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MH100 Establish and maintain the therapeutic relationship

Overview

This standard is about building and maintaining the therapeutic relationship. The boundaries of the relationship will need to be clearly defined. You will need to communicate empathy and understanding to your client whilst working towards mutually agreed goals. You will need to understand the complications of using self in the counselling process. You must be able to identify when and how to use self-disclosure and be aware of the difficulties and dangers of insufficiently considered self-disclosure. You will need to work with diversity as part of the process of therapy and challenge behaviour that discriminates or harms others. You must be able to recognise the impact of power imbalances. Your must be able to review the progress of counselling at suitable times during the therapeutic process and be able to negotiate an end date with the client allowing sufficient time to process the ending in according with your theoretical perspective. You must facilitate the client in the process of mourning at the end of counselling.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. theory and research on the working alliance
  2. how to express empathy and understanding
  3. how to establish trust at the beginning of the counselling relationship
  4. how to agree roles and responsibilities with client
  5. theory and practice that takes account of diversity
  6. the ethical framework for your profession
  7. optimal interaction between therapist and client linked to favourable outcome
  8. theory and research related to therapeutic alliance ruptures
  9. theories of relationship dynamics
  10. non verbal communication
  11. a consistent, coherent and in depth theoretical perspective
  12. the use of self in counselling as appropriate to the theoretical model of practice
  13. theories of self-disclosure
  14. timing of self-disclosure
  15. relevant legal, national, ethical and organisational requirements, policies and codes of practice
  16. the importance of acknowledging and working with your emotional response to the counselling whether disclosed or not
  17. psychopathology, including borderline personality disorders
  18. a working knowledge of self-awareness
  19. in-session negative impacts and ways of processing them
  20. the impact of discrimination and prejudice on mental health
  21. relevant theories and practice of cross cultural counselling
  22. relevant theories and practice of counselling in relation to spirituality
  23. relevant theories and practice of counselling in relation to children, young people and older adults
  24. relevant theories and practice of counselling in relation to sexual and gender identity
  25. relevant theories and practice of counselling in relation to any disability
  26. relevant legal, national, ethical and organisational requirements, policies and codes of practice
  27. different cultures and subcultures including lifestyle, ‘race’, gender, sexuality and age
  28. different religions and how they may influence clients’ life-choices
  29. how to conduct a non-discriminatory approach to professional and therapeutic counselling relationships
  30. relevant theories of power imbalance between counsellor and client
  31. relevant diversity legislation and human rights legislation

Performance Criteria

You must be able to do the following:

  1. clearly define the boundaries of the relationship
  2. communicate empathy and understanding of the client
  3. demonstrate a genuine concern for your client’s welfare
  4. facilitate the expression of emotion
  5. clearly agree roles and responsibilities with the client whilst in a counselling relationship
  6. communicate clearly using language that is accessible and appropriate for the client
  7. identify and work towards mutually agreed goals with your client
  8. identify and address issues of difference and diversity in the counselling relationship including power imbalance
  9. develop and sustain a relationship with the client that provides the safety and security required to explore complex emotional concerns
  10. recognise autonomy of the client and respect boundaries
  11. engage the client in collaborative team work to explore and resolve their difficulties
  12. recognise alliance ruptures and have competency, skills and ethics to be responsive
  13. recognise your emotional, physical and behavioural response to the client and consider ways in which it may be a response to an aspect of the client’s communication
  14. critically appraise research on the counselling alliance, particularly its relationship with outcome
  15. demonstrate the ability to recognise your emotional response to a client and use it in accordance with your underpinning theoretical perspective
  16. recognise the implications of using self in the counselling process
  17. understand the role and function of self-disclosure and other uses of the self in accordance with your theoretical perspective
  18. understand the difficulties and dangers of insufficiently considered self disclosure
  19. assess whether it is appropriate and useful to disclose about yourself in counselling
  20. assess whether it is appropriate and useful to disclose about your process in counselling
  21. make an informed decision about when and how to answer client’s personal questions
  22. identify when and how to use self-disclosure to strengthen the counselling alliance
  23. recognise when the pull towards self-disclosure may be an indicator of the psychopathology of the client
  24. consider ways in which self-disclosure is conveyed through dress, body language, notices, building signs, building access, photographs and other aspects of the counselling environment along with how welcoming and respectful you/staff are to client
  25. acknowledge diversity relating to gender, age, race, culture, language, ability, spirituality and sexuality as it impacts on the counselling relationship or the process of therapy
  26. acknowledge and demonstrate understanding and empathy of any inequality and discrimination experienced by the client
  27. apply and facilitate communication as appropriate for particular clients
  28. demonstrate knowledge and awareness of the impact of discrimination on mental health
  29. be open to own stereotypes and thinking and their potential to create a discriminatory environment for the client
  30. respect clients’ social, cultural, political, religious background
  31. challenge behaviour that discriminates or harms other individuals or communities and take any appropriate action
  32. understand the relationship between discrimination and power at a personal and institutional level
  33. recognise the impact of power imbalances
  34. critically appreciate theory and research underlying diversity in counselling

Additional Information

This National Occupational Standard was developed by Skills for Health.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004)

Dimension: Core 1 Communication
MH100 Establish and maintain the therapeutic relationship
Final version approved June 2010 © copyright Skills For Health
For competence management tools visit tools.skillsforhealth.org.uk
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