Strategies That Add Depth and Enhance the Relationship
This group of strategies is used to enhance and expand the communicative and relationship patterns that are established early in the counseling or therapeutic process. When used effectively, these strategies should open up deeper levels of communication and strengthen the relationship patterns that have already been established. Counselors or therapists using these strategies to model types of behaviors that they wish their clients to emulate. Such behaviors include, but are not limited to, risk taking, sharing of self, demonstrating trust, and honest interaction. This set of strategies includes self-disclosure, confrontation, and response to nonverbal behaviors. The following paragraphs present explanations and examples of these strategies.
This strategy has implications for both clients and counselors or therapists. In self-disclosing, the counselor or therapist shares with the client his or her feelings, thoughts, and experiences that are relevant to the situation presented by the client. The counselor or therapist draws upon situations from his or her own life experiences and selectively shares these personal reactions with the client. It is important to note that self-disclosure could have both a positive and a negative impact on the helping relationship, and care must be taken in measuring the impact it may have.
From a positive perspective, self-disclosure carries with it the possibility of modeling self-disclosure for the client or helping the client gain a different perspective on the presenting problems. From a negative perspective, self-disclosure might place the focus on the counselor's or therapist's issues rather than on those of the client. When used appropriately, gains are made by all persons involved, and the relationship moves to deeper levels of understanding and sharing.
Counselor/Therapist: (aware of the client's agitation) The anger I hear in your voice and words triggers anger in me as I think of my own lost relationships.
Client: (smiling) I am angry. I'm also glad you said that. Sometimes I feel like I'm the only one who ever felt this way.
Counselor/Therapist: (smiling) I am very pleased with what you just said. At this moment, I also do not feel alone with my anger.
This strategy enables the counselor or therapist to provide the client with feedback in which discrepancies are presented in an honest and matter-of-fact manner. A counselor or therapist uses this strategy to indicate his or her reaction to the client, to identify differences between the client's words and behaviors, and to challenge the client to put words and ideas into action. This type of direct and honest feedback should provide the client with insight as to how he or she is perceived, as well as indicate the degree of counselor or therapist caring.
Client: (smiling) I feel angry at myself a great deal. I want so much to find a person and develop a relationship that lasts.
Counselor [Therapist: You've said this several times in our sessions, but I'm not sure I believe you, based on what you do to keep it from happening. Make me believe you really want this to happen.
Client: What do you mean, you don't believe me? I just told you didn't I? What more do you want?
Counselor [Therapist: Yes, I've heard your words, but you haven't convinced me. I don't think you've convinced yourself either. Say something that will convince both of us.
Responding to Nonverbal Cues
This strategy enables a counselor or therapist to go beyond a client's words and respond to the messages that are being communicated by the client's physical actions. Care must be taken not to overgeneralize every subtle body movement. The counselor or therapist is looking for patterns that either confirm or deny the truth in the words the client uses to express him- or herself. When such patterns become apparent, it is the responsibility of the counselor or therapist to share these patterns with the client. It becomes the client's responsibility to confirm or deny the credibility of the perception.
Client: (turning away) Yes, you're right. I'm not convinced this is what I want (smiling). Maybe I was never meant to be happy.
Counselor/Therapist: What I said made you angry and, I would suspect, hurt a little. Did you notice you turned away before you began to speak? What were you telling me when you turned away?
Client: (smiling) What you said did hurt me. I was angry, but I'm also embarrassed not to be able to handle this part of my life. I don't like you seeing me this way.
Counselor/Therapist: I've noticed that on several occasions when you talk about your feelings such as anger, embarrassment, or hopelessness, you smile. What does the smile mean?
Client: (long pause) I guess I want you to believe that it isn't as bad as it sounds, or that I'm not as hopeless as I think I am.
Counselor/Therapist: It is bad, or you wouldn't be here, and "hopeless" is your word, not mine. Our time is up for today. Between now and next week, I want you to think about what we've discussed. See you next week?
The strategies we have outlined in this section enable a counselor or therapist to achieve more effectively both the process and outcome goals related to counseling or therapy. Choosing which strategy to use, when to use it, and its impact on the helping relationship is based on the education, experience, and personal dynamics that a counselor or therapist brings to the helping relationship.
A final factor that affects the helping relationship is cultural diversity. Awareness of cultural diversity addresses the counselor's or therapist's openness and motivation to understand more about his or her own diversity as well as the cultural differences that clients bring to the helping relationship (Arciniega & Newlon, 2003; Montgomery & Kottler, 2005; D. W. Sue & Sue, 2007; S. Sue, Zane, Hall, & Berger, 2009). Such understanding is often characterized as the cornerstone on which the helping relationship rests. This understanding, based on both education and life experience, should enable counselors or therapists to increase their sensitivity to the issues that confront clients, should enable them to develop insight into the many variables that affect clients, and should enable them to place clients' issues, problems, and concerns in their proper perspective. The key word in these last three statements is should. Experience indicates that the key factors in the development of cultural awareness are the individual's receptiveness, openness, and motivation to gain such awareness. Without these characteristics, education and experience will have little value. The combination of these characteristics with both education and experience enhances the chances of changing the should to will.
According to Weinrach and Thomas (1998), the emphasis on issues of diversity goes by several names: cross-cultural counseling, multicultural counseling, counseling for diversity, and diversity-sensitive counseling. Included under these terms is not only racial diversity but also diversity in areas such as age, culture, disability, education level, ethnicity, gender, language, physique, religion, residential location, sexual orientation, socioeconomic situation, trauma, and multiple and overlapping characteristics of all of these. It should be obvious that the portrait titled "diversity" is painted with a very broad brush.
When one considers racial diversity and realizes that within each racial grouping exist areas of diversity such as age, disability, sexual orientation, gender, religion, and so on, then one is able to grasp the true complexity that surrounds the subject of diversity. Patterson (1996) pointed out:
Because eveiy client belongs to numerous groups, it does not take much imagination to recognize that the number of combinations and permutations of these groups is staggering. Attempting to develop different theories, methods and techniques for each of these groups would be an insurmountable task. (pp. 227-228)
The insurmountable task suggested by Patterson (1996) could leave the counselor or therapist believing that there is very little one can do to individualize the helping process, via theories, methods, and techniques, to better meet the needs of such a diverse client population. However, it may not be the theories, methods, and techniques that need to be changed but the counselor's or therapist's knowledge, attitudes, values, and behaviors as these relate to diversity. If counselors or therapists enter into helping relationships aware of the degree of diversity that exists within each client, have taken the time and effort to better understand the factors surrounding these diversities, have come to accept and appreciate their own diversity and the values they place on diversity in others, and are able to communicate understanding, acceptance, and appreciation of this diversity to clients, then perhaps the insurmountable becomes surmormtable.
For example, counselors or therapists who work primarily with older people must not only become aware that this population (65 years and older) brings to counseling or therapy diversity in race, gender, culture, and language but also understand the diversity specific to their life stage. That is, this population of older adults face increased disability, increased health problems, increased trauma due to loss of significant others, lowered socioeconomic status due to retirement and living on a fixed income, and decreased self-importance stemming from living in and with a society that places a more positive emphasis on youth.
Awareness and understanding are the first steps. Counselors or therapists must also accept and appreciate not only their own diversity and the part it plays in their evaluation of others but also learn to accept and appreciate this diversity in others. As this relates to older persons, counselors or therapists are not free from ageism (society's negative evaluation of older persons) and its attitudes and values that impede both acceptance and appreciation. Confronting and changing these negative attitudes and values in self and being able to demonstrate to clients, through both words and behaviors, that such negative attitudes and values have no place in the helping relationship, provide counselors and therapists with the tools to accomplish the final step in this process, communication (Lemoire & Chen, 2005; Sanders & Bradley, 2005).
How does one communicate understanding, acceptance, and appreciation in the helping relationship? A look back at the core conditions presented earlier in this chapter should be a good starting point. Conditions such as empathic understanding, respect and positive regard, genuineness and congruence, concreteness, warmth, and immediacy all address ways of communicating understanding, acceptance, and appreciation and are foundational to the helping relationship. According to Patterson (1996), the nature of this relationship, as prescribed by the core conditions, has been known for a long time and has applicability across groups regardless of diversity. Therefore, a helping relationship based on the identified core conditions would be applicable not only to older people but also to clients presenting with other issues of diversity such as sexual orientation, disability, and religion. According to Weinrach and Thomas (1998), "The core conditions are nondiscriminatory" (p. 117).
Pedersen (1996, 2000) further contended that the counselor's or therapist's competence in providing this type of therapeutic relationship rests in the personal qualities he or she brings to the relationship. The development of these personal qualities and gaining the awareness, understanding, acceptance, appreciation, and competence to communicate these can only be achieved through education, life experiences, work experiences, self- evaluation, and the counselor's or therapist's willingness to be open to the learning inherent in these experiences..
According to McFadden (1996), counselors and therapist must strive to be culturally competent. The "culturally competent" counselor or therapist "not only implies recognition of and respect for members of diverse populations but also fosters an outcome that enables clients to function effectively in their own culture and with the majority population while promoting biculturallity" (p. 234).
Pedersen (1996) used the term culture-centered approach to describe counseling or therapy that recognizes that the person herself or himself has internalized patterns of behavior that are themselves culturally learned. If the emphasis is placed – as it should be – on accuracy of assessment, appropriateness of understanding, and competence of practice, then the counselor will need sensitivity to the cultural context, (p. 237)
Cultural diversity addresses the counselor's or therapist's openness and motivation to gain awareness, understanding, acceptance, and appreciation of client diversity and to develop the skills necessary to communicate this to the client in the helping relationship. Personal characteristics or behaviors that enhance a counselor's or therapist's ability to become culturally aware include, but are not limited to, the following:
• The need and the personal motivation to understand one's own cultural diversity as well as that of others.
• The need to seek out education, work experiences, and life experiences that will afford one the opportunity to gain greater awareness of cultural diversity.
• The need to be open to new ideas and differing frames of reference as they relate to cultural diversity.
• The need for self-assurance to admit what one does not know about the diversity of clients and the willingness to learn from clients.
• The need to be aware of one's own cultural stereotypes and biases and be open to changing them through education and experience.