Updated: Apr 23, 2020
As a person-centred therapist, I undertook a post graduate certificate, and then post graduate diploma in Counselling and Psychotherapy. The training was expensive, personally demanding and reassuringly rigorous. I work with clients experiencing stress, anxiety and depression. But when I’m asked the question ‘so what exactly do you do? well it's not that black and white and I find this quite difficult to answer in the moment. So I’ve written a couple of blogs about what counselling is as a handy reference point.
As a person-centred practitioner, the main tools of my trade are empathy, congruence and unconditional positive regard, numbers 3, 4 and 5 of Rogers’ six necessary and sufficient conditions for therapeutic healing. But there is so much more to it than this. McCleod and McCleod’s (2011) skills framework (1) is a useful guide which sets out the skills that the successful therapist is busy honing.
Rapport: when a client turns up in my therapy room in distress, the first job is to build a rapport with the client. It’s important that my client feels he can trust me from the outset, so that it feels safe for him to come back. To help the client to feel safe, comfortable and relaxed, I offer warmth, gentleness and kindness. I’m attuned to the client’s cues such as body language and facial expressions and attentive to the client’s needs. Is the room temperature ok? Would he like a drink? Would he like a window open? The client needs to feel cared for and held safely in that space.
Active listening: my first question tends to be ‘so what’s brought you here today?’ And then I sit back and listen. Very carefully. I’m open to what is being said by the client. I don’t make assumptions about the meaning that the client is making. Rather, I try to hear how the client is making sense of his own experience so that I’m accurately reflecting back the client’s feelings (1). I have to be very attentive to any potential listening blocks as these can get in the way of properly listening to understand. This means that a part of me is simultaneously tracking my own state in order to ‘tune out’ any listening blocks.
Attunement: I remain finely attuned to the client’s feeling state for the duration of the session. Clients can move through a whole range of emotions and it takes great skill and concentration in tracking the client’s emotions from moment to moment. This ensures that I’m able to capture the essence of what she is sharing, in order to accurately reflect it back to her in the moment. This helps the client to become more aware of what she is feeling. Sometimes these feelings are so subtle or just on the edge of awareness and may need gently teasing out to enable the client to bring them into her own awareness. Ineffective process monitoring can lead to clumsy interpretation of the client’s narrative and emotions. This risks her shifting from deep exploration of her feelings to a more superficial narrative (1). It’s therefore essential for the client’s therapeutic growth that I remain vigilant and fully attuned to her changing feeling state during the session.
Attending: ‘attending’ means paying full attention, ensuring that the client feels heard. I may occasionally use minimal encouragers such as ‘mmm’ or ‘yes’ to demonstrate that I’m following his thread (2). More often, I demonstrate attention through body language e.g. leaning in, facial expressions and nodding rather than interrupting his flow. I hadn’t actually realised how much I use body language to hold space for a client until I had to switch to online counselling because of Covid-19, which is a very different but still valuable experience.
Silence: silence is a powerful tool in the counselling room. If used carefully, it can support introspection in my clients (3). Use of silence in counselling is associated with the client’s increased levels of description, experiencing and insight as they use silence for deeper exploration (4). Silence however, whilst having a facilitative effect, can also have an inhibiting effect (5). A therapist’s silence could result in my client believing I’m unempathetic (6) and can result in client dropout (7). Therefore I stay fully attuned to his emotional state during silent moments, allowing him to use the space and time for introspection, waiting for him to emerge from the silence naturally, although depending on the circumstances, I may wonder out loud where he is in that silence to aid his expression.
Checking out/clarifying statements: I user clarifying statements to convey my understanding of my client’s experience. Sometimes ‘checking out’ can help to join up the dots for her, holding bits of information in mind and returning to these at key points to help her to join the dots and make sense of her own experiences. An example might be: ‘as I’m listening to you, I’m reminded of similarities between this experience and a previous experience.’ Or ‘it sounds like this is what you mean’ (1). This provides space for her to explore her sense-making at a deeper level and helps her to draw meaning from her experiences.
Boundary management: as a member of the BACP, it’s an important ethical requirement for me to maintain good boundaries. There is also definite therapeutic value in maintaining good boundaries. It is therefore important for me to role model good boundary management in order to help my clients to identify where their own boundaries may be a bit blurred or even breached and help them to strengthen their own boundaries (8). Boundary violations can be injurious to clients, therapists and the therapeutic process (9). A good starting point in helping my clients to learn good boundary management is managing time boundaries. I use techniques for holding time boundaries such as sticking to the end time even if a client is late, suggesting that clients keep an eye on the large clock on the wall and flagging 10 minutes towards the end of the session. This also ensures that clients can prepare to ready themselves for the session to close.
Restating or paraphrasing: restating the client’s narrative in a way which does not interrupt the client’s flow is a real skill for a counsellor to hone. The purpose of this is to enable the client to hear their feelings being articulated by reflecting words, images or metaphors that resonate with the client and communicated with a voice quality that subtly conveys a sense of caring and active engagement.
Metaphors: we all use metaphors every day, they are a feature of common parlance. A metaphor is a form of expression that is used to draw a comparison for effect, for example, using phrases like ‘it’s a jungle out there’ – meaning it’s fraught with danger and difficult to navigate, it’s not an actual jungle. Exploring the metaphors that clients use, or indeed exploring the metaphors that spring to mind as they speak are useful methods for deep exploration of their feeling state.
Reframing: cognitive reframing is more a tool of Cognitive Behavioural Therapists but can be a helpful technique that can be integrated into person centred counselling. Reframing is the technique of identifying maladaptive or irrational thoughts and then exploring ways of redefining the problem or alternative ways of thinking and feeling about an event that is less injurious to the client and more conducive to personal growth. However it is important that this is done with care, ensuring that the client doesn’t feel judged, criticised or unsafe.
Questions: generally speaking, questions are discouraged in person-centred counsellor training. If you’re asking the client questions, such as ‘why are you afraid’, or ‘what are you afraid of’, this risks disrupting the client’s flow, taking him out of his frame of reference whilst he thinks about his response. As a person-centred counsellor, I’m more likely to use a sense-making statement such as ‘as I’m listening to you, it feels to me that you’re afraid and I’m wondering if you could say more about that.’ However sometimes, a counsellor will integrate the use of Socratic questions in order to help a client explore some aspect of his experience. Whilst this technique is more likely to be found in other types of therapy such as Cognitive Behaviour Therapy, it can also be useful in person-centred, providing care is taken to remain in the client’s current frame of reference.
If you’ve ever tried to talk about your feelings with someone who isn’t a trained counsellor, you may have been left feeling frustrated as they try to advise you, or fix you, come up with solutions that don’t sit right with you or they simply change the subject because they are uncomfortable with your emotions. It’s a demanding job, properly attending to the emotional needs of another individual. It’s not a job just anyone can do, it’s a job for a trained professional. And the next time I’m asked ‘so what exactly do you do’ I’ll be pleased to point them to this ready response.
1) McLeod, J., & McLeod, J. (2011). Counselling Skills : A Practical Guide for Counsellors and Helping Professionals (Vol. 2nd ed. John McLeod, Julia McLeod). Maidenhead: McGraw-Hill
2) Ivey, A.E., Ivey, M.B. and Zalaquett, C.P. (2010) Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society, 7th edn. Belmont, CA: Brooks/Cole
3) Greenson, R. (1967/1985). The technique and practice of psychoanalysis. New York: International Universities Press.
4) Hill, C., Carter, J., & O'Farrell. A case study of the process and outcome of time-limited counselling. Journal of Counselling Psychology, 1983,30, 3-18.
5) Ladany, N., Hill, C.E., Thompson, B.J. and O’Brien, K.M. (2004). Therapist perspectives on using silence in therapy: A qualitative study. Counselling and Psychotherapy Researach, 4(1), 80-89.
6) Matarazzo, J.D., & Wiens, A.N. (1977). Speech behaviour as an objective correlate of empathy and outcome in interview and psychotherapy research: A review with implications for behaviour modification. Behaviour Modification, 1 (453-480).
7) Davis, H.S. (1977). An empirical study of the meanings of silence occurring early in psychotherapy. Dissertation Abstracts International, 51, 1484B. (University Microfilms No 77-19)
8) Chadda, T. and Slonim, R. (1998). Boundary transgressions in the psychotherapeutic framework: Who is the injured party? American Journal of Psychotherapy, 1998, 52:4 (489)
9) Epstein, R. (1994). Keeping boundaries. Maintaining safety and integrity in the psychotherapeutic process. Washington: American Psychiatric Press Inc. In Chadda, T. and Slonim, R. (1998). Boundary transgressions in the psychotherapeutic framework: Who is the injured party? American Journal of Psychotherapy. 52(4), p489.