To achieve success in counseling there has to be an agreed upon partnership. It takes time, energy and effort by both the person receiving counseling and the therapist. It takes a collaborative effort by both the counselor and the individual receiving the counseling.
Therapy is a commitment to make sometimes difficult adjustments in thinking patterns and behavior. Effective counseling is a two way street. It takes a time, energy and financial commitment from the client to make changes in behavior or thought patterns and then learn new ways of coping with thoughts, feelings and behaviors. It is hard work! This article will be discussing, client characteristics, therapist characteristics and treatment conditions that will help anyone achieve success with counseling.
The Therapy Relationship
The therapeutic alliance is a partnership where both therapist and patient agree on shared goals and work together on tasks which conceivably will produce a positive result. This alliance is built on acceptance, empathy and trust, with the perception that the relationship is a factor in successful therapy. The connection or therapeutic alliance between therapist and client has been a focus and examined many times throughout the historical development of psychotherapy. Copper & Lesser, 2011 explain the idea of the client being an active partner in the treatment process. Many therapists agree with viewing the relationship that is established and collaboration between therapist and client as one of the solutions if not the key, to the change process.
Past investigations have focused on client characteristics that have had an impact on the therapeutic alliance, such as motivation level and the ability to form relationships have shown that these traits and characteristics have an impact on both the relationship and the therapy outcome (Black et al., 2005). The research further explains that the clients capacity to form a relationship provides the foundation for the alliance, but it also appears that the therapists capacity to form relationships is just as important. The literature does lead us to believe that a good connection between therapist and client can happen quite quickly, even within the first 10 minutes, but on average it takes 2-3 sessions (Littauer et al., 2005).
Empathy is an essential ingredient in the healing process. A therapist’s empathy toward their client plays a role in developing the alliance, and its impact on the relationship is crucial. Moore (2006), suggests empathy is not simply communicated orally, but also with an increase in eye contact, body posture, tone of voice and listening skills. It is significant for therapists to think of not only the therapeutic alliance, but also the ways in which they show empathy as an influence on treatment results.
Why people go to counseling What is therapy?
There are numerous and varied reasons why people choose to go to counseling. Some people have experienced traumatic events, which they would like to explore in a safe setting; bereavement, separation, difficult life transitions, or distressful experiences from the childhood. Others seek help with learning how to cope with specific psychological or behavioral traits which they would like to change; depression, compulsive thoughts, difficulties with relationships or poor dietary habits. Many people seek counseling to explore a general feeling that their lives are not quite right, or learn how to cope with feelings of hopelessness associated with managing a chronic illness. However, it is not at all necessary to have a serious problem to achieve success with counseling. People may turn to counseling to develop a purpose, to find meaning in life, or attempt to stir up determination to achieve a goal.
Some people do not want to be in counseling because they were coerced into treatment. “My husband says I have a problem”. “My wife says I do not communicate”. “The judge says I have to do six sessions”. “My doctor said it all in my head”. These are not ideal therapy conditions, and it will take an experienced therapist to be able to help, and many do indeed benefit. Most people want to go to counseling to improve some problem or find ways to cope with a distressful life event. Some people experience feelings associated with anxiety mixed with the possibility of hope in removing or finding new ways to cope with the problem. The anxiety is often about how they think they will be judged by the therapist. The hope relates to having a positive attitude about their future ability to achieve success with managing the problem.
Often patients come to therapy having distinct goals, the alleviation of symptoms of one sort or another and then move onto contemplate other changes in the way they live. This is a laudable goal, although, at this point, treatment no longer fits the medical model. Treatment is directed at the difficulties everyone has in living and not just in ameliorating certain symptoms.
The Counselors Personality and Style
A therapist who is in the profession over a period of years may find that years later they are still learning. This is because psychotherapy is not a manner of operational exactness, but a way of being with a patient or a frame of mind. Like most things, therapy can be conducted poorly, less well or very well and keep in mind that a therapist who is a good fit for one patient may not be with the neighbor next door. A couple of studies have found a small correlation between therapist experience and successful therapeutic outcomes, however, the bulk of the evidence supports the idea that a more experienced therapist does not automatically produce more successful results (Hersoug, Hoglend, Monsen, & Havik, 2001). That old saying “practice makes perfect” does not seem to apply in much of the out-patient practice world.
One key element for solving problems and learning new ways to cope is the emotional attachment or relationship people have with their therapist. Education is taught, learning occurs, feelings are discussed, and thoughts are examined in relation to feelings. However, education, learning and exploring of issues are not ideal conditions for receiving help with managing a problem. I cannot stress how valuable it is for people to connect with the therapist and pay attention to the emotional chemistry. The issue of achieving success in counseling depends on this relationship.
Another ideal condition for the counseling situation is that the therapist must perceive the client as a whole person, not abnormal, difficult, or label someone with a psychiatric diagnosis. If therapists show respect and kindness and if clients can accept these gifts, they will achieve success in managing a problem. If genuine respect and understanding are not offered, and/or if the client cannot accept the offer of assistance, achieving success in counseling is severely compromised. This means that treatment may be a waste of time, energy and resources. However, I am often pleasantly surprised, as sometimes the most resistant clients do indeed make a 180 degree turn and become most successful in managing their life. Success in counseling does indeed relate to the relationship that people have with their therapist.
There are many rules such as those related to privacy, respecting sexual boundaries, attentive listening, and keeping the client as the focus of the discussion verses the therapist talking about their own issues. However, these are basic expectations of all therapists. What people want to evaluate is the therapists personality, their mannerisms and communication style. Some therapists, are more talkative than others, some use specialized techniques, some use humor, others analyze, and some are passive.The client needs to assess the therapists respect and evaluate how much the therapist seems to care about what is being discussed and then evaluate if the therapist suits their needs. People deserve the best match as this is their time and all clients deserve the professionalism it takes to help achieve success. If the client and the therapist are a suitable personality match, the question remains as to what are the client roles in achieving success in counseling.
Several themes emerge when clients are not successful in therapy. The main ones are intoxication or abusing substances during appointments, clients that are off their medications or those that need medications because they are psychotic, those that cannot make connections or lack insight, and those whose personalities do not fit with the therapists. Counseling can be difficult for people with significant character disturbances due to a lack of tolerance for emotional discomfort, as well as having the incapacity to be consistent. People who do not have their basic needs met or those that are extremely emotional also have a harder time in therapy. Resource barriers to success are lack of transportation, finances, childcare and insurance.
One study indicates that counseling does help those that seek it out (Hoglend, 1999). Bachelor et al. (2007) implies that a person with many clinical manifestations may have not as much skill to engage and work productively with the therapist. Overall, it appears that collaboration, motivation, personality characteristics, active engagement in the treatment tasks and the development of the relationship all have a direct association with a successful outcome. However, all clients deserve the therapist’s time, energy, caring and respect. Every client deserves to have these conditions even if the client is carried into the office “kicking and screaming”. Clients should find a safe, private, environment and a caring human being who will listen without judgment and without an air of superiority. Find a counselor who strives to understand in a holistic fashion and from your point of view.
The Four Client Qualities associated with Achieving Success in Counseling
Desire is the beginning of all achievements, not a dream, not a requirement, but a keen pulsating desire which transcends everything. Some individuals will report that they want to make changes in their life but lack the motivation or drive. They will begin by seeking therapy and indicate a desire for change but will not or cannot make the effort necessary to carry out the process. The primary goal to seek out therapy is that their life may have become so unmanageable that their life is in a state of crisis. In addition, these clients may also be in emotional pain over such an extended time causing their physical health to deteriorate.
A stressful situation may be upsetting, but it may also be beneficial. In various life situations, events may have to get worse before they get better for the change process to develop. Therefore, a crisis can be a life misfortune or calamity, but it can also be a way to make life better because it provides an incentive for personal growth and development. Without a strong desire for change, improvements are less likely to occur. When a person has both the desire to make changes and the motivation to do so, this is half of what it takes to achieve success.
Belief is one of the most significant building bricks to achieving success in any venture. If someone does not believe in themselves or in what they are attempting to accomplish then this makes the goal almost impossible. The more people believe in something the more they raise their chances of being successful. The concept of belief in oneself seems straightforward, but there are still those who fail because they do not possess the belief that they can achieve their goals.
One reason people face serious and lasting emotional distress is that they do not think counseling or psychotherapy can help. They have seen media programs or read books that disparage individuals who seek counseling, or render counselors and psychotherapists in an unflattering manner. Some may consider counseling as for the weak and cowardly. These people fail because they have little or no confidence in the healing process of change. The successful person understands that it takes self-esteem to achieve a goal. Successful people know that a certain amount of trust needs to be placed in a health care provider. They may also examine any lack of confidence with the therapist in the beginning stages of counseling. This lack of confidence in others may have arisen from early childhood issues and be the primary source of a persons pain.
Many people have the hope that the first therapy meetings will fix everything negative going on in their life and the first few sessions often do solve problems that people were already prepared to resolve. However, the problems that remain after the first few meetings are the tough ones. What people want to accomplish in counseling should be clearly defined during the beginning phases of the therapy process. The next step would be to explore a reasonable time frame for reaching the goals and decide on how progress will be measured.
Courage is not the absence of sorrow; it is, rather, the ability to push through life in spite of adversity. Many who need counseling will not consider it, or they look for treatment and have trouble making any adjustments in life. They want their world, circumstances or others to change, but they are not willing to work on anything about themselves. It is surprising how much emotional pain a person can suffer, just because they have difficulty embracing the idea of change. Many individuals have difficulty with the process of change because it can cause much anxiety getting outside one’s comfort zone. New habits, new methods of doing things, and changing thinking patterns or behaviors require energy and time, as well as courage. The person with courage is not paralyzed by the fear; they are empowered by it. Seeking help and making changes in lifestyle requires courage.
Patience and dedication unlocks the doors of imagination, allows vision, and gives us the right ingredients to turn that dream into a reality. Those who believe “anything worth having is worth waiting for”, will continue on in the quest for change, and are the ones who will triumph over adversity. The counseling process requires such dedication and patience. The key to achieving success in counseling is to support the course of treatment and recognize that some issues may take time to resolve as these problems developed over many years. If people possess or develop these attributes in the initial phase of counseling they will be on the path to success. Overcoming adversity and gaining achievement is the culmination of all four attributes of Desire, Belief, Courage, and Patience. People can have the real possibility of achieving success in counseling as well as achieving any realistic goals set in life.
During the first few sessions, the client and the therapist are developing rapport and are preparing for the work that it takes to make changes. In order to make a permanent change it involves a healthy relationship with the therapist and this takes time. People who do not understand this will typically leave quickly and say: “I went to therapy, and it didn’t work”. They were seeking and wanting advice, not therapy and they misunderstand the concepts and principles of therapy. This explains why the same problem may pop up throughout someone’s life. Therapy is about the relationship and working through the core problem with a kind, caring, competent professional, in hopes that the same problem will not re-surface at later date in time.
Therapy values the expression of emotion. What is also significant is whether the level of expressed emotion teaches the therapist the relative importance of each issue (mild importance, moderate importance and intensely important). Using anger as an example: One client may feel angry and explode often, but each outburst displays the same level of emotional pain. This person gets a lot of relief, but that is all, not to mention it confuses the therapist! Another client may occasionally get angry, but they do mention anger whenever they feel it and they show whether the anger is high, moderate or minor. This person gets more help at solving and coping with problems because the feeling is clearly expressed and the therapist understands the issue. The next task is to explore and assist with managing or coping with the discomfort. Having an understanding of feelings and how people communicate that knowledge is critical in achieving success in therapy.
How to Evaluate Successful Counseling
People can determine whether their work with the counselor is successful if they begin to gain insights about thoughts and behaviors. If clients feel they have been successful in making change, learning new behaviors, learning something new about themselves, have an increase in coping skills, and have fewer symptoms, then the goals have been accomplished. Reviewing the treatment plan is helpful in maintaining and increasing success, thus, clients feel they have made progress.
At the end of successful therapy, clients will feel better equipped to tackle life’s changes and challenges, by developing a slightly more flexible stance on how to handle life. People can decide whether their work with the counselor is successful by assessing if they begin to gain insights about thoughts and behaviors, which may have eluded them before they entered treatment. Over time, people should be able to identify patterns in the way they behave, discover the sources and understand stumbling blocks to happiness and then create different choices! The result is personal growth that empowers change and assists people in becoming the person they would like to be in the world. Therapy is about helping people achieve their goals. Over time, clients should be able to identify patterns in the way they act, trace their sources and understand stumbling blocks to happiness. The result is personal growth that empowers people to manage life and enjoy positive, life-affirming relationships.
The benefits of achieving success with counseling are:
- An immediate although perhaps modest relief of psychological pain and suffering.
- There is a speeding up of the natural tendency to feel emotionally well and in certain chronic states a slowing of the pathological process.
- There is avoidance of certain social upheavals that acutely disturbed patients are predisposed, such as the loss of a job, the dissolution of savings, the disturbance of family life.
- In certain cases, there is the improvement of a real growth of character. The individual thinks better of themself and is better able to cope with stress that relates to the difficulties of living.
- People who have been in successful treatment have to a greater extent gained mastery in themselves and their environment.
- In such ways psychotherapy may have a significant impact in someone who is profoundly emotionally upset, gradually, improving both mental state and performance.
In conclusion, people can achieve success in counseling to help overcome life’s challenges, regain a sense of control (feel empowered), regain happiness in life, and experience a more flexible wider range of emotional maturity. The practice of therapy is defined and achieving success is accomplished by exploring behaviors, emotions, life’s problems and the therapy process then builds on existing strengths.
Bachelor, A., Laverdiere, O., Gamache, D., & Bordeleau, V. (2007). Client’s collaboration in therapy: Self-perceptions and relationships with client psychological functioning, interpersonal relations, and motivation. Psychotherapy: Theory, Research, Practice, Training, 44(2), 175-192.
Black, S., Hardy, G., Turpin, G., & Parry, G. (2005). Self-reported attachment styles and therapeutic orientation of therapists and their relationship with reported general alliance quality and problems in therapy. Psychology & Psychotherapy: Theory, Research & Practice, 78, 363-377.
Cooper, M.G., & Leeser, J.G. (2011). Clinical social work practice an integrated approach (4th ed.). Boston, MA: Allyn & Bacon.
Hersoug, A., Hogland, P., Monsen, J., & Havik, O. (2001). Quality of working alliance in psychotherapy therapist variables and patient/therapist similarity as predictors. The Journal of Psychotherapy Practice and Research, 10, 205-216.
Hoglend, P. (1999). Psychotherapy research new findings and implications for training and practice. The Journal of Psychotherapy Practice and Research, 8, 257-263.
Littauer, H., Sexton, H., & Wynn, R. (2005). Qualities clients wish for in their therapists. Scandinavian Journal of Caring Sciences, 19, 28-31.
Moore, L.A. (2006). Empathy a clinician’s perspective. The ASHA Leader. Retrieved September 16, 2011 from http://www.asha.org/Publications/leader/2006/060815/f060815e.htm.
Live Healthy & Well
Dr. Cheryl MacDonald, RN., Psy’D.
Health Psychology of San Diego