A safe environment is crucial to develop a strong therapeutic alliance.

Equality may perhaps be a right, but no power on earth can ever turn it into a fact.

Honoré de Balzac

Seeking counselling takes courage, and it’s natural for many clients to feel apprehensive about the first meeting with the counsellor. Creating a warm and safe physical environment is an essential stepping-stone to building a strong therapeutic alliance. In this chapter guidance is given on setting up the counselling room in a way that helps the client feel comfortable so that they start sharing their concerns. We also provide examples of opening sentences to help break the ice, as well as discussing some other important topics, including building trust and boundary issues such as contracting and terminating sessions on time.

Paying attention to meeting, greeting and seating

For counselling to be effective, the counsellor needs to work at building a relationship of equals. This is easier said than done, especially in the early stages when the client may be feeling vulnerable and insecure, and bearing in mind that it is usual for the client to meet the counsellor on unfamiliar territory, i.e. the counsellor’s consulting room. Striving to keep the room neutral, in other words free from personal belongings such as books, ornaments and family photographs, is a positive step that counsellors can take to reduce the equality gap. Barriers such as desks should also be avoided, and chairs should be uniform and placed approximately three to four feet apart, and slightly at an angle. Being in direct eye contact with the counsellor can leave some clients feeling very uncomfortable or embarrassed. A small clock needs to be positioned where the counsellor can glance at it, and attention should be paid to the lighting, and room temperature. A box of tissues strategically placed where the client can easily reach them is a must, and a vase of fresh flowers or a potted plant can add a touch of warmth and colour to the setting, and reflect something of your personality. With the client’s permission, the counsellor may tape the sessions and this should be set up ready to use.

When meeting a new client, it is also important for the counsellor to pay attention to her own safety. Ensuring that someone else is around and having an alarm button close to hand can help to reduce any anxieties the counsellor might have. However, it should be pointed out that emotional barriers are far more potent that physical ones. Even if all the physical surroundings are perfect, the client still might not feel at ease if the counsellor and client are not in rapport. Figure 6 gives a view of how a counselling room might look.

Greeting the client

Greeting the client can be fairly informal:

• 1.Hello Pat, I’m Jan. Please sit down (indicates chair).
• 2.Hello Paul, my name is William. Please have a seat (indicates chair).
• 3.Hello Mrs Williams, my name is Jan – what name would you like me to call you by?
• 4.Hello, my name is William, and yours is?

Addressing clients by their first name can go a long way towards helping them feel comfortable and accepted. And introducing yourself by your first name can help to break down the barriers of unequality. However, do not assume that because you are feel comfortable being on first name terms that all people are. Ask the client how they want you to address them.

Issuing an open invitation to talk

Your opening sentence should be empathic and your posture should demonstrate to the client that you are ready to listen:

• 1.Pat, perhaps you would like to tell me in your own time what has prompted you to come and see me?
• 2.Paul, we have about 50 minutes to talk together today. Where you would like to begin?
• 3.To the confused client (Claire). You seem to have a lot of concerns. Which one would it help to talk about first?
• 4.To the reluctant client (Ellen). I get the feeling that it’s difficult for you to know where to begin.
• 5.To the resistant client (Danny), who has been sent by a third party – eg magistrates. I somehow sense that you don’t really want to be here, and I’m wondering how you feel about being sent.

For examples of appropriate posture see Figure 11 (page 41).

Building trust

Some clients who seek counselling have been badly let down, hurt or abused by other people, and trust may therefore be a major issue. Trust is something that has to be earned by the counsellor and it can be hard work. However, developing the skills of active listening; accurate, sensitive responding; reflecting feelings; empathy; genuineness; and demonstrating that you are fully present for the client can help to establish a solid foundation of trust. Indeed, the more the counsellor invests in the relationship, the stronger the trust and bond grows between client and counsellor:

• 1.Pat, I can see that you are very distressed because of what has happened.
• 2.Paul, I appreciate that talking about your job being made redundant is very painful for you.
• 3.To the confused client (Claire). Claire, thank you for sharing your concerns with me.
• 4.To the reluctant client (Ellen). It’s been brave of you to share so much with me.
• 5.To the resistant client (Danny). Thank you for being so honest by telling me how you feel about being here.

Knowing what to avoid

• Avoid restricting the client by placing emphasis on such topics as ‘difficulties’, ‘problems’, ‘help’; for example, saying, ‘Please go ahead and tell me the problem’. ‘What difficulties are you having?’ ‘How can I help you?’ Be careful about statements such as ‘I hope I can help you’. We may not be able to help at all.
• Avoid minimising counselling with expressions such as: ‘Let’s have a chat’, or ‘Shall we have a little talk?’ Counselling is not a chat. We talk, yes, but ‘chat’ carries with it inferences of a social meeting, which is not the purpose of counselling. To think of it as chat demeans the process.

Establishing the ground rules for effective counselling

Establishing clear boundaries (the ground rules for counselling) is another important stepping stone to building the therapeutic alliance. Boundaries may include agreement over such things as the duration of counselling, length of counselling sessions, limits of confidentiality, appropriate touching, number and duration of phone calls, sending and responding to emails, or strategies for managing episodes of self-harm or suicidal thoughts.

The terms on which counselling is being offered should be made clear to clients before counselling commences. These may be agreed verbally, or they may be set out in a formal written contract between counsellor and client, and signed by both parties. Subsequent revision of these terms should be agreed in advance of any change. Clear contracting enhances, and shows respect for, the client’s autonomy. A contract helps to ensure the professional nature of the relationship and may, in addition to the ground rules already mentioned, include:

• venue
• fees, if appropriate
• frequency of sessions
• how counselling will be evaluated
• process of referral, if and when necessary
• broad details of the counselling relationship
• duties and responsibilities of each party
• details of the counsellor’s supervision
• goals of counselling
• means by which the goals will be achieved
• the provision and completion of ‘homework’
• the setting of boundaries and expectations
• the terms of the therapeutic relationship
• provision for renegotiation of contract.

Gerard Egan, in the fourt edition of his popular book The Skilled Helper emphasises the point that:

Ideally, the contract is an instrument that makes clients more informed about the process, more collaborative with their helpers, and more proactive in managing their problems. At its best, a contract can help client and helper

develop mutual expectations, give clients a flavor of the mechanics of the helping process, diminish initial client anxiety and reluctance, provide a sense of direction, and enhance clients’ freedom of choice. (1990:81)

For an example of a written counselling contract see Figure 7.

Ending the first session

It is important to end sessions on time. This helps the client feel safe, and to understand the ‘ground rules’. When a session is nearing an end, it can be helpful to say something like: ‘We have about 10 minutes left of this session. Perhaps it would be helpful to summarise what we have talked about today.’ It can often prove beneficial to let your client summarise what has been discussed during the session. Something like, ‘What will you take away with you from today?’ helps the client to summarise. Your closing sentences need to be clear, and should indicate that it’s time to end the session.

Things to avoid

• Don’t introduce new topics into the concluding period. If you do this, it may confuse your client. He or she will think that they can still go on for a while. If your client introduces a new subject in the last few minutes of the session, you could say: ‘I can see that this is very important to you, and I think it is an area we could look at in more depth in our next session together. How would you feel about that?’
• Some clients wait until they are leaving before disclosing an important piece of information, for example, ‘Oh, by the way...’ This may reflect the client’s feeling of shame or embarrassment, or the realisation that this is their last opportunity to ‘let the cat out of the bag’. Don’t be manipulated into giving extra time. Again, show the client respect by saying something like: ‘I appreciate your courage in telling me that. I can see that it wasn’t easy for you, and it sounds as if you have been holding on to that secret for a long time. Would it help if we allocated the next session to give the situation the attention it deserves?’ Often, just verbalising a painful secret, and being heard, can bring a tremendous sense of relief.
• Don’t get hooked into the presenting problem. The problem which the client chooses to talk about, or the ‘presenting problem’ as it is sometimes called, is of considerable significance. It is what clients complain of, their ‘admission ticket’ to counselling, a ‘trial balloon’. Sometimes it is something which is not of primary importance in order to test out the counsellor, but more often it represents that aspect of the client’s problem which, at this present time, is giving him the most anxiety. Perhaps it would be too emotionally demanding to talk about the significant problem before the counselling relationship had been firmly established. Whatever the reasons, it is always wise to sit back and wait for the client to develop the theme. At the same time, it is essential to acknowledge the presenting problem, but being aware that there are probably other issues to be considered.

Exercise

Exercise 2

Building trust and rapport: case study

A distressed woman makes an appointment to see you. Immediately she enters the room she bursts into tears, and says: ‘He has left me, and I just don’t know what to do. I feel so lonely and the children are upset. What do you think I should do?’

Write a response that demonstrates that you are fully present with the client.

Example of how to build trust and rapport

‘I can see you are very distraught because your partner has walked out on you, and it’s hurting your children too. I’m also picking up that you feel your chances of sorting this out on your own are pretty low at the moment.’

Summary

This chapter has focused on developing the skills to help establish a safe and therapeutic environment for the client. Particular emphasis has been given to meeting, greeting and seating, boundary setting, and strategies for developing trust. The next important stage is acquiring the skills that can help clients to explore their problems.

When love and skill work together,
Expect a masterpiece.

                                           John Ruskin