PT45 Enable the client to understand their relational difficulties through their immediate experience within humanistic therapy

Overview

This standard focuses on the deliberate and instrumental use of the therapeutic relationship to facilitate a change in how the client understands their relationship difficulties outside therapy. It draws on the principle that human experience is multidimensional and that some aspects of experience, such as emotions, thoughts and images, are, at any moment, outside the client’s awareness. The standard emphasises the skills involved in paying rigorous attention to what is happening in the session, and through reflecting on the intersubjective characteristics of the therapeutic relationship. To do this, some therapists explore the unconscious through transference phenomena, others focus on the experience in the session through intuitions and somatic responses, and some may do both. This standard describes therapeutic practice adopted successfully in mental health and wellbeing interventions for adults, based on the philosophical tenets of the humanistic tradition and incorporating a range of approaches from a humanistic value base. (See reference in the additional information section on page 4.) To apply this standard, therapists also need to take account of the multiple problems and complex co-morbidities that individual clients may bring to therapy. Users of this standard will need to ensure that they are receiving supervision and that their practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies. Version No 1

Knowledge and Understanding

You will need to know and understand:

Relational processes in the immediate therapeutic relationship

1. the mechanism and nature of shared meanings co-constructed by therapist and client
2. how the therapeutic relationship reflects the relationship histories of both the client and the therapist
3. how the explicit and implicit meanings that shape the client’s and therapist’s perceptions of their world may be experienced within and influence the therapeutic relationship
4. how the client’s explicit, manifest communications may contain an implicit, latent meaning
5. ways in which aspects of past events can be re-experienced in the present
6. how the therapist may make use of their immediate emotional and embodied reactions to the client
7. the ways in which the therapist’s immediate responses and experiences within the therapeutic relationship can form a basis for communicating empathic understanding and informing exploration of the client’s subjectivity
   
   Mental health and wellbeing
   
8. the range and severity of mental health difficulties and their presentation
9. factors associated with the emergence, development and maintenance of mental health difficulties
10. humanistic models of mental distress
11. the ways in which mental health difficulties can impact on personal and interpersonal functioning
12. models of a fully functioning individual
    
    Conditions for therapeutic change
    
13. the rationale for responding empathically to the client and being warm, open, non-judgmental, genuine and transparent
14. how to employ the specific methodology, key concepts and relevant components of the model being used
15. how to maintain therapeutic conditions
16. the psychological conditions that make change more likely
    
    Principles of humanistic therapy
    
17. philosophy and principles that inform humanistic therapy
18. humanistic theories of therapeutic process
19. approaches to psychological therapy that have grown out of the humanistic psychology movement
20. experiential methods of learning
21. non-humanistic approaches that influence humanistic therapy
    
    Human growth and development and the origins of psychological difficulties
    
22. models of change, health and wellbeing
23. the impact of conflicts within the individual
24. the impact of social context on psychological growth and development
25. the role that emotional experiencing has in an individual’s awareness of how an action contributes to growth
26. the role of relationship in the development of self-experience
27. theories of the role of implicit or unconscious processes in the development of self-experience
28. the mechanisms by which difficulties develop in self-experience
29. how thinking, feeling and behaviour are determined by an individual’s subjective reality
30. the impact on psychological development of empathic attunement and acceptance and the extent of its absence during the formative years
31. the mechanism and effects of internalisation of the values, beliefs and attitudes of others
32. the development and benefits of the capacity to reflect on inner processes and experiences
33. the development of the capacity to balance inner and outer realities
34. the multiple perspectives from which human experience can be viewed
    
    The actualising tendency
    
35. the role of actualisation in human growth and health
36. the ways in which internal processes out of the client’s awareness can undermine, distort or block the actualising tendency
37. how the actualising tendency is expressed in the practice of humanistic therapy
38. the concept of symptoms as a signal for integrating experience and growth
39. the concept of symptoms as indicators of the actualisation process

Performance Criteria

You must be able to do the following:

1. respond to the client’s cues indicating their ability to sustain contact with current feelings, thoughts and processes as they emerge in the session and their ability to articulate what they are experiencing
2. articulate and explore the thoughts, feelings, intuitions and somatic responses that may arise in you and the client in a minute-by-minute way
3. facilitate the client in describing accurately what they experience in the here-and- now without interpreting or judging themselves 
4. reflect with the client on the intersubjective phenomena within the therapeutic relationship, including what some therapists will understand as transference and countertransference phenomena
5. when relevant to the client’s understanding of their relational patterns, be open to reflect empathically on:
1. what the client may be expressing indirectly in the process and content of their communications
2. ways in which the client manages feelings that are implied but unexpressed
3. the client’s apparent ambiguities and ambivalent feelings, how the client internalises their relationships and what they may not be aware that they are communicating
6. explore with the client your subjective associations in response to the evolving relationship, and their meaning, taking account of:
1. your capacity for attuning to subtle changes in your interactions with the client
2. how the developing therapeutic relationship might be affected by your or the client’s previous experience of relationships
3. the degree to which the client’s feelings towards you are the result of the way you are behaving
7. when ruptures or impasses occur in the therapeutic relationship, allow for opportunities to explore the client’s subjective experience of relationships
8. enable the client to use your shared understanding of the way their relationship has evolved with you to explore and understand the nature and origins of their relational difficulties and patterns
9. highlight areas of the use of immediacy to be explored in supervision

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard is derived from research reported in Roth A D, Hill A and Pilling S (2009) The competences required to deliver effective Humanistic Psychological Therapies. Centre for Outcomes Research & Effectiveness (CORE) University College London. This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: Core 2 Personal and people development