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To answer the questions I am going to explore and discuss Kohuts Self Psychology Integrative model and Clarksons 5 Relationship Integrative model. I will then discuss these approaches in relation to my personal growth and the counselling process.
The Self psychology integrative model was created by Heinz Kohut (M. Kahn 1990). Kohut believed that for a person to fully develop three main needs, need to be met. The first need is the need to be mirrored; this is the need for the child to be shown by the parents that the child is of great importance to them. The second need is the need to be idealized, It is important that the child can think that one parent is powerful, calm and confident. The third need is the need to be liked by others. Children need to know that they share some characteristics with their parents this will make a child feel like they belong. The first need of the developing self is the need to be "mirrored" what Kohut called the grandiose - exhibitionist. The second need of the developing self what Kohut called the idealised parental imago? The third need of the developing self is what Kohut called the twin ship or the alter ego. Kohut believes that if the child is not able to be mirrored, idealized or liked by child others. The child then gets the opportunity to build structures that are missing from the child's three main needs for itself from its own perspective. I am now going to move on to Clarkson.
The Clarkson 5 relationship integrative model created by Petruska Clarkson (Clarkson 1990) looks at the facets of the relationship. She believes that there are 5 therapeutic relationships that are of constructive use. The first is the working alliance; the second is the transferential/counter-transferential relationship. The third is the reparative /developmentally needed relationship. The fourth is the transpersonal relationship. The fifth is the person to person relationship. (Clarkson 1995) She also states that there has to be a relationship and it looks at all relationships from childhood to the present day, the therapeutic relationship being the most important of all.
The factors of the therapeutic relationship are that there has been an agreement made between the client and therapist that the session will be paid for at the beginning or at the end of the session. The second factor is that one of the people in the relationship has been trained to take part in it; the third factor is the therapist should be committed to helping the client change. Now I will discuss and explore these approaches.
Name: Cornell king Date: 03-12-12
Assignment: Theory assignment - Year 1 - Integrative
Explore and discuss Kohut's Self Psychology Integrative model and Clarkson's 5 Relationship model. Discuss these approaches in relation to your own personal growth and the counselling process.
The beginning of Kohut's movement away from the traditional way of psychoanalytic systematic procedure of treatment. He was able to pin point it to a female patient that cursed him in all their sessions. He thought he was dealing with oedipal transference (A. Milne 2010) (The term Oedipus complex is derived from the mythical Greek figure of Oedipus, the Oedipus complex is the desire to be with one parent of the opposite sex and remove the other parent of the same sex) But he realised he was wrong and stopped this approach and changed to listening to his patient instead of arguing with them.
He then realised that this was not resistance it was his patient's way of trying to let him see what her childhood was like growing up for her. Kohut turned away from the traditional hard stance of psychoanalytic practice and brought in the warmth and empathy of the humanistic approach. Kohut's was seen as a psychoanalyst that really increased the thinking about human development, psychopathology and theory. Kohut respected the power of the explanatory classical formulations and to build on the standard theory of psychology by adding to it.
Through his study of the psychoanalytic theory of development Kohut had found forms of transference that had not been recognised by anyone else yet. Gill and Kohut believed in the significance of the relationship between the therapist and the client. He has given therapist a new understanding and something of quality in the value of empathy conveyed to the client. There were two questions that Kohut would ask his students, his colleagues and his clients. The first was "My angry patient didn't get something from her parents what was it?", and the second was "what could be done about it?" The answers that he got changed his view and he started to integrate a more humanistic view in to his development, (Wikipedia, Heinz Kohut) Kohut expanded on his theory during the 1970's. Kohut tried to join psychoanalysis and humanism as one. I will now move on to Clarkson.
I am going to discuss and explore Clarkson's 5 relationship models of the client and therapist relationship of an integrative psychotherapeutic framework. The first model is the working alliance this is when the client and the therapist work together for the benefit of the client this alliance needs to be strong for this to work; both parties need to know their roles in the relationship. The second model is the transferential/counter transferential relationship this can be something like a parent, child impulse that the therapist needs to work with the therapist might need to take the role of the parent in the relationship. The third model is the reparative developmentally needed relationship; this relationship can heal past traumas.
The fourth model is the person to person relationship; this is where the therapist bonds with the client through showing respect and being equal to their client in the relationship their real self. The fifth model is the transpersonal relationship is the spiritual model of the relationship. I am now going to discuss the two approaches in relation to my development.
In relation to my personal development I think that Kohut's approach and the need for mirroring were not met adequately. I know that one of my parents was idealised by me. The need to be liked was met by my parents. The thing that I have realised from Kohut's approach is that because the need for mirroring was not met adequately by my parents the person I seek out to fulfil this need is my older sister. Even though Freud thought that this was a bad thing. Kohut thought that maturation was a lifelong process and this was a good thing. That means that a person will always be maturing in to the fully developed self. In relation to Clarkson's theory of the working alliance building trust, mutual respect, being empathic and congruent between me and relatives and friends in my personal life is always an ongoing process.
With most approaches to counselling it is vital that a good working alliance is built between client and therapist. This is essential to both Kohut's self psychology and Clarkson's 5 relationship model. Another important element that both approaches, share or have in common is that the therapist must be warm, empathic, mutual respect for client, equal in the relationship, be human and authentic or their real self. There is another thing they both have in common is very strict time boundaries, the sessions are fifty minutes from start to finish, and both Kohut's self psychology and Clarkson's 5 relationship model are talking therapies. Therapy can take a few sessions or many years for a client to fully recover. Both these approaches use empathy as a means of conveying understanding and their awareness of the client's feelings and thoughts.
There are significant differences in the therapeutic styles of these two approaches. The first approach I am going to discuss is the Kohut's self psychology his approach was from a psychoanalyst's stance that the client does not know themselves and the therapist does. But changed to integrate the view of humanist Carl Rogers and believed that clients know so much more than the therapists what they need to improve their situations. The second approach I am going to discuss is Clarkson's 5 relationship model. This approach is the therapist is their real self, has respect for the client, is equal to the client, the therapist must be committed to helping the client change from negative ways of thinking. But the therapist can take on an authority figure if the client enters in to a reparative relationship with their therapist.
Kohut self psychology believes that by meeting the needs that have not been met by the clients parents in childhood. Being empathic, understanding and explanatory to his client's, and being a human. Kohut also focuses on deficits from negligent parenting from his client's childhoods and their effect on the client's present behaviour and moods. (M. Kahn 1990) Kohut was a relationship therapist and thought that explanation had a value; he felt that client and therapist became more like fellow worker or a member of staff building in the explanatory system. He believed that the relationship he had with his client had greater complexity and maturity than a relationships based on empathy alone.
This approach emphasises on the three main needs outlined in the first paragraph of this essay. (M. Kahn 1990) Kohut also taught that not enough empathic acceptances from a child's parents drive large parts of the personality deep underground.
Clarkson's 5 relationship modal from an integrative perspective. From this view the way that I am now going to attempt to integrated these models in to the therapeutic relationship the first is exploring.
This part of the session is the working alliance where the therapist must focus on the client and cooperate to (Eddy Kloprogge 2008) build a basic contract which people agree to work together this is a good foundation for the therapeutic relationship to start. The therapists needs to listen to the client reflect feelings to the client to see if he has the right meaning at this point the therapist would find out what the client needs or wants and what the client would want to get from counselling. The therapist needs to attend in the session to show the client that he is focussed on the client. An important part of this is the person to person relationship that uses the core conditions. These are empathy, congruence and unconditional positive regard.
The middle understanding of the session is the transferential and the counter transferential relationship. This relationship could be the same as godparent or step parent and be deficient of real parents. This way of exploring with the client supporting them encouraging and accepting them for who they are. Transference can be seen as an adult returning to child like habits and events. It can appear in the relationship by the client taking past behaviours in to the present session and directing them at the therapist and not the parent that it was directed at in the past. The therapist might not be able to separate his thoughts for his parent and his client's parent Counter transference this relationship could be seen as parent and child. The therapist has a distorted view of the client and the therapist becomes the child and the client the parent. This cover immediacy this is the feelings of the client that come up for them in the session. The client and therapist relationship can heal previous trauma this is the reparative relationship and this is done by contributing the core conditions at the appropriate time during the session.
The end action of the session is the person to person relationship and the transpersonal relationship. The therapist in this part of the session is looking at the client's evaluation of the session. The client should be setting goals that are realistic and attainable. This is the transpersonal relationship also the spiritual dimension this is when things happen in the therapeutic relationship that there are no explanations for could be called "aha" moments. I think it's important not to look at this too much if it damages the other relationships.
Kohut's self psychology in relation to the therapeutic process in counselling. The first part is transference when the client takes feelings from the past in to the present, meaning in to the session that is happening with the therapist. This is when Kohut takes on the role of the parent, but instead of reacting to the client as their parent would, Kohut would respond to them using empathy as a tool. To make his clients feel understood and accept their experiences and then need for mirroring is accepted and understood. This also help the client get more of a sense of self.
This is the second part of the process is transmuting internalization in this part the client is going to start to build structures for themselves. Piece by piece the client will develop transmuting internalizations and the structures created by the client are important to the building a well integrated and strong self, the clients need to be mirrored won't bother them anymore because the need has been met in the therapeutic process.
The third part of the process is the alter ego in this part of the process the therapist makes his clients realised that they are the same as the rest of us through empathically interpreting the client's view of their self. The therapist must meet the need well enough for the client to develop a sense of belonging and feel part of society on a whole. The last part of the process is the self in this if all the needs are met the client will grow and have a healthy view of self not distorted by other external evaluation.
I am going to summarise I have discussed and explored the principles of Kohut's self psychology and Clarkson's 5 relationship model. I think that integrative models can work in practice as Kohut has shown by taking elements like empathy from the humanistic approach and practicing it within the psychodynamic reparative model in the psychodynamic approach it in to the reparative relationship approach and Clarkson's framework of the 5 relationship integrative model has shown that this theory can work. I think that for this integrative model to be used the therapist would have to be competent. I have discussed the differences in these therapeutic approaches. I think one of the similarities that both these two approaches focus on is the quality of the relationship between therapist and client to help facilitate client change and development.
However there are opposing theories in Clarkson's approach, for example the person to person and the transferential and counter transferential. Working from a person to person approach the therapist takes the view that he is in an equal relationship with his client he is not there to give advice or direction to his client and by applying the core conditions in the counselling process there will be some therapeutic change However the psychodynamic approach is more to do with interpreting the clients views and meaning. This is the way that psychological change happens.
The therapist adopts the position of authority in the relationship which is the total opposite of the person to person relationship. This is the same for Kohut's self psychology because through the transference in the relationship the therapist takes a position of a parent which is the authority figure in the relationship. Through transference the therapist employs empathy and a tool for a reparative relationship to help heal the client. Theoretically integrative models don't work because they cannot only be confusing for the therapist. It can also give the client opposing views of the therapist and their roles in the counselling process. But Kohut and Clarkson have shown that it can work if the therapist is sensitive to all the subtle changes within their clients and the counselling process.
P. Clarkson 1990, The therapeutic relationship, Whurr
P. Clarkson 1995, The therapeutic relationship, Whurr
M. Kahn 1990, Between therapist and client, Holt
Sue Culley and Tim Bond 2004, Integrative counselling in action, Sage
Dr. Eddy Kloprogge 2008, http://organizationalconstellation.blogspot.co.uk/2008/11/5-relationship-model.html
Heinz Kohut, http://en.wikipedia.org/wiki/Heinz_Kohut