PSYCHOTHERAPY & COUNSELLING

LESSON THREE

The Client's Needs in Therapy

In this lesson I want to take a brief look at the questions of respect and
empathy. When people approach a psychotherapist for help, it is usually because
their negative emotional patterns have become too painful for them to tolerate or
because their entire world seems to be falling apart.

The first problem encountered in helping such people is the period of

disintegration or disorientation which is experienced in the stepping from the old
into the new.

This is seen as a "limbo of chaos and uncertainty" from which they are
motivated to escape by the persuasive nature of the very pain they are enduring,
and individuals who have had enough of struggling, depression, constant anxiety,
and smouldering hostility are, in the main, -

1. Aware and appreciative of the fact that the course they are
currently on will continue to lead them in the wrong direction.

2. Sick and tired of being sick, and tired.

3. Have hit their personal rock bottom and are ready to make the inner
changes necessary so they can rebound.

4. Willing to take the risks associated with thinking and acting in new
ways.

Some people have to fall apart quite badly before they are willing to put
the pieces back together in a new and different pattern. Quite often such
individuals are in need of more specialised psychiatric help and therefore a
therapist would be well advised to assess his or her client group most carefully.

So how does a therapist help a client to change and overcome problems,

often of a lifetime? What are a client's needs in therapy? The one thing a client
does not need from the therapist he or she has chosen to seek help from is
indoctrination.

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As we have already established -

a) the efficacy of psychotherapy depends upon the development of the

relationship between the therapist and his client.

b) the degree of therapeutic success is proportional to the degree of

maturity attained in this relationship.

A mature relationship is seen as having three main ingredients in that -

1. It is a relationship in which neither submits to or dominates the

other.

2. It is a relationship in which each treats the other as a whole person

in his or her own right.

3. It is a relationship in which each accepts and respects his or her

differences from the other.

If this hypothesis is correct, then it follows that such therapeutic success as

may be obtained does not depend upon the acceptance by the client of the
therapist's convictions, but rather upon the client reaching a stage of development
in which he feels free to make up his own mind and to reach his own convictions.

In view of the above the student would do well to commit the following to
memory -

* The fact that a therapist holds a certain point of view does not mean
that this particular way of looking at life has to be implanted within
the client for therapeutic success to be achieved.

* It is actually a sign of failure if the client emerges from the

therapeutic relationship merely echoing the psychotherapist's
opinions.

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* Successful therapy should encourage the client to be more

themselves as independent entities and, therefore, to find their own
direction in life.

* The idea of indoctrination, of implanting dogmatic beliefs is, or

should be, entirely foreign to the spirit of any form of
psychotherapy.

Some misguided therapists have compared the psychotherapeutic process

to a conversion experience. They have supposed that their effectiveness depends
upon the indoctrination of the client with a set of dogmas derived from the school
of thought to which the therapist happens to subscribe.

In other words, it is suggested that a successfully treated client is a convert

to a particular school of thought, almost like a religion, and that the therapist must
be a fervent believer, intent on acquiring proselytes, who desires nothing so much
as to imbue his clients with his own dogmatic beliefs.

Yet even a therapist who is aware of this danger, however detached he or

she tries to be, cannot totally avoid influencing the client. Even if he is scrupulous
in his avoidance of the use of direct suggestion, his attitude to life and the kind of
person he himself is, will be communicated to the client.

The popular picture of the psychotherapist as a completely impersonal

interpreter of behaviour, who is simply a blank screen upon whom the client can
project images of people, and patterns of behaviour from his past, is not one very
practical. In any relationship between human beings they are bound to influence
each other to some degree.

Psychotherapy, unlike indoctrination, is a matter of mutual influence.

Indoctrination pre-supposes an authority who is in possession of "the truth" on
the one hand and a more or less misguided victim on the other, who is forced to
conform to a rigid structure which is unlikely to fit him exactly. Psychotherapy
should be very different.

Every successful psychotherapist develops a friendly and empathic

personal style. Indeed there is a need for the therapist to establish a relationship
which is as powerfully empathic as possible, right from the start.

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Were the therapist to become cold and aloof, even for a moment, the client
would remember this hurt and find it hard to trust the therapist and the special
client / therapist relationship would be damaged. Explicit empathy for the client's
humanity shows that the therapist cares and understands, or at least is trying his
hardest to do so.

You will soon find out that you cannot fake empathy, but oddly, you will
also soon become aware that it can be learned. All humans have some profound
bond of common experience. It is empathy that taps into this reservoir.

Establishing bonds of respect and empathy would appear to give licence

for the therapist to employ maximal therapeutic leverage. You need to show your
warmth and to be able to sense just how much the client wants to be pushed. It is
then that you push just slightly harder.

The client needs to be pushed and is expecting to be pushed. For some

reason, erring on the side of pushing too little comes across as cold. For all but
your most paranoid clients, it is suggested that you will find that, at some stage in
the therapeutic relationship, there will be a need for you to employ intrusive
empathic guesses which convey warmth and interest whilst exposing -

1. hidden thoughts

2. unidentified feelings

3. buried beliefs

Your largely intuitive guesses will often appear grossly intrusive, yet they
allow your client an easy exit. It is your empathic voice tone that allows these
statement and guesses to work. Consider:

"Your voice sounds very sad when you are talking about your wife."

It never works as well if you deliver interpretations with a built-in sneer

tone -

"You seem to feel that your wife never really loved you."

Subtle changes in your words or tone can profoundly alter what your
client hears.

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In the professional style that you develop, it is hoped that you will
endeavour to avoid the "blank screen approach" that I mentioned earlier in this
section. It is also hoped that you avoid falling into the trap of veering toward the
other extreme of a rigidly warm, non-judgemental approach.

The client needs therapy to be real and to feel real. The underlying message
conveyed to the client should be "Here we are together. I respect you as an
essentially worthwhile person. I am human too. No better, no worse. I want
to help you to build the life you want."

Empathy models the courage to feel intensely in a world which is

confusing. It is hoped that in your personal style, you will strive for just that.
When you hide behind being "clinical" or "maintaining a professional image,"
you often destroy your own ability to converse and interact directly. It is often
said that it is the language of the heart which is plain talk.

In the dealings with your clients, there is a need for you to project an
involvement that I can best describe as "passionate". Passion is seen as being -

Vibrant

Involved

Alive

Experiencing the full range of contradictory human feelings

Many clients come into therapy because of their inability to deal with their
own emotions. They are either being destroyed by their feelings or have buried
them to the extent that they have resurfaced in the form of strange and unwelcome
symptoms.

A therapist who projects the same fear of passionate existence cannot

address a primary need of the client in that he offers little hope for modelling how
to deal with intense feelings. So in your therapeutic role you need to allow
yourself to experience your full range of emotions.

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During those split seconds in which you begin to experience a feeling, you
need to ask yourself the following questions -

1) What is that I am feeling?

2) Is this feeling mostly related to my experience with this client or is it

left over from some other time?

3) Would it profit the client for me to show what I feel?

When actively engaged in therapy you will soon become aware that you do
not get the opportunity to ask yourself such questions. Instead, it is hoped that
you will become so attuned to the client through your obsession for empathy that
what you feel will be almost always a reaction to that specific client.

The client's need is for you to passionately reflect back what you feel and
try to teach the enrichment that passions can bring.

It is hoped that in the personal style that you adopt you will incorporate a
respect for the client's ability to rapidly change. It is suggested that, in the course
of the therapeutic process, you freely confront self-destructive and limiting
beliefs and behavioural patterns, employing ridicule or even loving anger when
your client demonstrates a lack of concern for himself or herself or others. You
can make use of the client's exposed emotions to help enhance their self
awareness. Such a perspective will show that even bad feelings have a rightful
place.

When a therapist employs passionate confrontation and intrusive empathy,

it seems to create an emotional resonance that provides a controlled channel for
the safe release of pent-up emotions. The client, in learning the courage to deal
with hidden feelings, also gains the courage to experiment with new behaviours.

Whilst the therapist attempts to challenge the client’s limiting and

unhelpful value systems, he should also actively encourage the client to develop
more useful assumptions and beliefs. (This is not the same as indoctrinating the
client with the therapist’s belief system).

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It is suggested that you focus most often on feelings, but also on the
attitudes, thoughts and behaviours that produce those feelings. Remember that
our feelings are a direct result of how we think. It is also suggested that the student
encourages self-confrontation and barrages the client with feedback, using
spouses, specific others and friends where appropriate.

This direct, open, highly charged atmosphere not only meets with the
client's needs, but also accomplishes a variety of purposes. The client's habitual
style is rendered ineffective. He or she is, for a period of time, deprived of the
usual social relationships which tend to perpetuate self-deprecating neurotic
behaviours. Through passionate confrontation, you are trying to establish a
controlled emotional instability and thus promote the fluidity that makes change
possible.

It is my personal view that passionate confrontation would seem vital for

the client's development of a loving, respectful attitude toward himself. It is a
highly stressful experience, but one that, as you will soon become aware, helps
make it possible to deal with the inevitable messiness of human life.

There is also a need for you, the therapist, to encourage consciously

adopted behavioural change. This is a concept which overlaps behavioural,
cognitive and Gestalt theories. It would also seem to be a part of the common
sense assumption that a person is not really different until they act differently.

It is suggested that you encourage clients to -

1. set specific behavioural goals

2. establish reward systems

3. keep records of their changes

4. try to act in accordance with the way they would like to be.

Central to this process of change is the assumption of a new self-belief or

self-concept. The client must be introduced to the possibility that they may not be
the person he has always believed himself to be, that he may indeed be able
to be more.

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In all processes of learning, it seems that first one must act as if one has
already changed. Actors and artists of all kinds have long been familiar with the
mysteries of immersing themselves in new roles.

As a therapist, there is a need for the student to endeavour to teach his or

her clients to master this process of designing a new role for themselves.

This itself is often an awkward and difficult task. For a client to act as if
they are more than they have even been will initially feel hypocritical. It creates
for the client an identity crisis that is necessary if change is to occur. In the
therapeutic process, consciously adopted behavioural change should be looked on
by the therapist as more crucial than insight or the reliving of past experiences.
Understanding changes nothing, action does.

As a therapist, it must be your goal to encourage clients to face their

fears and inevitable character defects, then focus on their strengths and their
assets.

When your clients believe they are well, they will act well. Acting well
makes it progressively easier to feel well. Lasting change requires both, and your
client needs lasting change.

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QUESTIONS ON LESSON THREE

Please answer the following questions using no more than 75 words for each.
Incorporate the questions within your answers
(eg. the number of days in the year is 365)

1. What is perceived as being a "limbo of chaos and uncertainty"?

2. What is seen as being the motivating force which moves a person to

seek help?

3. What is stated as being the one thing that a client does not need from
therapy?

4. On what does the efficacy of psychotherapy depend?

5. What is the degree of therapeutic success proportional to?

6. State the ingredients of a mature relationship.

7. State what therapeutic success depends on.

8. What is seen as a sign that therapy has failed?

9. How is indoctrination viewed?

10. What can result even if a therapist is careful to avoid influencing a

client?

11. What is considered to give licence for the therapist to employ

maximal leverage in the course of therapy?

12. State what intrusive empathic guesses help to expose.

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