Human Factor in Therapeutic Relationship

Abstract

Therapeutic relationship is a professional relationship that has been structured based on theoretical props. This relationship is a complicated, wide and unique relationship which develops between two people, where both sides\' personality and attitudes inevitably interfere. Therapist-client relationship experienced through transference and counter transference, especially in psychodynamic approaches, is accepted as the main aspect of therapeutic process. However, the approaches without dynamic/deterministic tendency also take therapist-client relationship into account seriously and stress uniqueness of interaction between two people. Being a person and a human naturally sometimes may negatively influence the relationship between the therapist and client and result in a relationship going out of the theoretical frame at times. As effective components of a therapeutic process, the factors that stem from being human include the unique personalities of the therapist and the client, their values and their attitude either made consciously or subconsciously. Literature has shown that the human-related factors are too effective to be denied in therapeutic relationship process. Ethical and theoretical knowledge can be inefficient to prevent the negative effects of these factors in therapeutic process at which point a deep insight and supervision would have a critical role in continuing an acceptable therapeutic relationship. This review is focused on the reflection of some therapeutic factors resulting from being human and development of counter transference onto the therapeutic process.

Keywords

• therapeutic relationship, psychotherapy, counseling, transference, counter-transference

Terapötik İlişkide İnsan Faktörü

Öz

Terapötik ilişki kuramsal dayanaklar doğrultusunda yapılandırılmış, profesyonel bir ilişkidir. Bu ilişki aynı zamanda, iki insan arasında gelişen ve her iki tarafın kişiliklerinin ve tutumlarının kaçınılmaz bir biçimde etkili olduğu bir etkileşimi içeren kapsamlı, karmaşık ve özgün bir ilişkidir. Aktarım ve karşı aktarım yoluyla ortaya çıkan terapist-danışan etkileşimi özellikle psikanalitik yönelimli yaklaşımlarda terapötik sürecin ana unsuru olarak ele alınmaktadır. Dinamik yönelimli olmayan yaklaşımlar da terapist-danışan etkileşimine özel bir önem vermekte ve bu ilişkinin aynı zamanda iki insanın etkileşimi olduğunu vurgulamaktadırlar. Terapötik ilişkide terapist ve danışanın insan olmalarından kaynaklanan ve zaman zaman kuramsal çerçevenin dışına çıkılmasına yol açan çeşitli karıştırıcı faktörler bulunmaktadır. Terapötik süreçte etkili olduğu kabul edilmesine karşın, tümüyle kontrol edilmesi mümkün olmayan "insan olmaktan" kaynaklanan faktörler terapist ve danışanın kendi özgün kişilikleri, değerleri ve terapötik süreçte bilinçli veya bilinçsiz olarak sergiledikleri tutumları kapsar. Yapılan çalışmalar insan olmaktan kaynaklanan faktörlerin, terapötik ilişki sürecinde göz ardı edilemeyecek ölçüde etkili olduğunu göstermektedir. Bu faktörlerin terapötik sürece olumsuz yansımalarını engellemek için etik ve kuramsal bilgi yetersiz kalabilmektedir. Bu noktada derin bir içgörü ve süpervizyon kritik bir işleve sahiptir. Bu gözden geçirme yazısı insan olmaktan kaynaklanan ve özellikle karşı aktarımın gelişmesine zemin hazırlayan bazı faktörlerin terapötik sürece yansımalarına odaklanmıştır.

Anahtar Kelimeler

• terapötik ilişki, psikoterapi, psikolojik danışma, aktarım, karşı aktarım

References

1. Corsini JC, Wedding D. Current Psychotherapies, 4th Ed.Illinois, F.E. Peacock Publishers, 1986.
2. Gelso CJ, Carter JA. Components of the psychotherapy relationship: their interaction and unfolding during treatment. J Couns Psychol 1994; 41:296-306.
3. Patterson E, Welfel ER. The Counseling Process, 5th Ed. Canada, Brooks Cole Publishing, 2000.
4. Xiangyi C. An exploratory study of Chinese psychotherapists' understanding and experiences of professional relationship in Mainland China (Ph.D. Thesis). Hong Kong, The Chinese University of Hong Kong, 2009.
5. Heid LS, Parish MT. The nature of self-integrated authenticity in counselors and therapists. 6th proceedings of the international conference on counseling in the 21st century, May 29-30 1997. Beijing, China.
6. Weishaar DL. The therapist’s experience of feeling in too deep with a client: a phenomenological exploration (Ph.D Thesis). Georgia, USA, Georgia State University, 2007.
7. Gelderman WA. A study of transference in the male to male counseling relationship (M.S. Thesis). Canada, St. Stephen's College, 1998.
8. Tellides C. The manifestation of transferans in the formation of the therapeutic relationship (Ph D. Thesis). Montreal, McGill University, 2006.

9. Beutler LE, Sandowicz M. The counseling relationship: what is this? The Counseling Psychology 1994; 22:98-103.
10. Tura SM. Günümüzde Psikoterapi. İstanbul: Metis Yayınları, 2000.
11. Wolstein B. The analysis of transference as an interpersonal process. Am J Psychother 1996; 504:499-509.
12. Corey G. Theory and Practice of Counseling and Psychotherapy, 5th Ed. USA: Brooks-Cole Publishing Company, 1996.
13. Gelso CJ, Mohr JJ. The working alliance and the transference/countertransference relationship: their manifestation with racial/ethnic and sexual orientation minority clients and therapists. Appl Prev Psychol 2001; 10:51-68.
14. Markos PA, Kottler JA. A humanist and a behaviorist come to terms with the human dimensions of helping. Guidance and Counseling 1995; 11:29-31.
15. Scaturo DJ. Technical skill and the therapeutic relationship: a fundamental dilemma in cognitive-behavioral and insight-oriented therapy. Fam Ther 2002; 291: 1-21.
16. Cooley EJ, Lajoy R. Therapeutic relationship and improvement as perceived by clients and therapists. J Clin Psychol 1980; 36:562-570.
17. Meier ST, Davis SR. Psikolojik Danışma; Temel Öğeler (Çev. Ed. Doğan S.), 1. Basım. Ankara, Pegema Yayıncılık, 2006.
18. Lichtenberg JW, Moberly RL, Wettersten KB, Corey AE, Merkley KB, Mull H. Relational control and relationship quality in psychotherapy. 103rd the annual meeting of the American Psychological Association, August 1-15, 1995, New York, USA.
19. Habicht MH. Interpersonal prosesses in psychoanalytic, cognitive analytical and cognitive behavioral therapy Evaluative information analyses reports, 2001. Retrieved from http://www.eric.ed.gov/ERIC, accessed Dec 22, 2009.
20. Tinsley HEA. Unrealistic expectations about counseling and psychotherapy: counseling psychologists' perceptions of their effects and modification. Guidance and Counseling 1994; 93:20-24.
21. Ain, S. Chipping away at the blank screen: therapist self-disclosure and the real relationship (M.S. Thesis). College Park, University of Maryland, 2008.
22. Audet, CT. Client experiences of therapist self-disclosure (Ph.D. Thesis). Canada, University of Alberta, 2004.
23. Egan G. The Skilled Helper. California, Brooks Cole Publishing, 1998.
24. Ivey AE. Intentional Interviewing and Counseling. California: Brooks Cole Publishing, 1998.
25. Sady S, Vaughn K. The Latino therapist’s use of self-disclosure in sessions as a tool to ımprove the therapeutic relationship (Ph.D. Thesis). Alliant International University, California School of Professional Psychology, 2005.
26. Johntson SH. Therapists’ modifications of psychotherapeutic boundaries (Ph.D Thesis). USA, Columbia University, 2001.
27. Owen IR. Boundaries in the practice of humanistic counselling. Br J Guid Counc 1997; 252:163-174.
28. Berzins JI. Discussion: androgyny, personality theory and psychotherapy. Psychol Women Q 1979; 33:248-254.
29. Soykan A. Hasta ve terapist etkileşimi: cinsiyetin rolü. Kriz Dergisi 1998; 6:23-31.
30. Liebert RM, Wicks-Nelson R, Kail RV. Developmental Psychology, 4th Ed. New Jersey, Prentice Hall, 1986.
31. Schroeder DA, Penner LA, Dovidio JF, Piliavin JA. The Psychology of Helping and Alturism. New York, McGraw-Hill, 1995.
32. Akdoğan R. Farklı cinsiyet rollerine sahip üniversite öğrencilerinin öfke yaşama bi- çimleri ve utangaçlık düzeylerinin incelenmesi. (Yüksek lisans tezi). Eskişehir, Anado- lu Üniversitesi, 2007.
33. Gehart DR, Lyle RR. Client experience of gender in therapeutic relationships: an interpretive ethnography. Fam Process 2001; 40:443-458.
34. Yogev S, Shadish WJ. The impact of gender stereotypes on the therapeutic behavior of beginning psychotherapists. 89th the annual convention of the American Psychological Association, Los Angeles, CA, USA, August 24-26, 1981.
35. Hayes JA, Gelso CJ. Effects of therapist-trainees’ anksiety and emphaty on countertransference behavior. J Clin Psychol 1991; 47:284-290.
36. Kivlighan DM, Clements L, Blake C, Amzen A, Brady L. Counselor sex role orientation, flexibility, and working alliance formation. J Couns Dev 1993; 71:95- 100.
37. Ametrano IM, Pappas JG. Client perceptions of counselor effectiveness: do gender and sex role orientation make a difference? Paper presented at the 18th Annual Meeting of the Eastern Educational Research Association, Hilton Head, SC, March 1-4, 1995.
38. Türküm AS. Who seeks help? Examining the differences in attitude of Turkish university students toward seeking psychological help by gender, gender roles and help-seeking experiences. J Mens Stud 2005; 13:389-401.
39. Burnham-Smith D. Counseling men: the effects of gender role Evaluative information analyses reports, 1996. Retrieved from http://www.eric.ed.gov/ERIC, accessed Oct 25, 2009.
40. Good GE, Scher M, Gilbert LA. Gender aware therapy: implication for therapists and male clients. 98th the annual convention of the American Psychological Association, Boston, MA, USA, August 10-14, 1990.
41. Coleman E, Schaefer S. Boundaries of sex and intimacy between client and counselor. J Couns Dev 1986; 64: 341-344.
42. Denial SIF. Adult attachment patterns and individual psychotherapy:a review. Clin Psychol Rev 2006; 26:968-984.
43. Whiting JB, Nebeker RS, Fife ST. Moral responsiveness and discontinuity in therapy: a qualitative study. Couns Values 2005; 50:20-37.
44. Rencher LL, Schillaci J, Goss S. Gender as Interpersonally Created in the Therapoutic Relationship: Client Considerations. Evaluative information analyses reports, 1994. Retrieved from http://www.eric.ed.gov/ERIC, accessed Nov 16, 2009.
45. Christopher JC. Counseling’s inescapable moral visions. J Couns Dev 1996; 75:17- 25.
46. Göka E, Türkçapar MH, Şirin A, Berber MS, Elverici ŞK, Soygür, H. Bir vaka: kül- türel fenomenlerin psikiyatrik tanılara etkisi. Kriz Dergisi 1994; 2:214-217.
47. Hare-Mustin RT. Reflections on the invisible: the missing social context in therapy 103rd the annual convention of the American Psychological Association, New York, USA, August 11-15, 1995.
48. Lawless JJ. Exploring the discourse of race, ethnicity, and culture in clinical supervision of marriage and family therapy utilizing conversation analyses (Ph.D. Thesis). Athens/Georgia, University of Georgia, 2000.
49. Young JS, Fuller JO. The assessment of spiritual ıssues in counseling. Guides/non classroom tests/questionnaries, 1996. Retrieved from http://www.eric.ed.gov/ERIC, accessed June 29, 2009.
50. Walker D, Gorsuch RL, Tan S. Therapists’ integration of religion and spirituality in counseling: a meta analysis. Couns Values 2004; 49:69-80.
51. Swim S. Process ethics: collaborative partnerships within therapeutic conversational communities (Ph.D. Thesis). Houston,USA, Faculty Houston Galveston Institute, Saybrook Graduate School and Research Center, 2003.
52. Chojan K. Self psychological analysis of the relationships among history, culture, ımmigration, and the psychological well-being of Polish-American migrants (Ph.D. Thesis). Chicago, USA, The Chicago School of Professional Psychology, 2007.
53. Guajardo KA. Spirituality and curanderismo in Meksican-Amerikan culture: a psychospiritual model of conjoint treatment (Ph.D. Thesis). Berkeley/Alameda, California School of Professional Psychology, 1999.
54. Muz S. Bilişsel Terapi ve Bilişsel Başaçıkma. (Yüksek lisans tezi). Konya, Selçuk Üniversitesi, 2009.
55. Aust CF. Using the client’s religious values to aid progress in therapy. Couns Values 1990; 34:125-129.
56. Ljungberg KL. The soul of psychotherapy: ıncorporating and religion into diversity training (Ph.D. Thesis). Hawai’i, Argosy University, 2006.
57. Sinclair SL, Monk G. Discursive empathy: a new foundation for therapeutic practice. Br J Guid Counc 2005; 33: 333-349.
58. Hellman ID, Morrison TL, Abramowitz SI. The stresses of psychotherapeutic work: a replication and extension. J Clin Psychol 1986; 42:197-205.
59. Farher BA. Burnout in psychotherapists: Incidence, types and trends. 96th the annual meeting of the American Psychological Association, August 12-16 1988. Atlanta, GA.
60. Gelso CJ, Latts MG, Gomez MJ, Fassinger RE. Countertransference management and therapy outcome: an initial evaluation. J Clin Psychol 2002; 58:861-867.
61. Boyden, S. Psychologist bereavement and self-disclosure: Impact on the therapeutic process (Ph.D. Thesis). Califronia, USA, California Institute of Integral Studies, 2005.
62. Göka E, Yüksel FV, Göral FS. İnsan ilişkilerinde yansıtmalı özdeşim. Türk Psikiyatri Dergisi 2006; 17:46-54.