Counselling Relationship and Successful Outcomes in Therapy

Introduction

The outcome of counselling is strongly dependent on the communication abilities of a therapist. Psychotherapy allows creating interpersonal relationships between counsellors and patients to improve the psychological state of the latter (Soma et al., 2020). Indeed, establishing a therapeutic alliance with clients is essential for creating an emotionally comfortable environment for a client to open sharing and discussion with the therapist (Angus & Kagan, 2007). Alliance in therapy consists of consensus about treatment goals, agreement about the tasks, and bonding (Wampold, 2015). Such techniques as active listening, reflection, and interpretation help strengthen relationships with clients and create bonds (Goldfried & Davila, 2005). Conversely, lack of communication and application of counselling techniques only results in adverse outcomes. Furthermore, it is crucial to consider the individuality of each client to predict the results of a therapy (Cuijpers et al., 2019). Counselling requires therapists to develop certain qualities that can improve therapeutic relationships with clients. Empathy, congruence, and unconditional positive regard contribute to establishing good counselling relationships and lead to successful therapy outcomes.

Factors Important for Counselling

The outcome of therapy depends on many factors, starting from therapeutic methods used by the counsellor to personal interaction with the client. Establishing a rapport and collaboration between a therapist and patient can become possible when clients’ concerns are understood and acknowledged (Tryon et al., 2018). Good connection and collaboration facilitate trust between client and counselor, resulting in positive therapy outcomes. Initial therapeutic relationships are strongly dependent upon the client’s first impression of a counsellor and the environment (Norcross & Wampold, 2018). A therapist’s expertise can be defined by reputation, competence, clinical accuracy, and clients’ outcomes (Hill et al., 2017). Counselors need to be effective at assigning the patient’s stage of change to apply the correct methodology because clients at various points toward change may perceive their problem differently (Krebs et al., 2018). Thus, accurate recognition of the stage will result in a better approach to a client’s issue. Furthermore, therapists should possess leadership skills to guide clients throughout counseling (McKibben et al., 2017). Counsellors should envision a bigger picture of the problem, analyze the information provided by clients, and make wise decisions about further steps in therapy.

A counsellor’s traits may sometimes play a more critical role than professional skills. However, adherence to treatment protocol and theoretical knowledge does not always predict therapy outcomes (Wampold et al., 2017). Indeed, a personalized approach to every client plays a more significant role in bonding (Norcross & Wampold, 2018). For example, such traits as professional self-doubt, emotional intelligence, and mindfulness positively affected patient outcomes (Heinonen & Nissen-Lie, 2020). Another factor contributing to counselling outcomes is empowering a client to change (Weinberger, 2014). Furthermore, the client needs to believe that he or she decided to take appropriate steps for improvement; otherwise, the patient may relapse (Weinberger, 2014). Moreover, if a session was not successful, a client may decide not to return to the same counsellor. Therefore, it is essential to listen actively and respond to patients appropriately (Stiles et al., 2017). Indeed, clients who remain with one therapist describe that their counsellors expressed respect, understanding, and interest (Luedke et al., 2017). Thus, a therapist needs to understand and reflect appropriately on clients’ emotions, concerns, and needs.

Pros and Cons of Empathy in Counselling

People seek understanding and acceptance when they come to psychological counselling. One of the most valuable tools for creating bonding with clients is empathizing with them. According to Lakeman (2020), “empathy is an emotional response (affective), dependent upon the interaction between trait capacities and state influences” (p. 1). In other words, it is the ability to understand one’s perspective about a specific issue, experience similar feelings, and communicating it to that person (McClintock et al., 2018). Empathy is an integral component of counsellors’ interaction with their clients.

Empathy is needed to build and maintain an alliance with clients during counselling. There are four types of empathy: affective, moral, cognitive, and behavioral (Bayne & Hays, 2017). Counsellors should possess all four types of empathy to determine the client’s emotions, motivate for bonding, accurately understand different perspectives, and convey it to another person (Bayne & Hays, 2017). Although emotions are transient, their proper utilization can help build trust between a therapist and a client, allowing for further collaboration and behavioral change (Allemand & Flückiger, 2017). Moreover, empathy may vary in different counselling sessions because of the temporality and changing nature of human emotions (Johnson & Karcher, 2019). The outcome of therapy often depends on the therapist’s ability to quickly manage their behavior and responses (Soma et al., 2020). However, empathy may be ineffective when clients prefer business relationships with their counsellors (Elliott et al., 2018). Therefore, it is crucial for therapists to quickly assess and detect what personality type a client has to establish therapeutic bonding and avoid misunderstanding.

Pros and Cons of Congruence in Counselling

The sincerity of a counsellor’s thoughts and feelings is crucial for effective therapy. The state in which a person understands and expresses his or her genuine emotions about an experience while remaining empathetic to someone’s feelings is called congruence (Sutanti, 2020). In other words, the therapist achieves congruence when one is in harmony between experience and awareness (Sutanti, 2020). Indeed, congruence is the central concept in patient-oriented counselling that initiates positive changes in a client’s behavior (Sutanti, 2020). Counsellor’s authenticity can create mental comfort for patients, making them more open to change. Demonstrating genuine emotions to a client may help develop a therapeutic alliance.

It is believed that congruence ensues from a four-stage process. The first step is when the therapist accepts one’s own emotions and thinking (Sutanti, 2020). The second step involves giving acceptance to a client’s feelings (Sutanti, 2020). Then, the counsellor experiences congruence and lastly communicates it to a patient (Sutanti, 2020). However, some clients can be overly suspicious about a counsellor’s methods for bonding because, as previously mentioned, these people view therapists as business partners rather than human beings who can aid in their psychological healing. Therefore, these patients require a different approach to ensure proper bonding.

Pros and Cons of Unconditional Positive Regard in Counselling

In addition to empathy and understanding, clients need unconditional positive regard. This term is referred to a warm attitude regardless of the personal qualities of a person (Farber et al., 2018). A patient needs to receive warm regard from a counsellor to start the journey towards improvement (Gelso & Perez-Rojas, 2017). The positive psychology theory claims that positive regard enables clients’ self-acceptance and subsequent positive change (Kim et al., 2020). However, unconditional positive regard seems to be effective only in moderate mood disorders and not for patients with acute psychoses (Farber et al., 2018). Moreover, this approach worked only if a client wanted to receive genuine acceptance (Farber et al., 2018). Otherwise, positive regard can be viewed as an inappropriate, manipulative method of a therapist.

Unconditional positive regard is a quality that every therapist should try to develop. It is probably challenging to have positive regard for every client because emotions may vary from session to session with different clients (Johnson & Karcher, 2019). The concept of unconditional positive regard does not mean that counsellors should develop acceptance for any action of their clients (Gelso & Perez-Rojas, 2017). Indeed, research shows that an adverse reaction from a therapist is allowed, but showing an understanding of a client as a human being who has the right to mistakes is crucial (Gelso & Perez-Rojas, 2017). Therefore, counsellors should strive to control their emotions and behavior to express a positive attitude towards patients who need understanding and acceptance to begin their emotional healing.

Conclusion

To sum up, therapeutic relationships between counsellors and their clients play an essential role in counseling outcomes. Although professional characteristics and therapeutics methods are necessary to achieve positive changes in patients’ emotional states, therapists’ personal qualities were equally critical. Empathy, unconditional positive regard, and congruence are crucial qualities in counselling. Empathy allows therapists to understand the emotional issues of their clients by viewing problems from patients’ perspectives. Congruence is a genuine expression of one’s feelings that helps demonstrate a counsellor’s authenticity to a client. Indeed, understanding and genuineness helps bond with patients and establish a therapeutic alliance. However, some patients may be resistant to this approach, needing business relationships with their therapists. Therefore, every counsellor should evaluate the needs of a client to provide an appropriate response. Unconditional positive regard is essential for initiating positive changes, but it is not easy to maintain the same attitude with different clients. Still, therapists should aim at expressing positive regard to all patients.

References

Allemand, M., & Flückiger, C. (2017). Changing personality traits: Some considerations from psychotherapy process-outcome research for intervention efforts on intentional personality change. Journal of Psychotherapy Integration, 27(4), 1-45.

Angus, L., & Kagan, F. (2007). Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research. Psychotherapy: Theory, Research, Practice, Training, 44(4), 371-377.

Bayne, H. B., & Hays, D. G. (2017). Examining conditions for empathy in counseling: An exploratory model. The Journal of Humanistic Counseling, 56(1), 32-52.

Cuijpers, P., Reijnders, M., & Huibers, M. J. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207-231.

Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399-410.

Farber, B. A., Suzuki, J. Y., & Lynch, D. A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4), 411-423.

Gelso, C. J., & Perez-Rojas, A. E. (2017). Inner experience and the good therapist. In L. G. Castonguay & C. E. Hill (Eds.), How and why are some therapists better than others: Understanding therapist effects (pp. 101–115). American Psychological Association.

Goldfried, M. R., & Davila, J. (2005). The role of relationship and technique in therapeutic change. Psychotherapy: Theory, Research, Practice, Training, 42(4), 421-430.

Heinonen, E., & Nissen-Lie, H. A. (2020). The professional and personal characteristics of effective psychotherapists: A systematic review. Psychotherapy Research, 30(4), 417-432.

Hill, C. E., Spiegel, S. B., Hoffman, M. A., Kivlighan Jr, D. M., & Gelso, C. J. (2017). Therapist expertise in psychotherapy revisited. The Counseling Psychologist, 45(1), 7-53.

Johnson, D. A., & Karcher, M. J. (2019). Validity evidence for a state-specific assessment of in-session counselor empathy: The state-empathic concern scale. Measurement and Evaluation in Counseling and Development, 52(4), 284-296.

Kim, J., Joseph, S., & Price, S. (2020). The positive psychology of relational depth and its association with unconditional positive self-regard and authenticity. Person-Centered & Experiential Psychotherapies, 19(1), 12–21. Web.

Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta‐analysis. Journal of Clinical Psychology, 74(11), 1964-1979.

Lakeman, R. (2020). Advanced empathy: A key to supporting people experiencing psychosis or other extreme states. Psychotherapy and Counselling Journal of Australia, 8(1), 1-14.

Luedke, A. J., Peluso, P. R., Diaz, P., Freund, R., & Baker, A. (2017). Predicting dropout in counseling using affect coding of the therapeutic relationship: An empirical analysis. Journal of Counseling & Development, 95(2), 125-134.

McClintock, A. S., Anderson, T., Patterson, C. L., & Wing, E. H. (2018). Early psychotherapeutic empathy, alliance, and client outcome: Preliminary evidence of indirect effects. Journal of Clinical Psychology, 74(6), 839-848.

McKibben, W. B., Umstead, L. K., & Borders, L. D. (2017). Identifying dynamics of counseling leadership: A content analysis study. Journal of Counseling & Development, 95(2), 192-202.

Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence‐based relationships and responsiveness. Journal of Clinical Psychology, 74(11), 1889-1906.

Soma, C. S., Baucom, B. R., Xiao, B., Butner, J. E., Hilpert, P., Narayanan, S., Atkins, D.C., & Imel, Z. E. (2020). Coregulation of therapist and client emotion during psychotherapy. Psychotherapy Research, 30(5), 591-603.

Stiles, W. B., & Horvath, A. O. (2017). Appropriate responsiveness as a contribution to therapist effects. In L. G. Castonguay & C. E. Hill (Eds.), How and why are some therapists better than others: Understanding therapist effects (pp. 71–84). American Psychological Association.

Sutanti, N. (2020). Understanding congruence in person-centred counselling practice: A trainee counsellor’s perspective. ProGCouns: Journal of Professionals in Guidance and Counseling, 1(2), 47-55.

Tryon, G. S., Birch, S. E., & Verkuilen, J. (2018). Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome. Psychotherapy, 55(4), 372-383.

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.

Wampold, B. E., Baldwin, S. A., Holtforth, M. g., & Imel, Z. E. (2017). What characterizes effective therapists? In L. G. Castonguay & C. E. Hill (Eds.), How and why are some therapists better than others: Understanding therapist effects (pp. 37–53). American Psychological Association.

Weinberger, J. (2014). Common factors are not so common and specific factors are not so specified: Toward an inclusive integration of psychotherapy research. Psychotherapy, 51(4), 514-518. Web.