Lesson 8: A Healing Relationship

Attention

Although this graphic is created for "Romantic Relationships" it generally describes the ways in which we develop and foster healthy relationships with everyone, including our clients.

Can you see how the philosophies of Psychosocial Rehabilitation manifest in these actions and skills?

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Apply the Freudian concepts of Transference and Countertransference to an analysis of the helping relationship
• Identify ways in which contracting is vital to the therapeutic process
• Identify ways in which the social support network of the therapist is important to the therapeutic process

Teaching

Read Chapter 7: A Healing Relationship in Hermon

Transference and Counter Transference

These terms, from classical Freudian Psychoanalytic theory, describe the emotional experiences that can sometimes happen as a result of relationship development.

In TRANSFERENCE, the person (client) begins to treat the therapist as the OBJECT of therapy, transferring the emotions they feel toward someone else on to the counselor. For example, a woman who is dealing with a domestic violence situation with her husband may begin to express her anger and fear toward the therapist.

In COUNTER TRANSFERENCE, the therapist begins to encounter feelings about the client. These can range from the emotions that occur when a client "pushes our buttons" or "sabotages" the plan we have been working on with them or toward a therapist having romantic and sexual feelings for the client.

In classical Psychoanalytic theory, developed by Sigmund Freud, transference and counter transference were desired outcomes that could then be analyzed to reveal hidden aspects of the personality. In Gestalt Therapy, developed by Fritz Perls, there is a technique called "Empty Chair" where the client is encouraged to transfer the emotions and actions they are feeling to the object (imagined) sitting in the chair.

Both concepts remain useful today in the work done by mental health workers but for different reasons. Transference is an opportunity to identify the clients' feelings and redirect them toward action, counter transferrence is an opportunity for the worker to re-establish boundaries and examine his or her own motivations.

Click HERE to read a great article about the Client's Perspective on Transference

Click HERE to read an article about Transference in Therapy

Click HERE to read an article about Counter Transference

Contracting

Contracting is the process by which we utilize the knowledge of the field of Behaviorism to develop an agreement with our clients.

Behaviorism is a major trend in psychology, one that directly follows from functionalism, the branch of psychology that focuses on the biological significance of natural processes, including behavior. Behaviorist theory goes further in its rejection of the unique nature of mental events. It does so by declaring that psychology is the study of only observable behaviors. Therefore, purely mental events, events that occur outside the realm of behavior are not the subject matter of psychology. In terms of a definition, behaviorism is the study of the relationship between individuals' environments and their behavior, without consulting hypothetical events that occur within their minds (Carlson & Buskist, 1997).

This movement gained much attention and praise from the vast number of scientists who claimed other theories in psychology were invalid because they were not empirical, and as a result not quantifiable. Behaviorism, in contrast, maintains an objective stance to ensure that research findings will be valid and capable of being relied upon. Behaviorists achieve this objective stance by refusing to deal with what they call the "black box" of the mind. One cannot measure what goes on inside an individual's mind, or at least not with certain validity. One can, however, measure and find patterns in that individual's actions in his or her environment. Behaviorism

We often hear of contracting in regards to contracting for safety. A written or verbal contract being created to ensure that someone "promises" to remain safe (or not kill themselves) by signing (or agreeing to) a contract, but the inclusion of a contract can be used to gain leverage and commitment on the part of the client for any aspect of their treatment. Certainly it may be said that treatment plans, since they require the signature of the client or guardian of the client, can be more successful due to this level of commitment and accountability by the client.

Read the following excerpt from Rosqvist, J. & Hersen, M. (2005). Encyclopedia of Behavior Modification and Cognitive Behavior Therapy to learn more about contracting when it might be used:

Contracting by Rosqvist & Hersen

I have found that when we are working with clients we are acting in ways that would be akin to their friend but we always have to remember that we are not the client's friend. Maintaining appropriate professional boundaries is very important for any mental health worker.

As a mental health worker you may be

• There when they need you
• The Client can depend on you
• You are honest and up front about what you think about their behavior
• You hold them accountable to what they promise to do
• You follow through with what you agreed to do
• You are non-judgmental

Working with contracts is a way to not only hold the client responsible for their role in the healing process, but to also hold the entire treatment team accountable as well. While not meant to be punitive, if one member of the treatment team (including the client) is not acting according to the contract, we can confront them and engage the discussion as to additional barriers that may have cropped up in the completion of the treatment plan.

Self Care

Developing a network of other supportive people in your life is critical in order to be a successful helper.

Carol Gilligan's Care Model of Moral Development captures the importance of self care so that we can care for others.

Video of Carol Gilligan sharing her thoughts: https://www.youtube.com/watch?v=2W_9MozRoKE

Here is a summary of Carol Gilligan's Care Model of Moral Development: https://www.youtube.com/watch?v=zIzpBuWzkBU

What do you do to take care of yourself? Do the people in your world support you taking care of yourself?

Read the information on vicarious trauma in this link: https://www.livingwell.org.au/professionals/confronting-vicarious-trauma/

Assessment

Lesson 8 Discussion A (for online course only)

We have learned that, above all, trauma can be very destructive of relationships. Sometimes the relationships most harmed are the ones most important to us. The concepts we are exposed to are classic Freudian constructs of transference and counter transference. Using the definitions to these terms discuss the various personal struggles one might have with transference and counter transference in a therapeutic or helping relationship.

Lesson 8 Discussion B (for online course only)

Discuss how contracting when working with a client and the social support network of the therapist are vital to a successful therapeutic process.

Lesson 8 Assignment Discussion Board

For this assignment you will be using the resources in a specific app (Self Help) and then creating a brief video presentation on the major components of that resource. Post a link to your presentation in the Lesson 8 Assignment Discussion board. (This will be graded as an assignment not a discussion but you are encouraged to look at and respond to each others' videos.)