (2)● Working on person empathy (3)● Working on therapeutic issues (4)


Table 1: The processing of discomfort in the therapeutic relationship(higher order categories, axial codes and main categories). The numbers of therapists that

touched on a particular axial code are noted in brackets.

1. RECEIVINGPrior to receiving an internal experience(discomfort) the therapists described them-selves as present, tuned into and ready toengage with clients. The discomfort affectedthem and their work.

(a) The therapist is present, tuned-in andreadyBefore experiencing discomfort in the thera-peutic relationship the therapists weretuned-in to their physical and emotionalstate (e.g. feeling tired). They were aware of

feelings towards the clients and therapeuticprocess (e.g. feeling irritated) and wereready to engage in the therapeutic process:

‘I go into a different mode... I totally focus onthe other person... I am listening to them... I allow myself to soak up whatever comes.’(Elsie)

(b) Therapist experiences a significantdiscomfort The therapists became aware of a significantdiscomfort which felt striking and clear. Itusually arrived suddenly and it felt persistent


3. EXPRESSING(a) Looking at appropriateness and safety of

using discomfort for therapy● Therapist’s ‘blocks’ (7)● Client’s process (8)● Quality of the therapeutic

relationship (5)● Awareness of potential risks (7)

(b) Making sure the discomfort is processedproperly and● the issue belongs to the client (4)● the therapist’s issues are separated and

processed (5)● the outcomes feel right and accurate (3)

(c) Working out how to use the discomfort● Timing and place (5)● Other preparations● Verbal or bodily disclosure (7)● Using discomfort for other therapeutic

purpose (2)

4. CONFIRMING(a) Connecting between the client’s and the

therapist’s experience● The client communicates the disclosure

connected with the client’s experience (6)

● The therapist senses that her disclosureconnected with the client’s experience (7)

(b) Shifts in the therapist’s discomfort● The therapist is feeling a shift in her

discomfort (8)● The therapist continues to feel the

discomfort (3)(c) Changes in the therapeutic relationship

● More openness in the therapeutic relationship (5)

● The therapist feels hopeful about the work (5)

● The client’s sense of safety have increased (5)

(d) Changes in the client● The client more aware of self (6)● The client able to trust her internal

locus of evaluation more (6)(e) The therapists’ positive views of using

her discomfort in the therapeuticrelationship (8)


Table 1: The processing of discomfort in the therapeutic relationship (continued).

and intense. The therapists described it asbodily sensations (e.g. feeling sick), emotions(e.g. feeling helpless) and thoughts:‘she was reminding me of somebody (Linda)… I was thrown back to the past… there was this…larger than life woman…she overwhelmed me… ‘(Linda)

(c) The therapist and the therapeuticrelationship are affectedHaving experienced a significant discomforttherapists were struggling with feelingvulnerable and having to hold the thera-

peutic space at the same time. They reportedfighting to stay engaged with clients.

‘I felt blown apart… frozen, paralysed…’ (Linda)The therapists reported feeling deskilledand concerned about their fitness topractice. As they had to get on with the situ-ation they were left feeling exhausted.

2. PROCESSINGReceiving the discomfort felt difficult to allof the therapists which led them to using arange of coping strategies including supervi-sion.


(a) Using internal coping strategies The most common coping strategy to dealwith the discomfort was alert watchfulnesswhich included monitoring self and listeningto the client. Another strategy was planningwhat to do (e.g. taking a painkiller).Distancing and separating were also usedincluding registering feelings but notentering into work. The therapists also usedstrategies to reduce tension and anxiety (e.g.self-reassurance), they sought support (e.g.sharing with a colleague), they avoided feel-ings or being more proactive.

‘I knew I could do assessment and said wouldyou like to start… I actually listened toinformation… responded… empathically… I did not enter into any work with her.’ (Linda)

(b) Making sense of the discomfortTherapists conceptualised how the discom-fort connected with the client through exam-ining how it felt and how that discomfort andthe client’s difficulties related to each other:

‘it felt that the client felt trapped in thisrelationship… there was identification: I amstuck, are you stuck?’ (Danielle)

The therapists were gathering more infor-mation on how the discomfort related to aclient’s difficulties through working at rela-tional depth (e.g. catching the quality of theclient’s feelings). The therapists also usedprocess identification (e.g. noticing that theclient keeps coming back to an issue) andprocess direction (e.g. asking questions) togain more information.

(c) Using supervisionTherapists used supervision to deal withdiscomfort which helped them to separate,contain and manage their feelings so thatthey were able to think of the client and notof their own feelings’. They were able to gainsome clarity whether the feelings related tothe client or to the therapist.

‘I talked about it in some depth in supervisionwhich helped me to manage it in subsequentsessions because that intense irritation that Ihad about her I see in terms of the process of herreferral.’ (Ruth)

Another reason for using supervision wasdiscussing practice issues (e.g. fears of notbeing able to work with a client). Therapistswere dealing with tension and anxiety andpersonal issues that were stirred up. Supervi-sion was also helpful in terms of exploringparallel process and understanding client’sfeelings.

3. EXPRESSINGHaving processed the discomfort, the thera-pists were considering using it for thera-peutic purposes. This included looking atthe appropriateness and safety of using it,making sure that it was fully processed andworking out how to exactly use it.

(a) Appropriateness and safety Before using the discomfort the therapistswere considering their own ‘blocks’:

‘in terms of sharing it with her I find that verydifficult, other people challenged her, she gives itback… there is a risk to me that she may go backand say this counsellor is a waste of time.’(Ruth)

The therapists considered the clients’process (e.g. not wanting the client to closedown) and risks of disclosure (e.g. beinggentle with a pregnant client). The thera-pists also paid attention to the quality of thetherapeutic relationship before using thediscomfort (e.g. the relationships feelingtrusting and open).

(b) Making sure the discomfort is processedproperlyPrior to using the discomfort the therapistswere making sure that it is processed prop-erly (e.g. re-checking if it was stirred up bythe client’s issue rather then their own)which involved waiting and watching if theclient brings more examples of the samematerial. They were making sure that theirown issues were separated and that theoutcome of the processing felt right andaccurate.

‘I just want to offer it and see what the client isgoing to do with it… there was an intuitivefeeling of rightness to it.’ (Garry)



(c) Working out how to use itThe therapists were preparing to use thediscomfort and considering appropriatetiming and place. Some therapists weresharing in the moment and one of them waswaiting until a pattern was established:

‘I waited till there was a pattern and when wehad couple of sessions… she gave quite a lot ofexamples of this… but I would have not broughtit if it was not present in the room.’ (Ruth)

The therapists were considering what to say(e.g. not wanting to share the whole extentof the feelings) and were preparing theclients for disclosure (e.g. by introducing it).

The therapists used the disclosure forverbal communication (e.g. owning directlyas it feels or sharing part of the feeling withinterpretation). The most common bodilydisclosure included the therapist’s facialexpression.

4. CONFIRMINGAfter communication the therapists werechecking if the disclosure was appropriateand effective. This involved a sense ofconnecting between the clients and the ther-apists, shifts in the therapist’s discomfort andnoticing changes in the therapeutic relation-ship and in the client.

(a) ConnectingThe therapists reported a sense of connect-ing with clients after disclosure whichincluded the client saying ‘exactly right’ andbringing it up a number of times during thesession. The therapists also sensed that theclients felt understood.

‘I was hoping to catch the point of energy andgo with this… her response was… to feelunderstood… she did not seem so all over theplace, it settled her.’ (Linda)

(b) Shifts in the therapist’s discomfortFor most of therapists discomfort disap-peared after disclosure or in supervision.One therapist felt relieved after sharing andother felt her ‘heart opened up’. There wasa sense of an energetic shift in work and that‘the circle felt completed after sharing’.

‘I would… use the word clean… it wasaccurate, no untidiness about it… it was reallygood.’ (Garry)

(c) Changes in the therapeutic relationshipsThe therapists felt there was more intimacyand openness in the relationship. They alsofelt hope and excitement about what wouldemerge next.

‘it feels really hopeful, if she is able to take…responsibility… [I feel]… excited… curious,what kind of effect it had on her.’ (Garry)

A number of clients felt safer to share moreof their vulnerable material.

(d) Changes in the clientsAfter the disclosure the clients seemed to bemore self-aware

‘and now she would.. come and say somethingabout old and new relationships and a fear oflosing him and would acknowledge this hugeunmet need there…’(Linda)

The clients also showed more internal locusof valuing themselves (e.g. taking moreresponsibility for herself and trusting herown ‘internal barometer’ more).

DiscussionThe initial naming of the stages thatemerged was inspired by Tansey and Burke(1989). However, the emerged processeswithin the stages were more relevant toperson-centred practice and resonated withGreenberg and Galler’s (2001) theory. Theemerged process was also inspired by theaccount of Elsie, one of the therapists whocommented:

‘as soon as somebody comes in I go into adifferent mode because I am there for them… I totally focus on the other person… I amlistening to them and I am picking up all kindsof things from them, not in a deliberatelyconscious way but it just happens. I allowmyself to soak up whatever comes… I don’t gointo my head… that opens the door forexchange… I don’t even see it as you and me…I am just focused so the messages are coming...itis not thought through, it is like a process thathas got a mind of its own and it is circular…



I don’t do anything with it until it doessomething with me… when it gets strong I feelsomething and I don’t try to stop it… it is clear,I need to get it out of the way really and it justfinds it way out… the timing is worked out bythe process coming, I have got this information,so you wait and you watch it, you receive itagain… my tuning into that person is alwaysguiding what and how and when say it back tothe person…’

1. RECEIVINGAccording to Greenberg and Geller (2001)the first step of congruence involvespreparing the ground. The therapist arrivesat the session holding the intention of beingfully there with the client. The therapistsuspends own concerns and clears the spaceinside. The research found that prior toseeing clients, therapists prepared them-selves by tuning-in to themselves, becomingaware of internal flow of feelings whichTudor and Worrall (1994) considered as thefirst requirement when using congruence.The therapists in this research became alsoready and open to receiving whatever comesfrom the client. This connects with thereceptivity aspect of connecting at relationaldepth (Mearns & Cooper, 2005). The thera-pists were ready and willing to use them-selves with clients through holistic listening:an attitude of, as Elsie put it, being ready tosoak up the client. All elements mentionedabove link with Greenberg and Geller’s(2001) concept of therapeutic presencewhich is the essential prerequisite forcongruence.

In this receptive state, where therapists,like Elsie, were totally absorbed and focusedin the moment, the therapist experienced asignificant discomfort which included bodilysensations, thoughts or feelings. Mearns andCooper (2005) confirmed that if the thera-pist is receptive and attuning to clients shewas likely to receive these experiences. Thediscomfort felt striking and persistent.Lietaer (1993) would say that this was anindication of its relevance for the client’sprocess.

The discomfort had a profound impacton the therapists as they felt anxious andfatigued. Although Kramer (2000) sawanxiety as an indicator that somethingimportant was happening in the therapeuticrelationship, it left the therapists feelingvulnerable and deskilled. Greenberg andGeller (2001) warned also that anxiety canblock therapist’s awareness which canbecome fused with the bodily tension.

2. PROCESSINGThe therapists in this research used anumber of coping strategies to deal with thediscomfort. The strategy most often used wasalert watchfulness which linked withKramer’s (2000) suggestions of observinganxiety signals changing as the interactionmoves on. The literature does not mentionthis but the therapists used other copingstrategies such as distancing, reducinganxiety, planning, reacting and being moreproactive.

Processing also included engaging theircognitive side and trying to make sense ofthe discomfort. This links with Tudor andWorrall’s (1994) self-awareness in action andWosket’s (1999) period of incubation. Super-vision was also used; this agrees withTamaner Brodley (2001) who said that thediscomfort needed to be worked throughprior to using it with clients.

3. EXPRESSINGGreenberg and Geller (2001) said that thiscomponent includes the expressing thediscomfort in a facilitative and disciplinedway. Therapists in this research used thediscomfort to facilitate the client’s processwhich involved finding an appropriate andsafe way to communicate it. This linked withMearns and Cooper’s (2005) concept ofexpressivity and with Tudor and Worrall’s(1994) third requirement inherent incongruence.

Appropriateness linked with Tudor andWorrall’s (1994) fourth requirement forcongruence. It involved therapists consid-ering their own blocks and Hill and Knox



(2002) warned that the disclosure has torelate to the client’s rather than the thera-pist’s needs. The therapists were consideringthe client’s process which linked with Green-berg and Galler’s (2001) recommendationto sense if the client was open or too vulner-able to receive the disclosure. The quality ofthe therapeutic relationship was also consid-ered and Wosket (1999) pointed out thatthat the relationship needs to be sufficientlyestablished to tolerate the challenge of thedisclosure. The therapists were aware ofpotential risks which linked with Jordan,Wallker and Hartling’s (2004) reminder ofthe ethical obligation not to harm.

The therapists were continuouslychecking whether their feelings related tothose of their client. This corresponds withGendlin’s (1962) advice to take a few steps ofself-attention before disclosure. They werealso checking for accuracy which connectedwith Turock’s (1980) concern not to misin-terpret the feelings and to keep listening toreceive the same message from the client.

In terms of timing of the disclosure, thetherapists were sharing in the moment, inthe following session or after supervision. Itfelt important to find an appropriatemoment to share as Hill et al. (1990)pointed out the timing is more importantthan how much is actually disclosed. Thislinks with Kramer (2000) who said that hekeeps quiet when the client is in a flow not todisturb the client. The therapists werepreparing what to say which was alsosupported by Kramer (2000). Mearns andThorne (1999) advised, however, not to waittoo long with the disclosure. They warnedabout the dangers of splurging congruencewhere the therapist holds a feeling over along period and discharges it usually out of apunitive motivation. Greenberg and Geller(2001) also warned about making sure thedisclosure involves a core feeling (e.g. hurt)rather than secondary (e.g. anger).

The therapists reported owning theirfeelings when disclosing following Rogers’(1970) advice to communicate their ownexperience rather than judging or evalu-

ating the client. For Greenberg and Geller(2001) the disclosure should be made non-judgementally, non-blamefully and notfrom a ‘one-up’ position. Hanson (2005)suggested making disclosures that were briefand concrete so the client could understandand accept. This was also apparent in thetherapists’ disclosures. Although the thera-pists did not mentioned this, Wosket (1999)talked about a gradient of responding. Shewould start by letting the client know thatshe noticed something giving the client theopportunity to comment and then, if stillneeded, move to more direct disclosure.Greenberg and Galler (2001) suggested alsocomprehensiveness and saying not only whatwas felt but also what was being felt aboutwhat was being felt.

4. CONFIRMINGThe research findings show that the partici-pants tended to ask and confirm if theirdisclosure was helpful to client, as consistentwith Kramer’s (2000) recommendations.Therapists were enthusiastic about usingdiscomfort and talked about it as ‘TheTherapy’. This finding agrees with Roger’slater publications (1980) where he consid-ered congruence as a core aspect of therapy.However, this finding is not confirmed inmore recent reviews of research on congru-ence. Klein et al. (2002) and Orlinsky et al.(2004) found that approximately only 30 percent of studies were showing links betweenlevels of congruence and positive outcomes.Cooper (2008) also added that studies thatask clients to describe most importantaspects of therapy did not indicate stronglinks between congruence and outcomes.Even though the evidence in regard tocongruence is not conclusive, SteeringCommittee (2002) indicated that congru-ence was a promising and probably effectiveelement of the therapeutic relationship.

In this research clients confirmed thatthe disclosure connected with their experi-ence and the therapists also sensed theconnection which Cooper (2005) referred toas a ‘feeling of interconnection’ (p.18).



The therapists reported feeling a shift whichwas consistent with Tamaner Brodley’s(2001) comment that the disclosuredispelled the therapist’s discomfort. Thetherapists felt more openness in the rela-tionship which was supported by Jourard(1971) who found that the personal open-ness of the therapist facilitates the opennessof the client as the power imbalance betweenthe therapist and the client is reduced.There was an increase of intimacy whichagreed with Wosket (1999) who commentedthat relational self-disclosure often fostersintimacy in the relationship. The therapistsfelt also more hopeful about the work whichwas supported by Mearns and Cooper (2005)who noticed feelings of satisfaction whenworking at depth which helped the thera-pists to keep motivated to engage on thatlevel. The clients’ sense of safety increasedwhich agreed with Mearns and Cooper(2005) who said that experiencing the thera-pist at relational depth gives the client asense of safety through which she or hecould begin to explore difficult aspects ofself. Also for Greenberg and Geller (2001)sharing own experience was a crucial factorin establishing trust and helping the client tofeel safer to tolerate relational anxiety.

The therapists reported that clientsbecame more aware and reflective aboutthemselves. This was confirmed by Doster andBrooks (1974) who found that clients weremore self-exploring after the therapist’s self-disclosure than in sessions with non-disclosingtherapists. Greenberg and Geller (2001) alsocommented that immediacy allowed clients tobe more present with themselves and reflectmore on underlying issues. The therapistsnoticed also that the clients developed moretrust in their internal locus of evaluation andfelt more confident in sharing about them-selves. Mearns and Cooper (2005) confirmedthat through relating at depth, clients mightdevelop the confidence and skills in relatingon that level. Similarly Jourard (1971)pointed out that therapists sharing their ownexperience served as a model for the clients tobe themselves.

ConclusionsAccording to Norcross (2002) the thera-peutic relationship is one of the most impor-tant contributors to a positive outcome intherapy. Counselling psychologists base theirwork on this finding and consider facilitatingtherapeutic relationships as one of thefundamental aspects of client work. A corepart of this work involves counsellingpsychologists’ use of self, which within theperson-centred approach is referred to ascongruence. Grafanaki (2001) said, however,that most research offers very limited accessto internal processes within congruence; it isstill one of the most complex issues to studywithin the person-centred approach. Thefindings of this research contribute to thisarea and show the stages and the processeswithin congruence. Therapists describedprocessing their experiences through thestages of receiving, processing, expressingand confirming. These findings are in linewith Greenberg and Geller’s (2001) stages ofprocessing congruence which involvedpreparing the ground, receptivity, inwardlyattending, expressing and contact. Green-berg and Geller (2001) also wrote about thetherapeutic presence, the pre-requisite forusing congruence within the person-centredwork which was also evident in this research.

In terms of implications for practise, thefindings from this research imply that to beable to use the self in the therapeutic rela-tionships, counselling psychologists need tolearn to be present and tune-in internally.This can be developed through, forexample, a daily meditative practice. Coun-selling psychologists also need to have a highlevel of self-awareness and integrity in orderto deal with these processes in sessions. Itoften involves having to work whilst internalblocks are activated, which could lead to themisuse of power in the relationship.According to Wyatt (2001) it is the responsi-bility if each therapist to self-reflect andmonitor these issues via supervision andpersonal therapy.

There are, however, limitations to thefindings of this research as they stay closely



to the researcher’s philosophy and way ofpractising. The participants were recruitedusing personal connections and perhapsthey, through wanting to be helpful to theircolleague (researcher), shared experiencesthat fitted with the researcher’s agenda. Inthe same way, the researcher recruited theparticipants and analysed the data in accor-dance with her own worldview and approachto therapy which has been included from theoutset of this research. Looking fromanother standpoint, however, the findings ofthis research have support from Siegel(2010) who examines the formation of thetherapeutic relationship from the point ofview of brain science. For him the keyelements of forming the therapeutic rela-tionship involve the therapist’s presence(openness to oneself and the other) andattunement (to one’s own flow of feelingsand to the other). When tuned in to the selfand the client, it is possible to resonate withown and other’s internal state. This is shown,for example, in Elsie’s account. Siegel(2010) concludes that we are biologicallypredisposed to resonate with one another(via ‘mirror neurons’) and in that way it ispossible to have an impact on and influenceone another’s internal states. This is one ofthe key aspects of therapy illustrated in thisresearch.

AcknowledgementsThis study was conducted in 2004–2006 aspart of the first author’s Qualification inCounselling Psychology and the secondauthor was her supervisor. Joanna would liketo thank her supervisor and also the thera-pists that took part in this study.

About the AuthorsJoanna Omylinska-Thurston Chartered Counselling Psychologist;HPC Registered;Liverpool Psychology Service for Cancer;Royal Liverpool and Broadgreen UniversityHospitals Trust.Joanna is currently undertaking the Top-upDoctorate in Counselling Psychology runjointly by the Caledonian University and theUniversity of Strathclyde.

Pamela E. JamesChartered Psychologist and HPC RegisteredCounselling Psychologist;Emeritus Professor of CounsellingPsychology;Independent Practitioner.

Correspondence:Email:[email protected]



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