A relational approach to therapy: how can this be applied in time-limited counselling in a university counselling service? Sheila Kirkham MA Psychological Therapies Leeds Metropolitan University June 2009

Introduction  A relational approach to therapy believes that relationships are fundamental in: The development of personality and a sense of self The difficulty clients bring to therapy (relations with self and other people) The therapeutic process (the therapy relationship is the heart of this process) Paul and Pelham (2000)

The problem  Given this belief, it could be assumed that a long time frame is needed to understand the relational development and patterns of the client, and to build an in-depth client-therapist relationship as the medium through which therapeutic change can take place.  But in many settings nowadays, shorter counselling contracts are the norm. In a university counselling service for example, how feasible is it to build and use the counsellor-client relationship, when the average length of a counselling contract might be four or five sessions?

Methodology  To address this problem, 3 research questions are posed: How has a relational approach to therapy been defined and put into practice? How has time-limited therapy been defined and put into practice? What are the particular needs of clients using a university counselling service?  A literature review of theoretical literature and research evidence is used to explore these questions.

Results  Key themes emerging from the literature search on a relational approach to therapy, and on time-limited counselling were tabulated, summarised and evaluated.  These were synthesised with data found on student counselling.  From this synthesis, a research-informed protocol for practitioners in student counselling was generated.  A key finding of the review was that ‘common factors’ in therapy are primary determinants for therapeutic change, and these ‘common factors’ are incorporated into the protocol. Relational factors Student counselling factors Time-limited factors Protocol

Recommendations  The review highlighted two specific questions for further research: is counselling effective in enhancing student achievement and retention? to what extent does a relational approach to therapy take into account not only a student’s interpersonal world, but also his wider social and cultural world?  The outcome of the review is a new protocol for practice for counsellors using a relational approach to therapy in time- limited student counselling  There is scope for exciting further research in conducting a study into the effectiveness of this protocol when applied in practice in a university counselling service.

Protocol – for a six session contract using a relational approach to therapy in a university counselling service Beginning phase Type of factorTherapist intervention / activity shared between therapist and client Time-limited / ‘common factors’  Therapist makes explicit the time-limited nature of the work; conveys hope that important and useful work can be done in time available. Relational  The therapist facilitates the client telling his story, including the story of his attachments / relationships. Time-limited / ‘common factors’  Therapist actively participates in enabling the client to formulate what he wants out of therapy. Time-limited  Client and therapist together develop a therapeutic focus for the work, homing in on what is most salient among the client’s concerns and recognising that less salient concerns will not be worked on in the time available. Set goals if appropriate. Relational / Time-limited  Therapist and client think together about how they are relating to each other in early phase of work, decide whether they feel they can work productively together, agree therapeutic frame, with specific emphasis on planning dates of meetings and identifying date of final session.

Protocol (continued) Throughout the six sessions Relational / ‘common factors’  Therapist conveys warmth, respect, empathy, acceptance, genuineness. Relational / ‘common factors’  Therapist conveys trustworthiness, reliability, consistency, with a view to building trust. Relational / ‘common factors’  Therapist provides non-judgemental environment for catharsis, ventilation, release of tension. Time-limited / student counselling  Therapist maintains the agreed therapeutic focus at forefront of the work, but notes if focus changes during exploration of client’s material and checks out with client whether new focus needs to be agreed; remains flexible and responsive to client need, particularly in the light of client’s academic situation. Time-limited  Therapist and client work together to discover client’s own resources, identify prior successful strategies used, imagine new strategies that ‘fit‘ for this particular client. Student counselling  Therapist is mindful of developmental stage of client and responsive to differing needs of younger and mature students. time-limited / ‘common factors’  Encouragement to try out new strategies; therapist reinforces successes; gives encouraging feedback.

Protocol (continued) Throughout the six sessions Relational  Therapist notices aspects of the story that are about early attachments and relational patterns; if relevant to focus of therapy, may draw these to the attention of the client, otherwise will simply keep them in mind as a background to understanding the relational world of the client. Relational  Therapist notices aspects of the therapeutic relationship that may reflect client’s relational patterns (transference); if relevant to focus of therapy, may draw these to the attention of the client, otherwise will simply keep them in mind as a background to understanding the relational world of the client. Relational / student counselling  Therapist and client together look outward at client’s wider relational world: therapist encourages client to access support if appropriate in client’s wider environment: tutor, other university support services, GP, family, friends. Student counselling  Therapist is mindful of the university context, checking out to what extent client concerns are impacting on client’s studies; facilitates client’s problem solving skills to address this. Time-limited / student counselling  Throughout therapy, therapist reminds self and client of time-limit, reflects on changes and reviews the work; assesses whether goals will be met or partially met, or whether further work, in this Service or in another setting might be needed.

Protocol (continued) Ending phase Time-limited / relational  Therapist and client review progress with regard to therapeutic focus, notice and reinforce any new behaviours or skills practiced or acquired, and reflect on how issues client presented at outset of therapy have been worked through and assimilated. Relational  Therapist encourages client to consider whether ending connects to client’s relational patterns. Time-limited / student counselling  Therapist and client together explore how learning from the therapy can be taken forward. Time-limited / student counselling  Therapist reminds client of availability of Counselling Service for future support.

Key references  AUCC (2004) Annual survey of counselling in UK colleges and universities. Rugby, British Association for Counselling and Psychotherapy.  Connell, J., Cahill, J., Barkham, M., Gilbody, S., & Madill, A. (2006) A systematic scoping review of the research on counselling in further and higher education. Rugby, British Association for Counselling and Psychotherapy.  Cooper, M. (2008) Essential research findings in counselling and psychotherapy. London, Sage.  Coren, A. (2001) Short-term psychotherapy: a psychodynamic approach. Basingstoke, Palgrave.  Haugh, S. & Paul, S. eds. (2008) The therapeutic relationship: perspectives and themes. Ross- on-Wye, PCCS Books.  Lambert, M. J. (2004) Bergin and Garfield’s handbook of psychotherapy and behavior change. 5th edition. New York, John Wiley and Sons Inc.  Leeds Metropolitan University Counselling Service (2009) Annual Report 07/08 [Internet], Leeds, Leeds Metropolitan University. Available from: [Accessed 9 May 2009].  Mitchell, S.A. (1988) Relational concepts in psychoanalysis. Cambridge, MA, Harvard University Press.  Norcross, J.C. ed. (2002) Psychotherapy relationships that work: therapist contributions and responsiveness to patients. New York, Oxford University Press Inc.  Paul, S. & Pelham, G. (2000) A relational approach to therapy. In Palmer, S. & Woolfe, R. eds. (2000) Integrative and eclectic counselling and psychotherapy. London, Sage, pp  Rana, R. (2000) Counselling students: a psychodynamic perspective. Basingstoke, Macmillan Press Ltd.  Roth, A. & Fonagy, P. (2005) What works for whom? 2nd ed. New York, The Guildford Press.  Royal College of Psychiatrists (2003) The mental health of students in higher education. Council Report CR112. London, Royal College of Psychiatrists.  Wampold, B. E. (2001) The great psychotherapy debate. Mahwah, NJ, Lawrence Erlbaum Associates, Publishers.