1. Understanding the Principles of Counseling and Psychotherapy
Chapter 7

2. Chapter 7 Overview
The therapeutic Alliance: Positive Affective Band, Cognitive Factors, Partnership, Conscious and Purposeful.
Maintaining the Therapeutic Alliance: (Boundary and Role Management) Boundaries, Ethics, Multiple roles, Flexibility of Boundaries, Therapist Self Disclosure, Harm From Disclosure.
Transference
Countertransference
Ruptures to the Therapeutic Alliance: Therapeutic Ruptures and Nonlinear Thinking, Identifying Ruptures to the Therapeutic Alliance, Repairing Ruptures to the Therapeutic Alliance.

3. The Therapeutic Alliance
…most Theoretical definitions of the alliance have three themes in common: (a) the collaborative nature of the relationship, (b) the affective bond between patient and therapist, and (c) the patient’s and therapist’s ability to agree on treatment goals and tasks. (Garske & Davis, p. 439).

4. Congruence/Genuineness:
Promising Elements of the Therapeutic Relationship (But Insufficient Research to Judge)
Congruence/Genuineness:
Two Components:
Therapist awareness of self as a person within the relationship
Therapist ability to share aspects of self with the client
Being congruent facilitates pointing out incongruence in clients
Clients are less likely to be dismissive or suspicious

5. Promising Elements of the Therapeutic Relationship (But Insufficient Research to Judge)
Transference: affective material arising out of the client’s unresolved conflicts that were projected onto the counselor by the client. Initially a psychoanalytic term developed by Sigmund Freud.

6. Transference
For present purposes: thoughts, feelings, and behaviors that
a client brings to the therapy,
a client attributes to a therapist,
may have little to do with actual therapist behavior or intentions
may need to become the focus of attention for the therapeutic relationship.

7. Transference Responding to transference:
“What is it about our relationship-that we have created together-that you find fulfilling?”
“Do you still really need that in your life?”
If you, indeed, still need that in your life, how might you go about appropriately eliciting that from someone in your life?”
See Clinical Exercise: Transference on p. 151

8. Promising Elements of the Therapeutic Relationship (But Insufficient Research to Judge)
Countertransference: affective material arising out of the therapist’s unresolved conflicts and personal sensitivities that may be projected onto a client.
Non-analytic traditions utilize their emotional reactions to a client as an important source of therapeutic information about the client.- emotions can be used as a barometer.

9. Five Countertransference Management Factors
Therapist self-insight: “I am feeling angry! Why?
Therapist self-integrations: “This isn’t about me”.
Anxiety management: “I don’t have to feel threatened by this”.
Empathy: “What is the person feeling?”
Conceptualizing ability: “What is it that this person’s feelings of anger and fear are telling me?”

10. Countertransference
Please turn to page 152 and review Clinical Case Example: Therapist Frustration

11. Promising Elements to the Therapeutic Relationship
Ruptures to the Therapeutic Alliance
“a tension or breakdown in the collaborative relationship between patient and therapist” (Safran et.al, 2002,p.236).
Major Sources of Ruptures: differences between therapist and client about the tasks of therapy, differences between them about goals or tx, and “strains” in their connection.
When ruptures occur, the process of negotiation must be moved front and center in therapy.

12. Ruptures to the Therapeutic Alliance
Once a rupture has occurred it is the counselors responsibility to attempt immediate repair.
Indicators: withdrawal behaviors and confrontation behaviors.
Repairing ruptures: attending to the rupture behaviors, exploring the rupture experience, exploring the client’s avoidance, and emergence of wish or need.
Client feedback to a therapist about the therapy is important in facilitating a positive treatment outcome.

13. Ruptures to the Therapeutic Alliance
Please turn to page 156 and review Clinical Exercise: Repairing Alliance Ruptures

14. Resistance Freud first to use this to describe non-compliant clients
“protecting the ego” unconsciously
Four different “process” types
Arguing
Interrupting
Negating
Ignoring
Interpretation: Interrupt or halt therapeutic progress.
Therapy is not enhanced by confronting!
When considering these “resistance” behaviors, related them to the 4 types of dilemmas (e.g., approach-avoidance, etc.).

15. Reactance Non-psychoanalytic approach
Reactance is a natural reaction to coercion
Especially to one’s values
A typical response in the change process
Thus, by definition, therapy produces this feeling
NO ONE LIKES TO BE COERCED! And although it might seem unseemly, therapy can be perceived by clients as a coercive experience.

16. Reactance
Therapy produces the feeling of being pulled in two directions (i.e., “I want to change, but I don’t want to be forced to change”);
While wanting to have their cake and eat it too (i.e., “I know that I need outside help to change, but I don’t want to give up control”); and
Ultimately finding themselves stuck between a rock and a hard place (i.e., “I can’t stay the same, but I’m not sure I want to change.”).
Therapists must expect it, and help client work through it.

17. Culture/Religion/Spirituality
Benefits to Treatment: When treatment is culturally adapted, outcomes are greatly improved
Employing individually tailored approaches that incorporate forgiveness strategies or redemptive narratives can be a useful addition to traditional psychotherapeutic approaches when clients hold strong religious, spiritual, or cultural views.
Matching therapists to clients based solely on either gender, ethnicity, or religion/spirituality does not seem to be supported by the literature unless there is a preference expressed by the client (Norcross & Wampold, 2011).

18. Maintaining the Therapeutic Alliance
Boundary and Role Management I:
Boundaries, Ethics and Boundaries.
Boundary and Role Management II:
Multiple Roles, Flexibility of Boundaries.
Boundary and Role Management III:
Therapist Self Disclosure, Harm from Disclosure.

19. Boundaries
All relationships are guided by boundaries. This is, within a given type of relationship (e.g. parent-child, husband-wife, teacher-pupil, doctor-patient, and supervisor-supervisee), there are certain behaviors that are prescribed (must take place) and certain behaviors and limits that are proscribed (must not take place).

20. Boundaries
The counselor has the responsibility to make certain that appropriate boundaries are maintained (Poon, 2007).
Therapeutic relationship boundaries must be carefully monitored.
Boundary Crossings
Boundary Violations

21. Ethics and Boundaries
American Counseling Association (ACA) Code of Ethics have defined ethical codes of conduct to help define the therapy relationship and thus protect both client and counselor.
Sexual Relationships
Giving/Receiving Gifts, etc.

22. Multiple Roles, Flexibility of Boundaries.
Dual or multiple relationships with a client can provide clear challenges to the therapeutic relationship.
“any association outside the ‘boundaries’ of the standard client-therapist relationship- for example, lunching, socializing, bartering, errand-running, or mutual business transactions (other than the fee-for-service)” (Lazarus & Zur,2002,p.xxvii)

23. Multiple Roles A conflict of Interest?
Please turn to page 168 and review “Clinical Exercise: A Conflict of Interest?”

24. Flexibility of Boundaries
Rigid vs. Flexible boundaries
“conflict of interest”
Are the therapists interests ahead of the client’s interests?
When in doubt consult with a trusted colleague, mentor, or supervisor.

25. Therapist Self Disclosure/Harm from Disclosure
Self-disclosure: the deliberate revealing of thoughts, feelings, or personal information by a therapist to a client in treatment.
“anonymous therapist”
Appropriate self-disclosures: can show authenticness if well-timed, and can strengthen the relationship.
Inappropriate self-disclosure: power imbalance, client vulnerability, exploitation, and inappropriate behaviors.

26. Therapist Self Disclosure
Contextual factors that a level I practitioner might take into account about self disclosure:
For whose benefit is this particular information being disclosed?
What is the rationale for the disclosure?
Does the disclosure strengthen the therapeutic alliance?
Is this disclosure appropriate for this particular client at this particular time?

27. Please turn to page 171and review Clinical Exercise: Self Disclosure
Harm From Disclosure
Self Disclosure
Please turn to page 171and review Clinical Exercise: Self Disclosure

28. THANK YOU.
Any Questions?