follow-up when developing treatment plans, and the goals and techniques used to achieve preferred outcomes for clients. More important, all stages of work with a client must be theoretically aligned, even if there are core dimensions to a helping relationship. For example, viewing a case from a psychodynamic lens and then using a cognitive behavioral strategy or intervention will not work, let alone make sense. We will introduce how theories are integrated, because many are harmonious and the way that the case is conceptualized may allow for various theoretical strategies.
Before we turn attention to integration, much of this chapter will focus on factors that affect the helping relationship: definitions and descriptions, stages, core conditions, and strategies. In addition, we discuss multicultural and social/cultural orientations as a necessary element of counseling and psychotherapy from theoretical conceptualization to intervention.
DEFINITIONS AND DESCRIPTIONS OF THE HELPING RELATIONSHIP
Although agreed-on definitions and descriptions of the helping relationship should be easy to find, this is not the case. Despite the importance of this relationship in the overall helping process, a perusal of textbooks and articles dealing with counseling and psychotherapy shows the lack of a common definition and that many theories and applications were developed by White, Western, and cisgendered men. Any definition should be grounded in awareness of the intersectional nature of identity and adapt the relationship to the client; for example, with trans and nonbinary clients, this should be affirming of nonconforming gender identity, ongoing minority stress, and resilience (see dickey & Singh, 2020). Rogers (1961), in his classical and seminal work On Becoming A Person, defined a helping relationship as one “in which at least one of the parties has the intent of promoting the growth, development, maturity, improved functioning, and improved coping with life of the other” (p. 39). Okun (1992) stated that “the development of a warm, trustful relationship between the helper and helpee underlies any strategy or approach to the helping process and, therefore, is a basic condition for the success of any helping process” (p. 14). Sommers-Flanagan (2015) noted that “each mental health counselor will inevitably display therapeutic relational factors in unique ways that may be difficult for other practitioners to replicate, because anything relational or interpersonal is alive, automatically unique, and therefore resists sterile descriptive language” (p. 100). Sommers-Flanagan went on to recommend that counselors implement core relational attitudes and behaviors based on evidence-based practice principles (see Sidebar 1.1).
It is easy to see the difficulty in categorically stating an accepted definition or description of the helping relationship, regardless of which of the aforementioned statements one chooses to embrace. Nevertheless, despite the differences, each carries with it directions and directives aimed at a single goal: the enhancement and encouragement of client change. The following definitive characteristics of the helping relationship embrace this goal and describe our conceptualization of this relationship:
Sidebar 1.1 The Importance of a Constructive Therapeutic Alliance
One of the most important things a counselor or therapist (beginning or experienced) must provide to all clients is a safe and constructive therapeutic alliance. Whether the counselor or therapist follows the constructs of a specific theory or develops an integrative approach, the helping relationship must be established in a way that encourages client self-disclosure and motivation to establish and work toward the attainment of goals. No matter how much expertise a counselor or therapist has to contribute to the counseling process, the helping relationship must be established in a way that provides a safe and affirming holding environment so that the client can move toward greater self-acceptance and decision-making.
A relationship initially structured by the counselor or therapist but open to cooperative restructuring based on the needs of the client
A relationship that affirms the intersecting identities of the client
A relationship in which all persons involved perceive the existence of trust, caring, concern, and commitment and act accordingly
A relationship in which the needs of the client are given priority over the needs of the counselor or therapist
A relationship that provides for the personal growth of all persons involved
A relationship that provides the safety needed for self-exploration for all persons involved
A relationship that promotes the potential of all persons involved
The major responsibility in creating this relationship rests initially with the counselor or therapist, with increasing demands for client involvement and commitment over time. It is a shared process, and only through such shared efforts will this relationship develop and flourish. This development evolves in stages that take the relationship from initiation to closure. The stages in this evolving process are the subject of the following section.
HELPING RELATIONSHIPS: STAGES
The helping relationship is a constant throughout the counseling or psychothera-peutic process. The definitive characteristics we have already discussed indicate that the relationship must be present from the initial meeting between the client and the counselor or therapist and continue through closure. Viewing the helping relationship as a constant throughout the helping process leads to visualizing this process from a developmental perspective. This development can best be viewed in terms of a narrow path whose limits are established by the client’s fear, anxiety, and resistance. Such client reactions should not be seen as lack of commitment to change; rather, they need to be understood in terms of the unknown nature of this developing alliance and the fact that this may be the first time the client has experienced this type of interaction. These reactions are often shared by the counselor or therapist based on their level of experience. The path broadens through the development of trust, safety, and understanding as the relationship develops. The once narrow path becomes a boulevard along which two persons move courageously toward their final destination—change. The movement along this broadening path is described by various authors in terms of stages or phases. Osipow et al. (1980), in discussing the stages of the helping relationship, stated,
Persons who experience the process of personal counseling seem to progress through several stages. First, there is an increased awareness of self and others. Second, there is an expanded exploration of self and environment (positive and negative behavioral tendencies). Third, there is increased commitment to self-enhancing behavior and its implementation. Fourth, there is an internalization of new and more productive thoughts and actions. Fifth, there is a stabilization of new behavior. (p. 73)
Egan (2013) stated that the helping relationship can be broken down into a minimum of three phases: building the relationship, challenging the client to find ways to change, and facilitating positive client action. The goal in the first phase is to build a foundation of mutual trust and client understanding. In the second phase, the counselor challenges the client to try on new ways of thinking, feeling, and behaving. In the third phase, the counselor aids the client in facilitating actions that lead to change and growth in the client’s life outside the counseling relationship.
Stages are connected to pantheoretical helping skills that counselors-in-training practice. These skills should be tied to theory, case conceptualization, and multicultural and social justice competencies and cultural humility. For example, in Hill et al.’s (2014) pantheoretical three-stage model, counseling students learn skills such as reflection of feeling to build relationship and share their narratives in stages. In Stage 1 (exploration), they learn skills to establish the therapeutic working relationship; in Stage 2 (insight), they learn skills such as immediacy to facilitate client discovery of new understandings
