PSYC201 Lecture Notes - Lecture 4: Therapeutic Relationship, Clinical Formulation
2 Jun 2018
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PSYC201 Lecture 4:
Part 1 – Theory Topic
• 1. First stage → establishing a therapeutic alliance
• 2. Second stage → developing an internal focus for change
Review – the therapeutic alliance
• We need to be able to successfully communicate that we:
o Understand their predicament
o Recognize their distress and empathise with it
o Are on their side and want the best for them
o Have a commitment to help them move forward
Empathic understanding:
• Clients will feel understood when we:
o 1. Repeatedly reflect the basic feelings, key issues and meanings being
expressed
o 2. Identify a common theme or pattern that links the client’s concerns
into a more coherent pattern – perhaps a case formulation (more on
that to come)
Family of origin
• Was the family of origin validating?
• Was it ok to express your emotions?
• Think of your own family of origin – what messages did you receive growing
up about emotions
• Was it ok to have an opinion which was different?
• Common to see “invalidation” – serious consequences for development of
‘sense of self’
Examples of empathic comments to build an alliance
• This his all been too much for you, more than you can stand
• You felt let down again
• It was disappointing – you wanted more than that
• Were you scared at all when that happened
• You wish things had turned out differently
• You felt ashamed that you lost control
• You want things to be different but it is so hard to change
Identify emotional meaning
• Essentially, when you listen to the client’s experience, you are finding the
feeling and meaning and reflecting that back – what’s in the heart of this?
• You are showing that you understand the core message, or the emotional
meaning of what has happened to the client
• Don’t just say “I understand” but communicate the central meaning of what
the client said → you can check ‘did I get that right or can you help me say it
better’
• Focus for change → client’s ownership and responsibility for change differs
widely i.e. responsibility is up to you COMPARED TO blaming someone else
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
First stage establishing a therapeutic alliance: 2. Second stage developing an internal focus for change. Empathic understanding: clients will feel understood when we, 1. Repeatedly reflect the basic feelings, key issues and meanings being expressed: 2. Identify a common theme or pattern that links the client"s concerns into a more coherent pattern perhaps a case formulation (more on that to come) Examples of empathic comments to build an alliance. The next step: the next step is to move away from focusing on external factors as the source of the problem, to focus on the clients own thoughts, feelings and reactions to the problematic behaviour of others, e. g. I"m sorry that your father does that to you. I can see how much it affects you when he criticizes your actions. What do you say or do when he does this? : e. g. I can see how frustrated you are that you end up taking care of everyone else.
