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