Psychological approaches to the consultation

Traditional Psychodynamic Psychoanalysts aimed to foster a transference relationship, in which the clients were encouraged to project their feelings onto the therapist who tried to remain impartial and almost anonymous. Negative feelings about past relationships were aired in this manner, sometimes using free association to discharge memories, and the therapist subsequently gave his interpretation.

In the post Freudian, Jungian era the attention was more of a therapeutic alliance, with the therapist expressing empathy. Free association was still the cornerstone of the process. Stack-Sullivan fostered a participant/observer relationship and introduced the idea of sitting at a 45degree angle to the patient, which is slightly less formal and gave each participant the opportunity to turn away and reflect. He paid attention to the way the clients communicated their concerns, not just what was being said but also how it was being said. He was an astute and unprejudiced observer of his own reactions as well as the clients, and like Jung, was interested in the projection and counter-transference of feelings.

The whole process became more open, and therapist and client collaborated. Jung developed the idea of a holding environment or space, so that the client would feel safe to talk freely. This was a move towards the Rogerian style of Client Centred Therapy.

The clients were encouraged to assume responsibility for their own problems and the therapist assumed the role of sympathetic and empathic listener.

Carl Rogers defines Empathy thus ...

"... the ability to perceive the internal frame of reference of another with accuaracy ... as if one were the other person...

... if this "as if" quality is lost, then one is in the state of identification."

There was no formal assessment because it was felt the this didn't help the client sort out their own goals. The responsibility for setting and accomplishing goals is shifted back to the client. A contract of roles and responsibilities is formed between client and therapist which states that, "this is an alliance in which I am facilitating you to help yourself". The premise is that, "You have all the resources you need within you if you think it through".

Rogers emphasised the importance of developing the clients trust in their ability to actualise their own potential within a supportive climate. He accomplished this by separating the client from the behaviour and from this attitude developed the concept of "unconditional positive regard", which means he aimed to be an unprejudiced observer and provide an outgoing positive feeling without reservation or evaluation. There are obvious ethical boundaries to this but if we build congruence, empathy and regard the client may adopt these qualities.

Autonomy is a wonderful and high minded qualtity to encourage in others, and as Rogers asserts our own insights are indeed more valuable to us than the therapists, but often insight needs a stimulus! One glaring shortcoming of his approach is that various clients need varying degrees of guidance! Most of us learn to walk before we fly, like Rogers, Maslow, Wilber, et al. to the dizzy heights of self-actualisation and autonomy.

Some client centered theorists abandoned the toolbox of therapeutic techniques and relied on the interpersonal encounter. (Fieldler's research shows that it doesn't matter which approach is used, either autonomous and humanistic or Psychodynamic, it is the interpersonal relationship that is the most significant element). As a result counselling, as a career, became available to anyone who had the time to do a few evening classes and hand in some minimal dissertation!

Empathy without challenge (Xref: therapeutics.1.2) is not a characteristic of Hypnotherapy today, even though the humanistic principles remain a cornerstone of the ideal therapeutic relationship.

Compare Rogers ideals of Client autonomy with Milton Ericksons "Utilization Approach" (Xref: therapeutics.1.3). He says:

"Suggestion can facilitate the utilization of abilites and potentials that already exist within a person ...

... but that remain undeveloped because of a lack of training or understanding ...

... we explore what life learnings, experiences and mental skills are available to deal with the problem".

Erickson has developed a process of therapeutic intervention which still uses the Rogerian thesis that the answer lies within the therapeutic repertory of the patient. N.L.P. and Life Coaching theorists emphasies this even further.

Gerard Egan introduced structure to the counselling agenda by listening to the clients story using a Rogerian approach. He would then clarify the story to identify the blind spots and then focus on these priorities and challenge them in order to provide leverage to help move forward towards the clients goal (Ref: The Skilled Helper).