The Therapeutic Relationship.

This is a topic that requires multiple tomes of knowledge to be able to capture even a fraction of what is known or theorised. I thought that here it would be interesting to talk about some ideas that help some therapists to be with their clients.

For some context, this blog covers a set of thoughts that Harry and I consider to be some of the most powerful and fundamental aspects of ‘successful’ therapy, this is not exhaustive or congruent with every school of thought in psychology, but seems to come through in the core of most ideas.

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The Therapeutic Relationship

The connection between client and practitioner is a commonality across (nearly) all schools of therapy and is one of the most important features (in different ways). Carl Rogers set out core conditions of therapy within a client-centred, or humanistic, model that we at Bristol Music Therapy consider to be helpful in working with people.

-          Congruence (Genuineness and authenticity)
-          Unconditional Positive Regard (A belief that the client is able to self-actualise)
-          Empathy (An understanding of the client’s subjective feelings)

Unconditional Positive Regard:
Self-actualisation is perhaps best known for being atop Maslow’s Hierarchy, the highest point that a human can reach. Maslow’s idea was that once the other layers of the hierarchy     were attended to, then the loop of self-actualisation could begin. Cambridge Dictionary defines it as: “a person's desire to use all their abilities to achieve and be everything that they possibly can.” Unpacking this idea, we get a sentence more like this: Unconditional belief that the client can reach the full extent of their potential to meaningfully fulfil themselves. This is a bit wordier, so no wonder Rogers decided to condense the idea slightly. Finally, “Unconditional” carries a lot of load here; it almost flies under the radar in its simplicity. This is a hope from the therapist regardless of the client’s disposition, barriers, life circumstances, and a plethora of other objects in the way. It’s almost radical in how far and deep reaching this hope is, however, it is intrinsic to Rogers’ view of therapy.

Empathy:
This is perhaps the most obvious aspect of a therapeutic relationship that one would expect. Your therapist being empathetic to whatever material is in the session or exists in the relationship is crucial, not only for your experience and journey through therapy as a client, but also for the therapist to be effective in their reflections and processing of sessions. Sometimes a shared empathy can be distracting, perhaps the therapist has had previous similar experiences to the client that are overwhelming or painful, however with their own therapy a therapist should be able to pick apart any tangles between their own projections and experiences and the clients. Other times that ‘insider information’ can be incredibly helpful, especially when the therapist is able to hold their own experiences and the clients separately, whilst still being “in tune” with them. Empathy is perhaps downstream of the final aspect that Rogers holds as crucial…

Congruence:
How is it possible to be empathetic without a genuine and authentic interest in the client? Clients can feel that. They can tell when the therapist is distracted or checked out, or even just never interested from the start. Congruence doesn’t start and end in interest, however. Authentic reactions to material in the session, genuine reflections, or disclosures (when appropriate), the kinds of responses and actions that feel real from the therapist are foundational to how the therapeutic relationship develops. If you, as a client, can bring real things to sessions, consciously or subconsciously, then the therapist needs to bring their authenticity to match it. Authenticity should be a cornerstone of most, if not all, human relationships; why would it be different in therapy?

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Yalom, in speaking to a member of a group therapy group, recalls the member’s insightful phrase,

“For the longest time I believed the group was a natural place for unnatural experiences. It was only later that I realized the opposite—it is an unnatural place for natural experiences.”

I find this statement to be almost revelatory. It’s not uncommon, as a client, to wonder about the artificiality of therapy; the transactional nature of money for time or services rendered. This is partially true, there is a front-facing transaction for these things, however that doesn’t make the process of therapy artificial. If therapy is about human connections and a journey together of clients finding ways to ‘be’, to ‘self-actualise’, then it would never work if the two people in the room weren’t available to be human with eachother.

The therapeutic relationship can be uniquely powerful and transformative, but it's only as real as the people in the room.

Garrick Wareham