The Perfect Therapeutic Recipe
Kathryn G. Morrow
Abilene Christian University
MFTO 601.W5
Professor Drew Jamieson
March 13th, 2023
The Perfect Therapeutic Recipe
The client-therapist relationship, also referred to as the therapeutic relationship is one of great importance. Multiple ingredients must be present within this relationship to create a recipe for positive client outcome. Positive client outcome includes increased motivation, greater openness to change, and improved treatment adherence (Lambert & Barley, 2001), and is largely affected by the elements of the relationship such as therapeutic transference, warmth, genuineness, and empathy, as well as a delicate balance of safety and acceptance.
Therapeutic Transference as a Definition of the Therapeutic Relationship
Therapeutic transference refers to the emotional bond that develops between a client and her therapist and is a wonderful way to describe the breadth and definition of the therapeutic relationship. This therapeutic relationship is crucial for the success of the therapeutic process.
One reason that therapeutic transference can be positive is that it allows clients to feel understood and supported by their therapists. When clients feel heard and validated, they are more likely to open up and share their innermost thoughts and feelings. By developing a positive therapeutic transference relationship, clients can learn to trust and develop healthy ways of relating to others.
Additionally, positive therapeutic transference can help clients to feel more motivated to make positive changes in their lives. When clients feel a sense of connection with their therapist, they may be more likely to engage in the therapeutic process and take an active role in their own treatment. This can lead to better treatment outcomes and improved overall mental health (Lambert & Barley, 2001).
The Central Ingredients
Interpersonal skills such as warmth, genuineness and empathy are fundamental for counselors to establish and maintain positive relationships with clients. A great counselor possesses a wide range of interpersonal skills that enables her to build trust, create rapport, and facilitate a successful counseling process. Active listening, effective communication, and cultural competence are some additional requisite skills that counselors must possess to build a positive therapeutic relationship with clients. Active listening involves being fully present and attentive to the client's concerns and providing feedback that shows the counselor is listening and understands their client's issues (Ivey & Ivey, 2017). Effective communication skills include using clear, concise language, paying attention to nonverbal cues, and providing feedback to clients (Wicks & Firth, 2019). These skills can help clients feel heard and valued, promoting trust and positive relationships. A great counselor must also possess cultural competence, which involves understanding and respecting clients' cultural backgrounds and values (Sue & Sue, 2016).
Counselors can develop these skills through training, practice, and self-reflection, leading to successful counseling outcomes for their clients. The following sections will focus on warmth, genuineness and empathy and their impact on positive client outcome.
Warmth
Warmth, one of the essential ingredients to the perfect therapeutic recipe, can be likened to unconditional positive regard or unconditional love. The ability of the therapist to be there for the client without bias or judgment, no matter who the client presents to be is known as non-possessive warmth, and is a very basic quality that should be present in all relationships, not just therapeutic ones. The degree of warmth, when combined with genuineness and empathy, has been shown to correlate positive to the level of personality change in the client, but when studied alone, in a more isolated environment, warmth was found to have no affect or a negative affect on client outcome (Truax & et al, 1966). Qualities that show warmth include respect, acceptance and commitment.
Genuineness
Warmth, while basic, is a key ingredient in the interpersonal skills of the therapist, but genuineness is a more high level skill necessary to facilitate the effectiveness of warmth. Genuineness can be simplified as the degree of real-ness of the therapist in her interactions with the client. Rogers (1957) says genuineness is when the therapist is being herself, without a mask or a facade. Qualities that would show genuineness are confidence, transparency and honesty.
Empathy
Empathy is another important interpersonal skill that a great counselor should possess and is the most important ingredient in the therapeutic recipe. According to Rogers (1957), empathy is a core condition for therapeutic change and is a crucial component of the client-therapist relationship. It involves understanding and sharing the client's feelings and experiences, and providing a supportive environment where clients can express themselves without fear of judgment (Geldard & Geldard, 2018). Empathy can help clients feel understood, accepted, and validated, which can increase their confidence and self-esteem. This, in turn, can help to reduce feelings of loneliness, shame, and isolation. When the client feels understood, she is more likely to open up, share her feelings, and work collaboratively with the therapist to achieve her therapeutic goals.
Ultimately, empathy is essential for building transference and a therapeutic alliance and for promoting positive therapeutic outcomes for the client. When therapists demonstrate empathy, they create a safe and supportive environment, which can help to strengthen the client's trust and confidence in the therapist. This can foster a more collaborative and effective therapeutic relationship, leading to better outcomes for the client. Qualities that would show empathy include validation, mimicking facial expressions and emotions, and helping to determine and name the client’s emotions.
The Balance of Safety and Acceptance
The therapeutic relationship is often characterized by a balance between safety and acceptance. Safety refers to the client's perception of being physically and emotionally secure in the therapeutic setting. Acceptance, very similar to warmth, refers to the therapist's ability to demonstrate unconditional positive regard for the client, accepting them without judgment or criticism. While both safety and acceptance are important components of the therapeutic relationship, there is a fine line between them that must be carefully navigated.
In some cases, not maintaining adequate balance could result in a troublesome situation. For example, a therapist may prioritize safety over acceptance, creating a sense of emotional distance between themselves and the client. This can create a sterile and clinical environment, which can be detrimental to the therapeutic process. The client may feel isolated, misunderstood, and unsupported, leading to feelings of disengagement or even abandonment.
Likewise, a therapist who prioritizes acceptance over safety may create a dangerous and potentially harmful therapeutic environment. By accepting harmful or destructive behavior, the therapist may inadvertently enable the client to continue their negative patterns of behavior, which can be detrimental to their well-being. This can also create a sense of confusion and uncertainty for the client, as they may not know what behaviors are acceptable or unacceptable in the therapeutic setting.
The balance between safety and acceptance in the therapeutic relationship is crucial. While both are important, prioritizing one over the other can be dangerous and potentially harmful to the client. A skilled therapist must navigate this balance carefully, creating a safe and supportive environment while also demonstrating unconditional positive regard and acceptance for the client. To mitigate these issues, a proactive mindset must be present in the therapist at all times.
Conclusion
Like any other recipe, the recipe for positive client outcome involves the right set of ingredients, added in the correct amount, at the right time, and with appropriate vigor. Rice, a simple menu item, can be easily spoiled by adding too much water or by cooking for too long. By having a healthy level of positive transference, effective personal skills such as warmth, genuineness and empathy, as well as the perfect balance of safety and acceptance, a therapist has a great chance at a positive outcome for her clients.
References
Geldard, K., & Geldard, D. (2018). Basic personal counseling: A training manual for counselors (8th ed.). Pearson.
Geller, J. D. (2018). The balance of safety and acceptance in psychotherapy. Journal of Clinical Psychology, 74(11), 1941-1949. doi: 10.1002/jclp.22654
Ivey, A. E., & Ivey, M. B. (2017). Intentional interviewing and counseling: Facilitating client development in a multicultural society (9th ed.). Cengage Learning.
Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361.
Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley.
Wicks, R. J., & Firth, J. (2019). Communication skills for mental health nurses. CRC Press.