Counselling Practice

By definition; counselling interventions and techniques can be described as a unique interrelationship between a client and a counsellor, with the sole aim to promote a change and growth and encourage a shift in behaviour towards fulfilling his or her human potential. (Feltham & Horton, 2006) It is the responsibility of the counsellor to contribute to the process of change during the counselling process, to enhance his or her client’s personal development.

The current essay will critically evaluate three counselling intervention / techniques and use this evaluation to reflect on the application of the humanistic theory in counselling practice and how they contribute to the effectiveness of the process. Historically, within psychology and counselling a wide range of attitudes and approaches have been developed; in order to provide the client the ability to explore his inner world. Theories such as Rogers’ theory the Gestalt theory and the Psychoanalytic theory, all serve to allow exploration and aim to increase the level of awareness as well as the level of motivation to change.

By facilitating the client to explore his or her hidden world by using interventions the client can begin to recognise and change thoughts, feelings and behaviours and begin a healing process and step forward toward self-actualisation. Self disclosure is one such intervention used widely within humanistic counselling. It is believed by some to be beneficial to the relationship whilst other schools of thought debate its usefulness.

Beutler (1978) states that “the degree either of the experimenter or therapist self-disclosure precipitates a similar disclosure level in subjects and patients”. But Strong and Claiborne (1982) write that ‘therapist disclosure to encourage patient disclosure does not seem like a good use of the therapist’s power unless specific disclosure is needed”. Disclosing self is a point in the process by which we let ourselves be known to the other. By discussing self I mean that the counsellor makes a conscious decision to reveal something to the client.

Essentially, we share with the client a similar experience to the one that is causing her present difficulties. In one sense, the counsellor cannot help but disclose themselves as they communicate their characteristics to the client in every look, movement, emotional response, and sound as well as with the words they use (Strong & Claiborne, 1982). It is the use of more direct self-disclosure which is up for discussion. Self-disclosure can be challenging to the client by presenting an intimacy, which some clients may find difficult to handle (Egan, 1994).

However, some clients may be very comfortable with this intimacy which can only serve to strengthen the relationship, by way of the counsellor reinforcing their congruence. Within my helping role in the spinal injuries unit, unwittingly I was using self-disclosure very early on in relationship. Inskipp (2006) would argue that self-disclosure at the beginning of a relationship is usually not helpful. Newly injured patients were eager to seek out my experiences of both the spinal unit and discharge into the home environment. This involved a great deal of self-disclosure and honest reporting of my own experience.

On reflection, this served to show me as a kindred spirit with a true understanding and in some cases allowed them to offload their deep fears. I believe this worked uniquely within this given environment; however this level of self-disclosure would not translate into a professional counselling relationship. As I am a full-time wheelchair user, I wonder how helpful it would be too self-disclose early into the therapeutic relationship my personal circumstances with regard to why I am confined to a wheelchair. It is human nature to be curious and see the wheelchair is an abnormality.

If this disclosure was done early on I question whether I would be seen to be congruent, satisfy curiosity and allow the process to progress; or merely perceived as a martyr or creating an intimacy too early in the relationship. Within a professional counselling relationship self-disclosure can act as a model for the client to talk more openly, when used timely it may serve to build a relationship by shortening the psychological distance between the client and the counsellor and serving to build trust and reinforcing the counsellors congruence.

However it is important not to lose sight of however similar a situation, each individual will experience it differently and may not want to be classified as similar to the counsellor. (Inskipp, 2006). The counsellor may believe they are increasing their attractiveness or genuineness to the client by disclosing similarities. However, by doing this they may reduce the client’s perception of their competence and expertise. The client may even feel unsafe to see the therapist as less well adjusted (Feltham & Horton, 2006).

Equally, they may be perceived by giving reassurance, that the client’s problems are not as serious as they had thought. In this incident, the worst-case scenario is that the client will have reduced motivation to therapy or less desire to change. Feltham and Horton 2006 recognise that many self-help groups work on the principle of group self-disclosure to encourage and challenge clients. They state that these self-help groups may work as it is a peer experience. In one-to-one counselling, it is important to acknowledge that the counsellor is not a peer.

And self-disclosure must be used skilfully. Towards the end of the therapeutic relationship, the client may not be quite so focused on themselves as their own problems may not require as much attention. Throughout the process they become aware of the therapist as a person and may become more curious of them as an individual. At this point they may express an interest by asking questions about the therapist as a person. This may be an indication that the process is now nearing or at its end (Patterson, 1985). Self-disclosure can often take the form of immediacy.

By this I mean, the counsellor disclosing thoughts and feelings about what is happening in the therapist client relationship in the ‘here and now’. Immediacy is both a person centred and Gestalt intervention, it aims to raise awareness. Skilled use of open and honest communication allows the therapist to be aware of what is happening in the counselling relationship at any given moment and reflecting this back to the client sensitively. It is an intervention that allows the counsellor to focus on the way the relationship itself has developed and how it is helping or identifying what is standing in the way of progress.

(Egan, 1994). The sole purpose of immediacy is to strengthen the working alliance. Immediacy can be useful to ensure contact is not broken throughout the process. Immediacy can be used to address a whole host of situations for example if the session has become directionless and no progress is being made, there is tension between counsellor and client; where trust seems to be an issue; where there is a social distance (Egan, 1994). Whilst the open and honest nature of immediacy can be perceived as being congruent, some clients may find it both challenging and confrontational.

For example, the client may have taken umbrage to something the counsellor has said earlier in the relationship, when the counsellor suggests that they feel tension between the client and the counsellor, the client may find it difficult to articulate this when challenged. Equally, many clients are comfortable talking about their feelings in the past rather than the “now”. The counsellor may use immediacy to provide a model for speaking about thoughts and feelings that are not usually expressed (Inskipp, 2006), to raise awareness pushing the client to talk about their present feelings.

In line with these examples, immediacy is only appropriate when the counselling relationship is firmly established. Used well immediacy can build or repair therapeutic relationship, deepen congruence and nurture the therapeutic interaction. (Egan, 1994) States that immediacy is a demanding skill and very difficult to execute. The therapist needs to be able to catch typical moment as they happen and react to them and in doing so raise awareness. Within the forum of raising awareness, Gestalt techniques and interventions can be used to great effect.

(Perls, 1969) Saw Gestalt as the only psychotherapy based purely on phenomenology, a psychological approach based on a philosophy which works away from concepts and towards pure awareness. (Clarkson, 1998) The philosophical assumptions of Gestalt argue that people can only experience themselves in the present and the past can only be experienced by remembering. (Clarkson, 1998). This is very much in keeping with Rogers’s theory of dealing with the here and now. By raising awareness, taking responsibility and owning all aspects of self that client can be moved toward self-healing and change will naturally follow.

Within the umbrella of Gestalt the counsellor may take on a more active and directive role, allowing them to be more experimental many techniques can be used to achieve this. One such intervention used frequently is the empty chair. Empty chair work encourages the client to explore their relationships with others, or explore aspects of themselves by imagining them to be present and engaging in dialogue in some way. (Ellis, 2000). Empty chair work aims to be helpful in raising the client’s awareness and is about bringing feelings relationships and conflicts to life within the therapy room, rather than just discussing and speculating.

It can be presented to a client as an experiment they may wish to try and is usually done so with the aid of an empty chair. The purpose of the chairs is to allow them to be another person whether that person is a separate entity or themselves in the past or the future. Inskipp (2006) acknowledges that this can be used to benefit the clients that struggle to articulate strong emotions such as grief or anger. I would advocate that this technique can be used to express any emotion, the chairs serving merely as a vehicle to depersonalise the feeling but allow them to be expressed all the same. The

client is encouraged to act out the dialogue change positions as though adopting different roles. From a personal point of view, I found this to be very beneficial within skills and process session. By allowing myself to re-enact a situation which had been causing me niggling doubt I was able to verbalise how I really felt towards my ex-husband. On the back of this, for the first time I was able to rationally appreciate the situation from his point of view also. Although feeling rather silly at first I did find it quite liberating to express how I actually felt to the imaginary person sitting in the chair.

This gave me an appreciation of how this must feel for a client. Clearly, some clients may not benefit from this due to feeling self-conscious and uncomfortable with the whole role-play setup. Within my helping role at the spinal unit I can now reflect that the empty chair technique could probably be used to great effect. Sustaining a spinal injury, makes an individual look at themselves as two different people. The person they were before the accident and the person they have become as a result of the accident. The same can also be said of friends and family who have been affected by the accident.

Giving the individual and the friends and family the opportunity to use an empty chair; to explore how the old self would view the relationship with the new self and their loved ones, may serve to meet some middle ground towards acceptance and dealing with the grief that everybody affected is feeling. Whilst the directive nature of Gestalt experiments can encourage therapeutic relationships to blossom Corey (2000) expressed some concern regarding the therapists ability to abuse their power by creating a, high-intensity interaction. Rogerians believe that in pure person centred counselling the balance of power is always with the client.

The concern is in the nature of therapists being absorbed with using Gestalt techniques with other theories and becoming very active and directive within the therapy session. The intensity of the therapy might not be suitable for all patients, and even disruptive for some, despite the competence of the therapist. In addition, there is a lack of monitored, scientific research evidence supporting the effectiveness of Gestalt therapy (Corey, 2000). In summary, not all interventions can be used with all clients. Clients must be seen and communicated with on the basis of their individual needs and capabilities.

The client centred core conditions may be implemented in different ways by different therapists with different clients. They must always be consistent with the nature of the conditions themselves and used only when a good therapeutic relationship has been established. There is some freedom to use interventions and techniques. Interventions must not be used as a bag of tricks that can be pulled out as a therapist sees fit. The freedom of the therapist stops if the directive nature infringes on the freedom of the client to be responsible and direct his own life. (Patterson, 1985) Word Count 2163

REFERENCES

Beutler, L. (1978). Psychotherapy and persuasion. In L. Beutler, & R. Green, Special problems in child and adolescent behaviour (pp. 119 -159). Westport: Techonomic. Clarkson, P. (1998). Gestalt Counselling in Action. London: Sage Publications. Corey, G. (2000). Gestalt therapy” in theory and practice of counselling and psychotherapy. California: Wadsworth and Thomson. Egan, G. (1994). the skilled helper. California: Wadsworth. Ellis, M. S. (2000). Theory and approaches. Humanistic existential approaches. In C. H. Feltham, the Sage Handbook of counselling and psychotherapy (pp. 289 – 293).

London: Sage. Feltham, C. , & Horton, I. (2006). The SAGE Handbook of Counselling and Psychotherapy. London: SAGE Publications. Inskipp, F. (2006). Therapeutic skills and clinical practice. In C. Feltham, & I. Horton, The Sage Handbook of counselling and psychotherapy (pp. 84 – 85). London: Sage. Patterson, C. (1985). The therapeutic relationship. Monterey California: Brooks/Cole. Perls, F. (1969). Gestalt therapy verbatim. Californiania: Real People Press. Strong, S. , & Claiborne, C. (1982). Changes through interaction: Social psychological processes of counselling and psychotherapy. New York: Wiley.

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