Homeworks academic service


The effects of a client therapist relationship in producing change in an individual

The therapeutic relationship has been argued to be one of the most important factors in psychotherapy. Currently, Cognitive Behavioural Therapy CBT and the value of the therapeutic relationship have been receiving more attention in the literature and research. In this paper, I discuss a case study that supports the value of the therapeutic relationship when working from a CBT approach.

This belief was confirmed by this case. CBT was the therapeutic approach I adopted. I found, as a therapist in training, that I was battling to apply therapy, namely CBT and its techniques, to the case and I felt that it was creating distance between me and the client, and the therapeutic relationship. This difficulty enabled me to realise the importance of the therapeutic relationship ii and how without it, I found therapy to be impossible.

There were many dimensions of interest to this case, but what I was interested in particularly within the therapeutic process with Noluthando, was the value of the relationship between therapist and client when working from a Cognitive Behavioural Therapy approach.

  • According to Addis, Wade, and Hatgis 1999 , training programs and psychotherapy researchers of manualised therapeutic approaches such as CBT need to focus more on the value of the therapeutic relationship to address the perception that these approaches turn therapists into technicians, rather than authentic human beings;
  • However, subsequently, Raue et al.

Bordin 1994 differentiates between the therapeutic relationship from the therapeutic alliance by describing the alliance as being a relationship in which both the therapist and the client work together in therapy.

Many authors agree with Hobson 1985 who states that the therapeutic relationship is what is crucial in any therapy. Yalom and Leszcz 2005 uphold that the relationship is integral for any therapy to be effective and meaningful for clients.

Many more authors place value on the therapeutic relationship. Reisner 2005 points to the therapist as being the important factor in determining the outcome of therapy and that the strong alliance formed between therapist and client is a powerful indicator of positives gained in therapy. Teyber 2006 says that forming a strong therapeutic relationship early is the best predictor of positive treatment outcomes, and that the relationship is the foundation of change for the client.

Garfield 1997 highlights common factors that are important in most therapies, and that one of the common factors is the therapeutic relationship. This is considered as one of the most basic factors but is crucial for continuation in therapy and change.

Some psychotherapy approaches follow a view that the therapeutic relationship is sufficient in itself and all that is necessary for therapy.

  • Noluthando reported experiencing living away from home as difficult, but was receiving a scholarship that was providing for her financially to finish her schooling which denoted the attendance of this particular school;
  • In this paper, I will examine the therapeutic relationship in order to define it and determine the nature of its effectiveness, while exploring any other opinions to the contrary;
  • She reported that she was trying to pick up weight, was sleeping a bit better, and was feeling excited about the Soccer World Cup;
  • He preferred to consider them as three continua along which the therapist was constantly striving to move further.

However, Garfield 1997 relates that the relationship between therapist and client is necessary but other variables need to be applied too. Duncan 2002 tells how therapists place so much emphasis on tools and technique, whilst the perception of how the client views the therapeutic relationship is what is crucial to positive outcomes in therapy.

CBT and the Therapeutic Relationship [ TOP ] Many authors have argued about the importance of the therapeutic relationship and how it is one of the most valuable factors in therapy. One of the major criticisms of Cognitive Behavioural Therapy CBT as recounted by Sanders and Wills 1999is that CBT pays little attention to one of the most valuable cornerstones of therapy, and that is of the therapeutic relationship. Value was placed on technique. The therapeutic relationship was considered a by-product that just happened as part of the process, but technique was the most important part of therapy with its focus on restructuring automatic thoughts and dysfunctional beliefs, and for clients to do this themselves.

Beck, Rush, Shaw, and Emery 1979 call attention to the therapeutic characteristics of warmth, genuineness and accurate empathy, and how these characteristics are necessary but not sufficient in themselves for positive change in therapy.

The therapeutic qualities are viewed as a means to provide the space for CBT techniques to be applied. This therefore, revealed the view of not regarding the therapeutic relationship as being of primary significance. Presently, there has been more focus given to the therapeutic relationship in CBT. The relationship in CBT is not viewed as a precondition to technique, but rather the use of both technical and interpersonal factors can result in a favourable outcome Giovazolias, 2004.

According to Leahy 2008CBT values therapeutic tasks such as working in the here-and-now, rationalisation, behavioural activation, and solving problems; which is different to therapies such as Psychodynamic Therapy.

There was a problem providing the content you requested

Previously, such behaviours as being avoidant, blaming and assurance seeking are often mentioned in psychodynamic terms and other therapies, and it is suggested that CBT ignores these factors by providing no space for them in the therapy. However, Leahy 2008 relates how the relationship between therapist and client may provide insight into how the client operates in other relationships.

Whisman 1993 discusses five studies that looked at the therapeutic relationship as a moderator of change in depression from a CBT approach. Three of the studies found the therapeutic relationship partially significant for a positive outcome with CBT, whereas two of the studies revealed the therapeutic relationship as unimportant for a positive outcome with CBT.

Whisman 1993thereby, argues for further research into the importance of the therapeutic relationship when working from a CBT approach, as there is little evidence supporting its role in a positive outcome in treatment, other than it being a contributory factor. Leahy 2008 explains how people often have the mistaken belief that the relationship is not a focus in therapy because, in the training of CBT, emphasis is placed on technique, which is falsely believed to be enough for change.

According to Belsher and Wilkes 1994novice CBT therapists are too often focused on technique and forget to consider the therapeutic principles. Wright and Davis 1994 advocate for CBT training programs to include intensive supervision on the therapeutic relationship and relational issues.

According to Addis, Wade, and Hatgis 1999training programs and psychotherapy researchers of manualised therapeutic approaches such as CBT need to focus more the effects of a client therapist relationship in producing change in an individual the value of the therapeutic relationship to address the perception that these approaches turn therapists into technicians, rather than authentic human beings.

Beck 2011 stresses the importance of a warm therapeutic relationship, rather than the misconceived idea of CBT therapists as being cold and mechanical. Noluthando was referred to me as a 17 year old girl, who had attempted suicide earlier in the year and was displaying the criteria, according to the DSM IV-TR 2000for Major Depressive Disorder.

My training in CBT included a series of seminars and workshops at my training institution, as well as being supervised by my clinical supervisor, who was trained and used CBT as her primary modality. Butler, Chapman, Forman, and Beck 2006 researched the positive treatment outcomes with CBT, which revealed that, as a therapy, it is highly effective for a number of psychological disorders, including that of children with depression and adolescents with unipolar depression.

A number of authors Brent et al. Rogers 1961 ascribes being genuine and real in the therapeutic relationship as very important, as it surmounts to the likelihood of change in the client. I found that in using CBT, it was nearly impossible to use techniques to my client without feeling inauthentic and feeling as if I was further isolating and closing communication down.

This difficulty enabled me to realise the importance of the therapeutic relationship and how without it, I found therapy to be impossible. CBT is often misconstrued as being purely technique orientated, and that the relationship and collaboration between therapist and client is neglected and viewed as secondary in therapy Westbrook et al.

With Noluthando specifically, the forming of the collaborative relationship after a number of sessions enabled her to become more involved in therapy, providing her a space to open up more, which was her initial goal when she started therapy.

A case study examines the experience of either the clinician or client of the case in a narrative that may explain the problem experienced, investigate why a person is the way that they are, the treatment and why or how it worked, and other such issues. Fishman 2005 emphasises the usefulness of case studies in research, because multiple case studies can enable inductive reasoning and generalisation for future utilisation. Quality case studies have enabled critique and reflection on existing theories and the beginnings of new theories in the social sciences Lindegger, 2002.

  1. I felt that it would possibly take time for her to develop trust with me as she has difficulty with trust in her other relationships.
  2. Noluthando spoke about an early life experience, in which her father told her about how her mother left her on the street without any food or anyone to care for her.
  3. The unhelpful behaviours that she engages in are her inactivity, the suicide attempt she made earlier in the year, not eating, and avoiding her feelings.
  4. According to Addis, Wade, and Hatgis 1999 , training programs and psychotherapy researchers of manualised therapeutic approaches such as CBT need to focus more on the value of the therapeutic relationship to address the perception that these approaches turn therapists into technicians, rather than authentic human beings. In the session, I provided psycho-education about CBT and the hot cross bun that looks at five aspects of life that are interconnected, namely.
  5. The lack of activity provides her with more time to think about the negative aspects of her life and maintains her ruminating state. Therapy Narratives [ TOP ] The description of the sessions below provides the details and reflections of 11 therapy sessions, to outline what happened in therapy and to provide a narrative of the therapeutic relationship that developed between Noluthando and myself.

For this case study, I decided to use a hermeneutic approach with a strong emphasis on Phenomenology to explore the psychotherapy process. Phenomenology, according to Terre Blanche and Kelly 2002is an approach that aims to gain understanding of people and their experiences in context. In this case study, a narrative of the sessions will be presented, which embody my experience of working with Noluthando.

The narrative of the sessions is discussed under themes that were derived from an exploration of what happened in sessions. Noluthando signed an informed consent form for her therapy to be recorded and used for research purposes.

Informed consent was discussed with her in the first session of therapy. She is fluent in English, which is her second language.

  • The effects of psychotherapy;
  • Each item is rated on a 21-point scale.

At the time of psychotherapy, Noluthando was 17 years of age and in Grade 11 at a high school. She was boarding away from her family at her school. Noluthando reported experiencing living away from home as difficult, but was receiving a scholarship that was providing for her financially to finish her schooling which denoted the attendance of this particular school. She would visit her home, a township in the Eastern Cape, South Africa, during the school holidays and on long weekends.

The home setting that she found herself living in was problematic and she was exposed to difficult life experiences on a daily basis. Noluthando described her father as being abusive towards her mother, and she had witnessed this throughout her life. It seemed, as reported by Noluthando, that communication within the family is closed and they often do not speak about their feelings or even directly to each other.

Presenting Problem and Reason for Referral [ TOP ] Noluthando was referred to the psychology clinic by the school counsellor after she had attempted suicide earlier in the year. Noluthando reported that during the year of 2009, she was performing well at school and although she was experiencing problems at home, she felt that she was coping.

Noluthando told me that she attempted suicide after an incident in which she could not obtain help from her parents, with regard to finding a home for her recently homeless cousin. She attempted suicide by drinking a poisonous liquid and was admitted to hospital. She had difficulty conveying her feelings and displayed a depressed mood state. Noluthando reported not being interested in activities she used to enjoy such as reading fictional books and attending church. She found it difficult to eat, had lost weight and said that she had no interest in the taste of food; whilst, with sleeping, she would battle to fall asleep, and then would wake in the early hours of the morning, unable to fall asleep again.

Noluthando experienced feelings of blame and guilt because she felt that she was not doing anything to stop the difficult circumstances at home, such as the abuse her mother experienced from her father. She also reported having a lack of energy, having difficulty concentrating on her studies, and feeling irritated.

All of these symptoms, although varying in manifestation, had been present for more than two weeks. The precipitating factors are factors related to the proximal events that have triggered the problem.

Perpetuating factors are also known as the maintaining factors, and these factors maintain the problem. Case formulations in CBT change, depending on the client and what is brought out in a session and therefore, is a work in progress, which enables planning and is used collaboratively with the client, allowing them to agree or disagree with the formulation.

This collaboration of the case formulation empowers the client to be aware and have insight into themselves, but also to understand their problem. Noluthando had become withdrawn in her behaviour and was not engaging in activities that she previously enjoyed. According to Noluthando, she was not eating and had lost her appetite, as well as having difficulty in sleeping. She was also closing herself down from communicating with others by being quiet and not opening up to others.

She had thoughts of not feeling the effects of a client therapist relationship in producing change in an individual enough and thoughts of being a failure. Predisposing Factors [ TOP ] Noluthando reported that she could not remember a time when her mother was not drinking alcohol and witnessing her father abusing her mother.

Noluthando had never had an open and communicative relationship with her parents, which suggests that the model she received from her parents, on communicating and openness, was absent in her early years as a child.

According to Seroczynski, Jacquez, and Cole 2006depressed adolescents generally have experienced distressing home lifestyles and come from troubled homes. Noluthando lost her maternal grandparents at a young age and reported being particularly close to her grandmother.

She still thinks about her often and may have still been dealing with her loss. Precipitating Factors [ TOP ] Noluthando reported finding it difficult to attend a school that is so far from home. Being far away from home may be difficult because of the thoughts she may have about what is happening at home in her absence. She said that she feels responsible for the events and problems at home and has a sense of failure, as she does not take any action to help her mother when she witnesses her father abusing her.

Negative core beliefs of parents and parenting styles which are poor in nature, may cause insecure attachments in childhood and are associated with an increase in depressive features later in life as described by Shah 2000. Rothschild 1999 says that disturbances and problems in early childhood relationships have shown to increase vulnerability to depression. The silence makes it difficult for her to reach out to someone when problems become too much for her and when she needs help.

This made her vulnerable to the suicide attempt she made earlier in 2010. Kaplan, Sadock, and Grebb 1994 attribute suicide attempt rates as being higher in persons who are socially isolated.

Noluthando had lost her appetite, had little interest in food and had lost weight. Her difficulties in eating, affect her mood and can affect her energy levels, adding to her depressed mood state. Noluthando has difficulty sleeping and wakes early in the morning, which may leave her with little energy during the day, consequently affecting her mood.