Importance of the
therapeutic relationship
Discussing the importance of the therapeutic relationship in hypnotherapy and how building rapport and working within a code of ethics would assist you to form and deliver appropriate and effective hypnotherapy.
Rapport with a client in any therapeutic setting is, perhaps, the most valuable aspect of the relationship. Without building a positive relationship with the client it may not be possible to ever fully allow the client to drop their guard in a way that is sufficient to produce a successful relationship. Particularly in hypnotherapy, where the client may arrive with preconceptions about hypnosis (the example I often give to new clients in discussion about what to expect is that many people think of ‘when I click my fingers, you’ll be a chicken’ as the central modus operandi of hypnosis because of a misconception that comes from stage shows which are toying with mental processes which are illegal (Anon., 1978) dangerous and highly unethical), it is of paramount importance that the client immediately identifies a trustworthiness and professionalism in the therapist.
One important factor is to set up the environment. According to Hadley and Studacher ‘there should be a relaxed atmosphere. Soft colours, comfortable furnishings, lush green plants, and soothing music contribute to a sense of restfulness and calm.’ (Hadley & Studacher, 1996). This allows the client to relax upon arrival and will naturally assist with the development of the clients ability to be open to hypnotherapeutic suggestion.
It may be important to recognise also that in your place of work there may be troubleshooting locations which may cause disturbances. This could be, for example, an office phone or a photocopier that may cause distractions when trying to get the person into a hypnotic state. Hadley and Studacher add that it may be advisable to ‘find out if children are usually playing outside, or if construction is going on in the neighbourhood. (Hadley & Studacher, 1996). This will allow for preparation of scripts that allow this to be brought into the deepener; for example ‘you may hear noises such as industrial machinery, but in noticing and accepting these for what they are, if anything they add to your level of relaxation’. Many of the disturbances could be entirely beyond your control and subsequently has to be taken into consideration regardless.
The appearance of the counsellor is important to note as being either too formal or not quite formal enough may bring into question the level of comfort that the client feels upon their arrival. For example, if the client arrives wearing a suit and you are dressed in a t-shirt, the client may feel overdressed and become anxious or unduly stressed about this and subsequently find it difficult to relax sufficiently as they feel they are overdressed. Similarly, if a client comes in wearing a t-shirt and the therapist is, as posited by Hadley and Studacher, wearing ‘an expensive dark suit, dress shoes, and a silk blouse or designer shirt and your client is dressed rather casually, he or she will probably feel subordinate and slightly self-conscious’ (Hadley & Studacher, 1996). Hadley and Studacher argue in favour of dressing ‘neat, but casual – your client will be put at ease’. (Hadley & Studacher, 1996)
It is important in the early stages to remind the client that the process they are about to embark on through hypnotherapy is safe (Hadley & Studacher, 1996) and this reassurance should be fully explained, particularly in explaining that the person’s defence mechanisms will not allow them to put themselves into a dangerous situation so as they become aware of danger they will invariably come out of their hypnotic state. It is important to note that the client will feel vulnerable and subsequently will need reassurance and reminders that this is
The key factor in the relationship is one of real vulnerability on the part of the client (Karle & Boyes, 2010). The relationship develops a bond which is unlike most others and by its very nature is highly open to abuse because of the work performed within the client’s subconscious. In this way, suggestion could be used for the therapist’s own gratification and to develop romantic relationships with unwitting clients. This, of course, is the pinnacle of unethical behaviour and would invariably cause more damage than positive therapeutic effects. A real challenge with this is that the client could, in many cases, fail to recognise this abuse of power despite it being the practitioners intentional all along. The client could feel that they have had many of their presenting issues resolved as a result and be totally unaware that any abuse of power has taken place.
This vulnerability must be carefully managed in a relationship built on mutual intention toward progress from both the therapist, where the only hope and expectation of the practitioner is to provide positive results for the mental health of the client and provide the client to move forward without the permanent continued support of the therapist in question. There could be pragmatic issues in this regard. After having had barriers in their life removed by a therapist, it would be quite a logical step for the feeling of safety, comfort and warmth towards that therapist would lead to the client feeling something akin to romantic love. This is why it is strongly suggested that within any code of ethics that romantic relationships are something to be abstained from (Feltham & Horton, Ian, 2000).
The therapeutic relationship must have an emphasis, alongside abstinence from relationships with clients, have and emphasis on respect for client autonomy, clear contracting in advance of therapy, confidentiality and being non-exploitative of clients (Feltham & Horton, Ian, 2000). This paper will seek to clarify each of these before elaborating on the ways in which the embodiment of these will allow the therapist to exude professionalism and subsequently develop a strong and effective relationship with the client.
Firstly, the autonomy of the client. The client would ideally be present of their own accord and be wanting to discover a measurable improvement in their life. If they feel that this is not being achieved, they should, of their own volition, be free to end the therapeutic relationship. Genuine comfort between the client is more easily achieved in this way, along with empathy and unconditional positive regard for the client (Mearns & Thorne, 2020). Empathy is an attempt to understand where the client is coming from, whilst unconditional positive regard for the client means that whilst the client’s beliefs may not align with those of the therapist, the therapist accepts this about the client and allows for a continued relationship to give space for anything to be discussed without fear of abandonment by the therapist. With these facets in place, the client should feel comfortable enough to pursue a therapeutic relationship which offers a safe space in which they can feel secure enough to fully express themselves with safety and comfort.
Secondly, clear contracting is an important part of any therapeutic relationship as this protects the therapist with regards payment for services and to waver any responsibility in the event the client has adverse effects from the treatment. This provides two key positives, firstly, the client has an understanding of exactly what the relationship with the therapist is, including the formality of the arrangement. Furthermore, the comfort that is provided for the therapist by having such a contract in place will allow the therapist to feel more congruent with the client as there is a clear and transparent document in place that allows all parties to proceed in a safe setting.
There is a conceivable issue surrounding creating such a contract. For example, if a contract of extensive length but the bounds of this contract extend beyond the client’s need, it could present an ethical dilemma surrounding client autonomy. Therefore, an ethical consideration into ways and means of termination of the contract in advance of an agreed term (so long as there is an agreement between client and counsellor as part of the therapeutic relationship) should be taken into account.
Thirdly, clients should rightly expect confidentiality. As a means of creating this confidentiality it is important to discuss with the client exactly what the confidentiality agreement means and the function it serves between client and therapist. Naturally, the information is sensitive and in many cases may be a deeply held secret that hasn’t been shared with anyone previously. The therapeutic basis for sharing this requires confidentiality as the fear that something may be shared and their friends or family (or anyone they know for that matter) may discover these secrets. The best way to exemplify the confidentiality of the relationship is to go over the contract and clearly state that as per the accreditation provided by the National Hypnotherapy Society, in the event the therapist was found to be breaking confidentiality, they would be open to a complaints procedure and could subsequently, as a result of a complaint, lose accreditation from the society and lose ability to practice.
Of course, there are circumstances under which the confidentiality agreement must be broken. Clients who are suicidal present one such issue. According to Feltham and Horton, there are some who view suicidal intent as ‘the ultimate act of autonomy’ (Feltham & Horton, Ian, 2000) and subsequently view it as unethical to break confidentiality even if they do see it as something which is for the good of the client. Feltham and Horton go on to explain that the opposite extreme to this is feeling that someone who is ‘seriously suicidal’ will probably find that ‘if someone can be given temporary protection, their suicidal intent usually subsides’ (Feltham & Horton, Ian, 2000).
Another concern is that a person may be a danger to others. This provides an altogether different position. Feltham and Horton state that ‘Most codes of professional ethics and professional guidelines will permit breaching confidentiality and actively intervening to frustrate the client’s intended outcome’ (Feltham & Horton, Ian, 2000). It is, in this case, very important to make the client aware of this stipulation at the contracting stage so that they don’t feel betrayed by the therapist. This may, many would argue, be unavoidable but there must come a stage at which responsibility for the safety of others takes precedent over the client-therapist relationship.
Finally, the non-exploitative element of the relationship is an important consideration beyond the sexual element discussed, there’s also the possibilities of financial exploitation or exploitation for services which could be offered. This could include, for example, insisting on free labour. For example, a contract in exchange for services could be deemed inappropriate owing to the potential long term nature of the therapy and the question over equating value between the two services.
For example, if a contract was to be agreed for six sessions of counselling in exchange for a tiling contractor to complete work on the therapist’s bathroom, if both were operating at an hourly rate of £50 per hour, it could mean that the contractor receives a limited service from the counsellor as the therapeutic contract could end up being insufficient. This also has tax implications and could be viewed as tax evasion.
Combined, all of the above create a positive and productive relationship in which all parties feel entirely safe. The therapeutic relationship that this creates is one of stability and certainty, which means that the client can be entirely comfortable and begin to explain the full extent of the reasons why they have sought therapy in the first place. The issue of the client being a danger to others notwithstanding, there is a real and practical need for the relationship between the client to be built on trust which is built on a bedrock of a congruent and empathetic understanding alongside unconditional positive regard (Mearns & Thorne, 2020).
It is important to note at this stage that the relationship doesn’t necessarily mean that the therapist has to like the client or even particularly enjoy their company, but that their intention is to see a positive change in the client over time. This change should always be the priority for the therapist and the development of friendship or any other over-familiar relationship is a path toward unethical behaviour and a watering down of the therapeutic relationship.
Furthermore, Karle and Boys suggest that if a person is performing hypnotherapy for their ‘enjoyment rather than benefit of the patient’ then the therapist should cease to perform the practice of hypnotherapy. Fundamentally, the client’s need is the priority within the therapeutic relationship. This is not to say that the therapist cannot enjoy the company of the client, but if the enjoyment of this company becomes a reason to cling to the client beyond their practical need.
To conclude, the therapeutic relationship is one which requires a close bond between the therapist and the client, a bond built on mutual respect and congruence. The relationship is unusual in many ways because unlike almost all other professions, the counsellor holds a level of intimacy with the client that in many cases may be the only relationship in which they feel genuinely understood, where they experience warmth and positive regard. Hypnotherapy requires a relaxing environment but the broader picture is that from the very first moment the client meets the therapist, the rapport between the two people is something which is central to a beneficial therapeutic relationship.
If no relationship can be built, things simply do not click between the client and therapist in the initial consultation or the first few sessions, then it is probably advisable for the therapeutic relationship to end and an alternative referral made, as a continuation of this relationship is not really in the interest of any of the parties involved.
Bibliography
Anon., 1978. Hypnotism Act 1952. [Online]
Available at: https://www.legislation.gov.uk/ukpga/Geo6and1Eliz2/15-16/46
Feltham, C. & Horton, Ian, 2000. Handbook of Counselling and Psychotherapy. London: Sage Publications.
Hadley, J. & Studacher, C., 1996. Hypnosis for Change. 3rd Edition ed. Oakland, CA: New Harbinger.
Karle, H. W. & Boyes, J. H., 2010. Hypnotherapy: A Practical Handbook. London: Free Association Books.
Mearns, D. & Thorne, B., 2020. Person-Centred Counselling in Action. 4 ed. London: Sage Publications.