Psychology “working alliance”

The effectiveness of therapy in counselling is dependent substantially on two factors; namely, the patient’s cooperation, and the expertise of the therapist. Many experts in the field of Psychology have observed the significant contribution of the client to the over-all process. The individual’s perception of the therapist is extremely crucial to the ensuing treatment. Without the needed initial positive perception of the therapist on the part of the one seeking treatment, the whole process will not generate a desired momentum that would set the entire scheme in a strategic stance.

Of course, the expertise of the therapist is another major factor – actually, the other half – but it’s a given to the whole package of treatment (Borys and Hope, 1989). Since a “working alliance” has to be established first before the actual treatment is administered, there are important or vital considerations for this “working alliance” between client and therapist to occur, which can be influenced greatly by the occurrence of transference and counter-transference, and this is in precis, the intentions of this paper.

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This will be considered as part of the issues and challenges that therapists face as they practice their profession (Corey, 2004, p. 36-112). Discussion The past baggage of the client. From any vantage point, the level of trust by client on his therapist, whether that perception is based on attractiveness, trustworthiness or as someone who knows what he may be dealing with in terms of credentials, are valid, and is the utmost concern of the helping relationship. Trust in the part of the client is necessary for the healing process.
However, because the full ramifications of the issue almost always hinge on the perceptions of the client, the problems and hindrances need to be addressed or at least cited for clarity and deliberation at the outset of the relationship (Corey, 2004, p. 36-145). As hinted above, the client may be bringing (emotional) baggage into their mutual involvement which may be due to prior engagements with other professionals in the therapeutic relations, whether positive or negative.
Oftentimes, in many cases, these may be liaisons which were unsuccessful, distasteful or even traumatic for a few. The author pointed out that any form of future therapy will be affected due to these previous experiences, and it has to be dealt with right away at the outset (Horvath & Luborsky, 1993, p. 4). Defining transference and counter-transference It was a Freudian conception that catapulted “transference” into a much recognized terminology within the counseling practice.
This was first observed when in the practice of psychotherapy, patients or clients developed strong emotionalities such as attachments and even fantasies that were not realistic. In greater sphere today, transference does not happen within psychotherapy but rather a common encounter by many. Closest to the term transference, is an illustration such that a person can be considered a biological time machine, when something is recalled based on certain situations or conversations that trigger the recollection and bring episodes and passions to the current reality.
The elements of a person’s past needs in emotionality and psychological areas are transferred into the present. Furthermore, the feelings can be confusing as to the reasons of its appearance and oftentimes powerful enough an influencer of relationships and conduct of one’s affairs. Illustration 1. (Source: Dombeck, 2009) For most people, there is recognition of the presence of a triangle in the figure above; a recognition when in reality, no triangle is actually present.
This optical illusion of a triangle exists due to prior exposure to a similar figure. The presence of a triangle is similar to transference experience wherein prior exposure to people and relationships bring many resulting experiences to the present even without much effort or strain (Dombeck, 2009). In therapeutic relationship, the understanding of the presence of transference in all of one’s relationships helps a practitioner to also provide the client insights into complications comprising transference (Corey, 2004).
Actively evaluating these possibilities of the practitioner’s transference tendencies can help eliminate or reduce problems that hinder the therapeutic relationship. Hating a therapist or developing an infatuation are strong feelings that can be experienced by a client which are examples of transference. Therefore, it is within the context of the helping profession and it is legitimate for a therapist to search or evaluate together with the client what similar treatments he experienced before had he felt the same emotions.
Self-awareness is an important aspect in emotional growth and/or maturity hence awareness of the therapist’s own tendencies is a fundamental ingredient in the practice. This must also be effectively conveyed to and understood by the client (Kitchener, 2000, p 45). Moreover, the occurrence of counter-transference in which the therapist develops attitudes and feelings (transference) towards his client can be real and more often counter productive. Dealing carefully with the issues that the therapist possesses are critical aspects of the profession.
Only experts and those who intentionally had established ethical ways of dealing with patients or clients can better handle counter-transferences that occur (Welfel, 2005, p. 320). Bereavement, loss and termination Bereavement is loss of a loved one and any form of loss such as death, separation and the termination of relationship of whichever kind as long as these relationships were vital to the psychological well-being of an individual are all considered similar or the same (Jacobs et al. , 2000).
All these human experiences are common to one’s existence and unavoidable or inevitable in one’s lifetime. When a person experiences grief, he goes through a state of mourning and various upheavals in his emotions and psychological functioning arise. It can range from panic disorder, major depression, anxiety disorder or even PTSD (posttraumatic stress disorders) which may result to drug or alcohol use or the increase of the consumption of toxic and harmful substances (Jacobs et al. , 2000; Jacobs & Prigerson, 2000, p.
23). Transference and issues of loss or termination The experience of grieving for loss can be possible also when a client has to terminate his or her therapeutic relationship. Prior experiences of loss such as death or separation like divorce can probably trigger similar emotions when the therapist finally says goodbye and closes the professional relationship with this client. This was true with a friend who had gone through therapy and for the long while attained a semblance of well-being because of the sessions.
However, because this was already turning to a progressively successful helping relationship, her therapist slowly accented the possibilities of the need for terminating the therapy. This friend came home and started to experience similar to a panic disorder which she went through when her husband announced that he was divorcing her. Waves of anger and frustration, and mostly grief and loss and emptiness seemed to engulf her, threatening to overwhelm her again. This was a critical episode of her life which might unravel the strengths she had gained in the therapy (Jacobs & Prigerson, 2000, p.
23). Therapist’s counter-transference on client’s issues of loss, bereavement or termination As mentioned, awareness of one’s issues must be a matter of choice and constant self-monitoring and evaluation since this can be critical to the client’s optimal functioning or recovery as well as the therapist’s own retention of psychological and physical well-being (Welfel, 2005, p. 235-355). Thus, issues of loss, bereavement or termination that once affected the therapist should also be dealt with and preparations in handling for potential occurrence are a must (Neimeyer, 2000).
In my case, it is undeniably true that I have had occasions that a therapeutic relationship turned sour because of counter-transference. In the issue of termination though, another friend-client of mine went through grief counseling because of the death of her child whose demise was untimely in a sense. It was an accident of which she was also a witness. In the course of their helping relationship, this client-friend soon overcame her grief and loss and was restored to the normal day to day conduct of her affairs. Thus, there was time to say goodbye, and this client-friend turned to say goodbye to her therapist.
Unbeknownst to her, the therapeutic relationship was already awakening deep issues within her therapist. There developed a counter-transference that though the therapist was trying to avoid and limit had already gone its course. Until the termination came to its final stage, this client-friend never knew of what was happening because her therapist never made her aware of the dilemma. I came to know about it because I knew both the therapist and the client as I was partly instrumental to their meeting. In short, the therapist had developed strong feelings of attachment to the client.
She said that when termination came it was as if feelings of rejection came all over again reminiscent of the time when her former husband of several years told her that everything between them was a joke and that he was leaving her for someone else. The separation was sudden and quick and she said she was not allowed time to stall the relationship or even convince her husband to stay. Her loss was devastating and it was an issue for her of trust, denial of friendship and deep seated anger for the plain thought of someone important just leaving her for not enough convincing reasons.
It was for this therapist a very irrational step to do to one who was faithful and true. Thus, though the situations were vastly different, there was the friendship that she caught her unawares and her reactions to the termination was something that surprised the therapist. Her issues on leaving and loss were critically revived at this point with her client. Probably, she was not critically aware of where the emotions will be aroused that triggers the counter-transference or that she let her guard down.
Whichever, the important thing is that the therapist reassesses her vulnerability and must again provide ways that will enable her to handle her relationships better in the future (Kitchener, 2000; Welfel, 2005). Conclusion 2. The fitness of the therapist By fitness, we mean sufficient, wide-ranging exposure, and right training to the kind of illness/es or disorder/s that he may be dealing. Even with years spent in the academe will not guarantee the development of skills in handling such complex and true-to-life situations or scenarios.
At times, the theoretic skills acquired, instead of enabling the new therapist, may deter or hamper the process. This means to say that the therapist must possess more than head-knowledge; he should not allow his schooling to affect him to the extent that it made him conceited with no room for more learning especially when additional knowledge are available in the patient himself. He must also have the sensitivity to employ his gut-feeling to at times, direct the course of the therapy (Davison et al. , 2000).
Therapeutic relationships are almost always exhausting, but it will be an undesirable experience for the alliance partners when just one of them becomes disinterested, hence as Luborsky pressed that “reciprocity” must be established, cultivated or maintained until the relationship is terminated, hopefully because the client is well (Horvath & Luborsky, 1993, p. 4). Bibliography 1. Borys, D. S. & Pope, K. S. (1989). Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers. Professional Psychology: Research and Practice, 20(5), 283-293. 2. Corey, Gerald (2004).
Theory and practice of counseling and psychotherapy. Thomson Learning, USA. 3. Davison, Gerald C. and John M. Neale (2001). Abnormal Psychology. Eighth ed. John & Wiley Sons, Inc. 4. Dombeck, Mark (2009). Transference. Accessed June 2, 2009 at http://www. mentalhelp. net/poc/view_doc. php? type=doc&id=8253 5. Kitchener, K. S. (2000). Foundations of ethical practice, research, and teaching in psychology. Mahwah, NJ: Lawrence Erlbaum Associates. 6. Horvath, Adam O. , Lester Luborsky (1993). Journal of Consulting and Clinical Psychology, Vol. 61, No. 4,561-573 Copyright 1993 by the American Psychological Association, Inc.
0022-006X/93/S3. 00 7. Jacobs S & Prigerson H. (2000) . Psychotherapy of traumatic grief: a review of evidence for psychotherapeutic treatments. Death Studies, 24, 479-495. 8. Jacobs, Shelby, Carolyn Mazure, and Holly Prigerson (2000) “Diagnostic Criteria for Traumatic Grief. ” Death Studies 24 185–199. 9. Neimeyer R. (2000). Searching for the meaning of meanings: grief therapy and the process of reconstruction. Death Studies,24:531-558. 10. Welfel, Elizabeth R (2005). Ethics in Counseling and Psychotherapy: Standards, Research, and Emerging Issues: Wadsworth Publishing

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