14. 协作工作

本章知识点阐述

Working collaboratively After reading the earlier chapters we expect that yon will probably agree that a central outcome of any counselling process is for change to occur in the person being helped. People typically come to see a counsellor in a distressed emotional state with the expectation that as a result of counselling they will find solutions to their problems and will feel better, in other words, they have an expectation of change. This change may involve changes to their emotional feelings and/or thoughts so that they feel better, or may involve changes in their behaviour so that they are more able to deal effectively with issues that confront them in daily life. WHAT FACTORS PROMOTE POSITIVE COUNSELLING OUTCOMES? Have you, the reader, previously thought about what it is that enables a person who is engaged in a counselling process to change? We invite you to think for a minute about what might contribute to the change process. In Chapter 2 we discussed some of the desirable attributes of a counsellor and of the counselling relationship. Now we have some questions to ask: • Are counsellor attributes sufficient to produce change? • Are attributes of the counselling relationship sufficient to produce change? • Is it the use of particular counselling skills that produces change? • Is it the counsellor who is effective in promoting change in the person seeking help, or is it the person themselves who generates the change? If you are in a training group you might want to discuss these questions in your group before continuing to read on. It is clearly useful to be able to answer these questions so that we can understand more fully how counselling can enable a person to change.

RESEARCH INTO THE EFFECTIVENESS OF COUNSELLING Carl Rogers was one of the first people to initiate research into counselling practice by analysing the characteristics of counselling conversations and the counselling relationship. He began doing this in the 1950s and his contribution with regard to he nature of the counselling relationship and the use of reflective listening skills continues to be of major importance. Since Rogers’ time, a considerable amount of research has been conducted with regard to the characteristics of the counselling process and the effectiveness of counselling, There have been many contributors to the literature in this area, including Frank and Frank (1991), Horvath (2001) and Wampold and Imel (2015). Most authors agree that research studies have identified the influence of common factors and the therapeutic alliance in producing positive outcomes for those who seek counselling.

COMMON FACTORS In the previous chapter we considered a number of different approaches to counselling. As a consequence, you may be asking, 'Which counselling approach is the most effective?' Some authors contend that when practised by competent counsellors who adhere to a particular model of counselling, all the approaches are almost equally effective, and their effectiveness depends on a number of factors which are common to all approaches. Further, a consistent finding through research into the effectiveness of counselling is that there are a number of factors common to all counselling approaches that have a positive influence on the experience of the person seeking counselling and on the effectiveness of counselling (Wampold & lmel, 2015). The common factors that have been identified as helpful are described in different ways by different authors. Included among these factors are: • the counsellor s personal qualities • the relationship between the person seeking help and the counsellor • the person trusting that the counsellor is able to be of help • personal factors of the person seeking help • the influence of hope and optimism.

QUALITIES OF THE COUNSELLOR AND THE COUNSELLING RELATIONSHIP Desirable personal qualities of the counsellor and the relationship between the person being helped and the counsellor were discussed in Chapter 2. However, an additional perspective on the relationship, in recent years referred to as the therapeutic alliance, will be described later in this chapter. THE PERSON TRUSTING THAT THE COUNSELLOR IS ABLE TO BE OF HELP We might ask the question ‘How can a counsellor obtain a person’s trust in such a way that they will believe that the counsellor can be of help?’ You may wish to think about this question for a while before reading on.

While we believe that it is helpful for a counsellor to have the necessary7 personal qualities and to be able to create a relationship with the person seeking help, as described in Chapter 2, we do not consider this to be sufficient. For the counselling relationship to be fully effective the counsellor needs to be proficient in the use of counselling skills and in attending to the counselling process. When the counsellor does these things competently, the person is likely to feel confident in working with the counsellor in order to achieve their desired goals. The counsellor needs to be skilful when selecting and making use of individual micro-skills. Also, the counsellor needs to have an understanding of and expertise in facilitating the overall counselling process, not only as it occurs in each individual session but also as it extends over a series of counselling sessions. The counselling process will depend on the particular counselling model preferred by the counsellor. This might be one of the models listed in the previous chapter or might be an integrative counselling approach, as described in Chapters 15 and 16, which brings together strategies from a variety of models. PERSONAL FACTORS OF THE PERSON SEEKING HELP Earlier we asked the question ds it the counsellor who is effective in promoting change in the person seeking help, or is it the person themselves who generates the change?" It seems to us that most human beings have within them the resilience and ability to heal themselves, and this fits with Rogers’ belief that each person has the ability to find their own solutions. So what is it that the counsellor does? The counsellor acts as a facilitator working together with the person to promote, amplify and extend the possibility of change (Bohart & 1 allman, 1996). THE INFLUENCE OF HOPE AND OPTIMISM When His Holiness the Dalai Lama was in conversation with psychiatrist Howard Cutler (Dalai Lama & Cutler, 2000), they agreed that for a person to change in attitude the person must first realise that this is possible, must wish to do so and .... t............................... ........ must then implement the changes. If we accept that this is correct, then it is clearlv useful for us as counsellors to enable those who seek our help to have the hope and expectation that change is possible.

Hope and optimism are processes used in varying degrees by most people to cope with daily life. Like anyone, we ourselves will sometimes sink into thinking negatively and become pessimistic. Are you the same? We have discovered that being in a negative frame of mind is uncomfortable for us, so when we recognise our negativity we are motivated to change our attitude so that we are more positive and hopeful. A useful question is 4How can we use counselling to engender hope?’ Frank and Frank (1991) suggest that a counsellor who is hopeful can contribute to a sense of hope and optimism in the person seeking help. They also suggest that the explanation the counsellor gives about why the person is experiencing the presenting problem can lead to their sense of hope for the future. In view of this, we have come to the conclusion that being hopeful is in some way contagious, and that if the counsellor is hopeful about outcomes for the person seeking help, then that person is likely to start to feel hopeful themselves.

THE THERAPEUTIC ALLIANCE As discussed previously, Rogers placed great emphasis on the value of the counselling relationship. He believed that the counselling relationship was therapeutic in itself (Rogers, 1961). Since Rogers’ work, the concept of the therapeutic alliance has been introduced and investigated. Research has shown a strong positive relationship between the therapeutic alliance and counselling outcomes (Hovarth, 2001). The idea that the therapeutic alliance is of importance in counselling outcomes was originally proposed by B ordin (1975). He suggested that initially it is important to establish a bond between the person seeking help and the counsellor, including the development of trust, acceptance and confidence, and additionally that there should be agreement between the person and the counsellor with regard to the counselling behaviours, interventions and cognitions that form the counselling process (Bambling & King, 2001). Therefore, the concept of the therapeutic alliance suggests that, in addition to particular attributes of the counsellor and of the counselling relationship, a collaborative therapeutic relationship makes an important contribution to the promotion of change. We ourselves do not think that to achieve a good therapeutic alliance the counsellor needs, when counselling commences, to consult in a structured or formal way with the person seeking help in order to negotiate agreement with regard to the counselling process and goals. However, many counsellors do believe that this is important, so you will need to decide for yourself what you think is appropriate. In our view, an effective therapeutic alliance extends the relationship between the person seeking help and the counsellor to enable them to work together collaboratively throughout the whole process of counselling. If this is done successfully, the reason that the person has come for counselling will be discovered, and the purpose and goals of the counselling process will become clear as the counsellor collaborates with them. Further, through collaboration, solutions will be found. Creating a therapeutic alliance ensures that the person seeking help is valued as a person, as explained in Chapter 2, and that they are respected as being capable of working towards the discovery of solutions. However, rather than being a bystander, the counsellor collaborates with them in a working relationship. 1 his enables the counsellor to enter into a respectful partnership with them in exploring new wavs of addressing problems and finding solutions. In this working relationship the person seeking help brings their innate skills, competencies, resources and natural ability to self- heal into the relationship, while the counsellor collaborates by offering their counselling expertise and skills, and sharing their ideas as an equal, rather than as an expert. This collaboration is effected with the person’s full knowledge and understanding so that they are aware of their own and the counsellor’s roles.

BEING COLLABORATIVE WHILE SHOWING RESPECT FOR THE PERSON’S COMPETENCE It is interesting to note that some theoretical models place a stronger emphasis on collaboration between a counsellor and the person seeking help than other models. In Person-Centred Counselling there is a strong emphasis on the ability of the person seeking help to find solutions from their own resources. 1 he counsellor is a facilitator who facilitates a process that enables the person to use their own inner processes in order to resolve issues and find solutions. Other approaches, such as Narrative Therapy and Solution-Focused Therapy, emphasise the need for the counsellor to work together with the person as equal partners in finding solutions, while still respecting the person’s competence. In these latter approaches, the counsellor is active in using questions to propose and explore possible alternative solutions with the person. 1 here are therefore differences in emphasis between the models of counselling. Some counsellors believe that primarily we need to facilitate a process that relies on the person’s ability to discover their own solutions, while others believe that while respecting the person’s abilities it is also beneficial to focus on engaging in a collaborative process to discover solutions. Clearly, you will want to decide for yourself what fits best for you. If a useful counselling relationship is to occur, the counsellor must respect and value the person seeking help as a capable person. It is extremely important for a counsellor to respect their competence and to hold the belief that they, have the inner resources needed to deal with troubling issues, find solutions to problems, make decisions to change behaviour and put desired changes into action. Some people come to counselling believing that they do not have the inner resources and capability to do such things. Their expectation is that the counsellor will help them by finding solutions for them. Often such people appear to lack a sense of personal powrer and self-confidence, which they require to enable them to be self-reliant. If the counsellor maintains the belief that they do have the required inner strength and competence required for self-reliance, then the counsellor will be in a position to enable them to get in touch with their own strengths and resources, to become self- reliant, to make decisions that suit them, and consequently to gain in self-esteem. In facilitating this process the integrative counsellor may, as a collaborative partner, introduce new ideas which can be explored with the person. If this is done with sensitivity and respect, the person can continue to be encouraged to explore their issues, to make their own decisions, and to find solutions which are a good fit for them. Also, the counselling conversation can be enriched by the introduction of additional ideas by the counsellor. In this situation, the person is likely to believe that the counsellor cares enough to be involved as an equal partner in the exploration of problems and the search for solutions, thereby enhancing the relationship; the counsellor is actively^ helpful and involved in a process that is purposeful while working collaboratively with the person as an equal partner by contributing their own skills and attributes to the counselling conversation. During this collaborative process, the counsellor shows respect for the person’s competence and ability as they explore troubling issues and make personal decisions which suit them. At the beginning of the chapter we listed a number of questions related to the question ‘What factors promote positive counselling outcomes?1 We hope you will agree that we have provided some answers to this question, while leaving you to make your own decisions about what you think is best with regard to counselling practice.

Learning summary Research has shown that some factors that are common to all counselling approaches promote effective counselling outcomes. The person seeking help needs to trust that the counsellor is able to be of help. The counsellor is a facilitator and enables the person to use their own natural resources in order to change. The therapeutic alliance involves the use of a collaborative working relationship. Being collaborative enables the counsellor to show respect by engaging with the person as an equal partner and by bringing different skills and attributes to the counselling conversation. References and further reading Bambling, M. & King, R. 2001, ‘Therapeutic alliance in clinical practice’, Psychotherapy Australia, 8(1), November. Bertolino, B. & O’Hanlon, B. 2002, Collaborative, Competency Based Counselling and Therapy, Allyn & Bacon, Boston. Bohart, A.C. & Tallman, K. 1996, ‘The active client: therapy as self-help’. Journal of Humanistic Psychology, 36: 7-30. Bordin, E.S. 1975, ‘The working alliance: basis for a general theory of psycho-therapy’, paper presented at the meeting of the Society for Psychotherapy Research, Washington, DC, August. Dalai Lama & Cutler, H.C. 2000, The Art of Happiness: Handbook for Lining (audio tapes), Simon & Schuster, New York. 1)ryden, W. 2009, ‘The therapcutic a 11 iancc as an integrating framework', in W. Dryden & A. Reevcs, Key Issues for Counselling in Action, 2nd edn, SAGE, London, pp. 1 — 18. Frank, J.D. & Frank, J.B. 1991, Persuasion and Healing: A Comparative Study of Psychotherapy, 3rd edn, Johns Flopkins University Press, Baltimore. Horvath, A.O. 2001, ‘The therapeutic alliance: concepts, research and training’, Australian Psychologist, 36: 170-6. Rogers, C.R. 1961, On Becoming a Person, Constable, London. Wampold, B.E. & Imel, Z.E. 2015, The Great Psychotherapy Debate: The Evidence for IVhat Makes Psychotherapy 14TR, Routledge, New York.