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Research Paper

The therapists use of self: A closer look at the processes within congruence
Joanna Omylinska-Thurston & Pamela E. James
Background and research aims: The researchers aim was to find out from person-centred practitioners how they process their inner experiences in the therapeutic relationship. From a theoretical standpoint, it meant creating a framework of processes and stages within congruence. Methodology: Seven person-centred therapists were interviewed with regard to how they processed and used a strong feeling, thought or sensation that they experienced with a client. Data was gathered using semistructured interviews. Grounded Theory Approach was used to analyse the data. Results: It was found that the therapists processed their internal experiences in the therapeutic relationship through the stages of Receiving, Processing, Expressing and Confirming. Conclusions: It seems that to be able to use the self in the therapeutic relationship counselling psychologists need to be present and tuned-in internally to create conditions for receiving thoughts and feelings from clients. According to the therapists participating in this study who used their internal experiences in therapy, it seemed helpful for clients and a key aspect of the therapeutic process. It did require, however, the therapists to have a high level of self-awareness and internal discipline in order not to act-out and misuse power in the therapeutic relationships. These findings indicate the importance of continuous personal development for practising counselling psychologists Keywords: therapists use of self; congruence; empathy; therapeutic relationship; countertransference.

Background and research aims


HE FIRST authors (Joanna) initial employment in the National Health Service (NHS) involved being an assistant psychologist with people with learning disabilities. Her then supervisor introduced her to the idea that the therapists thoughts and feelings during therapy could give insight into the inner world of the client. This was particularly useful when working with people with learning disabilities who often had communication difficulties. Sinason (1992), for example, wrote passionately about these issues. At the time the first author was also training to be a personcentred counsellor, and whilst working with clients, she often picked up feelings in the room and felt that clients found it helpful when she shared these feelings with them. As this process seemed very useful for clients but also very complex, she wanted to find out how other therapists dealt with these situa20

tions and the idea for this research was born. Therefore the aim of this research was to find out from person-centred practitioners how they process their inner experiences in therapy. Strawbridge and Woolfe (2003) considered the therapists use of self as a vital part of the therapeutic relationship. The terms congruence and empathy from within the person-centred approach and counter-transference from within the psychodynamic approach have been used to describe the therapists inner experiences during therapy and their use of these with clients. Although this research looks at person-centred processes it seemed important to include counter-transference as, historically, Freuds introduction of this term, focused attention on this area of therapeutic practice. Heimann (1950) saw counter-transference as all of the therapists internal responses to the patient. The therapist was

Counselling Psychology Review, Vol. 26, No. 3, September 2011 The British Psychological Society ISSN 0269-6975

The therapists use of self: A closer look at the processes within congruence

encouraged to examine what was going on for him/her whilst working with the patient and use this knowledge to further understand the patient. Racker (1953) differentiated complementary or concordant identifications. Concordant identifications were seen as empathic responses to the patients thoughts and feelings. Complementary identifications were explained in terms of projective identification (Klein, 1946) where the client unconsciously stirs up within the therapist a powerful experiential state that complements the clients immediate self-experience. To gain an understanding of how this process can be used therapeutically, Tansey and Burke (1989) introduced a unitary sequence of the processing of counter-transference which included a Reception Phase, an Internal Processing Phase and a Communication Phase. The Reception Phase starts as the therapist begins to experience the interactional pressure and an affect signalling counter-transference, but he needs to be aware of any other interference to his own mental set. The Internal Processing Phase involves containing this emotional response and separating from it, in order to observe self and the patient. Then the therapist needs to listen through his working models to gather more information about the interactions between patient and therapists and to establish if concordant and complementary identifications are operating. The Communication Phase involves non-interpretative and transference or counter-transference-based communications, referring to the therapists experience and understanding of the patient. Empathy, from a person-centred perspective, involves laying aside ones own way of experiencing reality and perceiving what it is like for the client (Mearns & Thorne, 1988). It includes ongoing effort to stay attuned to a clients process and being receptive to the client. According to Cooper (2005) this way of working often involves experiencing a range of thoughts, feelings and bodily sensations and communicating these experiences

back to clients can bring powerful moments of connection. The communicating aspect of empathy links with congruence. This research investigates congruence. For the purposes of this research, congruence relates to the therapist processing and communicating her inner experiencing of the client in a genuine and authentic way (Klein et al., 2002). This involves the therapists awareness and integrity and the ability to communicate this awareness to the client. Congruence has also been named as immediacy (Turock, 1980) and transparency (Lietaer, 1993). Lietaer said that the therapist should share her feelings with her client only when it is in response to the clients experience, when it is relevant to the immediate concern of the client and if it is persistent or particularly striking. Tudor and Worrall (1994) identified four requirements needed when using congruence: (1) that the therapist is aware of the flow of feelings and sensations within (self-awareness); (2) that the therapist is able to be and to live these experiences (self-awareness in action); (3) that the therapist is able and willing to communicate that awareness in the immediate moment of the relationship with a client (communication); and (4) that the therapist evolves coherent and ethical criteria for assessing when it may be appropriate to share that awareness (appropriateness). Lietaer (1993) underlined that the disclosure could provide the client with a corrective emotional experience, as the therapist experiencing of her client may substantially differ from the clients distorted view of himself. Greenberg and Geller (2001) put forward a theory of stages within congruence, and highlighted the importance of therapeutic presence as a prerequisite for congruence. The movement within congruence spanned four steps. The first step involves preparing the ground within oneself for being fully there with the client. The second step involves receptivity and taking in the fullness of the clients experience. The third step includes inwardly attending and 21

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being in contact with how the experience resonates in the therapists own body. The fourth step is expressing and contact which involves expressing that inner resonance or directly connecting with the client. According to Greenberg and Geller the experience of this process involves total absorption; the therapist trusts that whatever emerges is necessary for healing to occur. The therapists movement of attention is guided by what is most poignant in the moment. Linking with the definitions and processes within the congruence, the aim of this research is to find out how personcentred practitioners process and use their inner experiences within the therapeutic relationship.

Methodology
Participants Seven therapists were recruited gradually, on a basis of theoretical sampling (McLeod, 2001). All therapists were trained as counsellors. Six therapists core training was in the person-centred approach. One therapists core training was in psychodynamic counselling but she also drew on the personcentred approach. One therapist described her orientation as person-centred/phenomenological/transpersonal. The group consisted of six women and one man representing ages 29 to 54 (M=47.4). All therapists had been in practice for three to 18 years (M=7.85). Ethical considerations Participants were recruited from the researchers place of work in the NHS and they knew the researcher as a counsellor and trainee counselling psychologist. All therapists also run private therapy practices. The inclusion criteria included actively using self in therapy and an interest in exploring this process in more detail. The therapists were not required to include client data and it was not specified if the therapists experience related to NHS or private practice. The researcher knew the participants from the workplace and was aware of the limitations 22

of this for the validity of the results. The participants might have wanted to be helpful to share experiences that fitted with the researchers agenda. The researcher encouraged the participants to be themselves and speak truthfully about their experience. It was explained that anything they say would not affect their relationship with the researcher. Although the researcher knew the participants through researchers place of work it seemed that a personal connection was important for this research. Mearns and McLeod (1984) pointed out that trust, good rapport and quality of research relationship were of critical importance in the qualitative research and this seemed particularly important in this project as it involved asking the therapists about potentially embarrassing and exposing experiences from their practice. A number of ethical issues were carefully considered. All participants volunteered to take part in this project after reading the participants information letter. It was important to emphasise that they did not have to agree to taking part and could withdraw at any point and that would not have an impact on the personal connections with the researcher. All participants consented to being interviewed and audiorecorded. They were reassured about the confidentiality and anonymity of their answers and that all identifiable data would be removed from transcripts. It was explained that the recordings of the interviews would be destroyed once the research was completed. Although the researcher was available for any additional post-interview sessions if needed, the participants had separate supervision/personal therapy arrangements if any issues emerged during interviews that needed to be taken to therapy/supervision. Elliott et al. (1999) pointed out that the researchers perspective will have an impact on the way the research in carried out and they suggested making a bracketing statement to enable readers to interpret the researchers understanding of the data. This information has been included from the outset of this research.

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Ethical approval for this research was gained from COREC (Central Office for Research Ethics Committees). Interview procedure Interviews were used to collect the therapists stories (McLeod, 2001). The therapists were invited to tell their story of working with a client with whom they had a strong internal experience (intuition, gut feeling, thought or bodily sensations) and if and how they used this experience in the therapeutic relationship. Pilot studies highlighted the need for a structure within which the story could be told, so a flexible structure of openended questions was created. The structure included briefly introducing the client and describing the experience, reflecting on how the situation affected the therapist and how they coped with it, how they processed the experience, how they used it, how the client responded and what impact it had on therapy. To explore the stories further the researcher also used questions from the Interpersonal Process Recall (IPR) procedure which is often utilised in counsellors training to help trainee counsellors to become aware of their inner processes during their sessions with clients (Kagan, 1975). IPR has been validated as a psychotherapy process research method by Elliott (1992). Semi-structured interviews were conducted and eight accounts collected (within the flow of her story one therapist gave two accounts). The interviews lasted for approximately one hour (45 to 90 minutes). The interviews were taped and transcribed. Analysis The analysis was guided by the grounded theory approach (Glaser & Strauss, 1967) and the guidelines outlined by McLeod (2001). The interviews were transcribed. After each interview, every question and response was numbered. Any emerging preliminary themes were noted and considered in the subsequent interviews. After a number of interviews there was a sense that

certain themes were being repeated. This was taken as an indicator that enough material has been collected. The first step of analysis involved open coding in order to generate as many as possible alternative categories of meaning units. The categories were framed in terms of what the therapist were feeling, thinking or doing. Every category was given a name and a code relating to the paragraph of interview it came from, to ensure that they were derived from the original transcript. The next step involved clustering categories into a story order and higher order categories (I). These were then clustered further into higher order (II). The final stage of analysis included axial coding and identifying themes emerging within every higher order category. This stage of analysis involved drawing on the work of Grafanaki and McLeod (2002), Rennie (2004) and osiak (1994). Throughout the analysis constant refinement of the categories and themes was applied. The whole analysis was repeated twice for accuracy. Any categories that were not adequately grounded in the transcript were excluded. Furthermore, identified higher order categories, axial codes and main categories were matched with the story of every interview to address any discrepancies in the emerging results. To provide the credibility check (Elliott et al., 1999), the individual stories were sent to all therapists for comments.

Findings
The aim of this research was to find out how therapists used their inner experiences in the therapeutic relationship to inform person-centred practice. During the process of clustering it was noted that the therapists were going through a cycle: feeling uncomfortable/anxious to comfortable with a sense of release. From the analysis, the processing of internal experiences involved going through stages of (main categories) Receiving, Processing, Expressing and Confirming. The results are summarised in Table 1.

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Table 1: The processing of discomfort in the therapeutic relationship (higher order categories, axial codes and main categories). The numbers of therapists that touched on a particular axial code are noted in brackets.
1. RECEIVING (a) The therapist is present, tuned-in and ready Tuned-in to physical/emotional state (6) Aware of outside influences (4) Aware of feelings towards the client and the therapeutic process (8) Ready to engage in the therapeutic relationship (5) (b) The therapist experiences significant discomfort which is: striking (6) persistent (4) out of the therapists control (7) powerful and clear (8) experienced as bodily sensations (5) experienced as emotions (4) experienced as thoughts (6) (c) The therapist and the therapeutic relationship are affected Feeling more vulnerable (6) Anxiety level is increased (8) Emotional and physical fatigue (6) Unsure of what to do (4) Forced to disengage (5) Struggling with unwanted responsibility (5) Concerned about fitness to practice (6) 2. PROCESSING (a) The therapist is using internal coping strategies to deal with the discomfort Distancing/ separating (5) Reducing tension/anxiety (5) Support seeking (5) Wanting to escape/ avoid (4) Alert watchfulness (8) Initiating therapeutic activities (4) Focusing on self (4) Planning (6) Reacting to difficult feelings (4) Minimalising (3) Wishful thinking (4) (b) Making sense of her discomfort Working on her self-awareness (7) Working on person empathy (7) Working on relational depth (8) Process identification (8) Process direction (5) (c) Using supervision (4) Reducing tension/anxiety (2) Separating feelings (4) Working on self awareness (2) Working on person empathy (3) Working on therapeutic issues (4)

1. RECEIVING Prior to receiving an internal experience (discomfort) the therapists described themselves as present, tuned into and ready to engage with clients. The discomfort affected them and their work. (a) The therapist is present, tuned-in and ready Before experiencing discomfort in the therapeutic relationship the therapists were tuned-in to their physical and emotional state (e.g. feeling tired). They were aware of 24

feelings towards the clients and therapeutic process (e.g. feeling irritated) and were ready to engage in the therapeutic process: I go into a different mode... I totally focus on the other person... I am listening to them... I allow myself to soak up whatever comes. (Elsie) (b) Therapist experiences a significant discomfort The therapists became aware of a significant discomfort which felt striking and clear. It usually arrived suddenly and it felt persistent

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The therapists use of self: A closer look at the processes within congruence

Table 1: The processing of discomfort in the therapeutic relationship (continued).

3. EXPRESSING (a) Looking at appropriateness and safety of using discomfort for therapy Therapists blocks (7) Clients process (8) Quality of the therapeutic relationship (5) Awareness of potential risks (7) (b) Making sure the discomfort is processed properly and the issue belongs to the client (4) the therapists issues are separated and processed (5) the outcomes feel right and accurate (3) (c) Working out how to use the discomfort Timing and place (5) Other preparations Verbal or bodily disclosure (7) Using discomfort for other therapeutic purpose (2)

4. CONFIRMING (a) Connecting between the clients and the therapists experience The client communicates the disclosure connected with the clients experience (6) The therapist senses that her disclosure connected with the clients experience (7) (b) Shifts in the therapists discomfort The therapist is feeling a shift in her discomfort (8) The therapist continues to feel the discomfort (3) (c) Changes in the therapeutic relationship More openness in the therapeutic relationship (5) The therapist feels hopeful about the work (5) The clients sense of safety have increased (5) (d) Changes in the client The client more aware of self (6) The client able to trust her internal locus of evaluation more (6) (e) The therapists positive views of using her discomfort in the therapeutic relationship (8)

and intense. The therapists described it as bodily sensations (e.g. feeling sick), emotions (e.g. feeling helpless) and thoughts: she was reminding me of somebody (Linda) I was thrown back to the past there was this larger than life womanshe overwhelmed me (Linda) (c) The therapist and the therapeutic relationship are affected Having experienced a significant discomfort therapists were struggling with feeling vulnerable and having to hold the thera-

peutic space at the same time. They reported fighting to stay engaged with clients. I felt blown apart frozen, paralysed (Linda) The therapists reported feeling deskilled and concerned about their fitness to practice. As they had to get on with the situation they were left feeling exhausted. 2. PROCESSING Receiving the discomfort felt difficult to all of the therapists which led them to using a range of coping strategies including supervision. 25

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(a) Using internal coping strategies The most common coping strategy to deal with the discomfort was alert watchfulness which included monitoring self and listening to the client. Another strategy was planning what to do (e.g. taking a painkiller). Distancing and separating were also used including registering feelings but not entering into work. The therapists also used strategies to reduce tension and anxiety (e.g. self-reassurance), they sought support (e.g. sharing with a colleague), they avoided feelings or being more proactive. I knew I could do assessment and said would you like to start I actually listened to information responded empathically I did not enter into any work with her. (Linda) (b) Making sense of the discomfort Therapists conceptualised how the discomfort connected with the client through examining how it felt and how that discomfort and the clients difficulties related to each other: it felt that the client felt trapped in this relationship there was identification: I am stuck, are you stuck? (Danielle) The therapists were gathering more information on how the discomfort related to a clients difficulties through working at relational depth (e.g. catching the quality of the clients feelings). The therapists also used process identification (e.g. noticing that the client keeps coming back to an issue) and process direction (e.g. asking questions) to gain more information. (c) Using supervision Therapists used supervision to deal with discomfort which helped them to separate, contain and manage their feelings so that they were able to think of the client and not of their own feelings. They were able to gain some clarity whether the feelings related to the client or to the therapist. I talked about it in some depth in supervision which helped me to manage it in subsequent sessions because that intense irritation that I had about her I see in terms of the process of her referral. (Ruth) 26

Another reason for using supervision was discussing practice issues (e.g. fears of not being able to work with a client). Therapists were dealing with tension and anxiety and personal issues that were stirred up. Supervision was also helpful in terms of exploring parallel process and understanding clients feelings. 3. EXPRESSING Having processed the discomfort, the therapists were considering using it for therapeutic purposes. This included looking at the appropriateness and safety of using it, making sure that it was fully processed and working out how to exactly use it. (a) Appropriateness and safety Before using the discomfort the therapists were considering their own blocks: in terms of sharing it with her I find that very difficult, other people challenged her, she gives it back there is a risk to me that she may go back and say this counsellor is a waste of time. (Ruth) The therapists considered the clients process (e.g. not wanting the client to close down) and risks of disclosure (e.g. being gentle with a pregnant client). The therapists also paid attention to the quality of the therapeutic relationship before using the discomfort (e.g. the relationships feeling trusting and open). (b) Making sure the discomfort is processed properly Prior to using the discomfort the therapists were making sure that it is processed properly (e.g. re-checking if it was stirred up by the clients issue rather then their own) which involved waiting and watching if the client brings more examples of the same material. They were making sure that their own issues were separated and that the outcome of the processing felt right and accurate. I just want to offer it and see what the client is going to do with it there was an intuitive feeling of rightness to it. (Garry)

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(c) Working out how to use it The therapists were preparing to use the discomfort and considering appropriate timing and place. Some therapists were sharing in the moment and one of them was waiting until a pattern was established: I waited till there was a pattern and when we had couple of sessions she gave quite a lot of examples of this but I would have not brought it if it was not present in the room. (Ruth) The therapists were considering what to say (e.g. not wanting to share the whole extent of the feelings) and were preparing the clients for disclosure (e.g. by introducing it). The therapists used the disclosure for verbal communication (e.g. owning directly as it feels or sharing part of the feeling with interpretation). The most common bodily disclosure included the therapists facial expression. 4. CONFIRMING After communication the therapists were checking if the disclosure was appropriate and effective. This involved a sense of connecting between the clients and the therapists, shifts in the therapists discomfort and noticing changes in the therapeutic relationship and in the client. (a) Connecting The therapists reported a sense of connecting with clients after disclosure which included the client saying exactly right and bringing it up a number of times during the session. The therapists also sensed that the clients felt understood. I was hoping to catch the point of energy and go with this her response was to feel understood she did not seem so all over the place, it settled her. (Linda) (b) Shifts in the therapists discomfort For most of therapists discomfort disappeared after disclosure or in supervision. One therapist felt relieved after sharing and other felt her heart opened up. There was a sense of an energetic shift in work and that the circle felt completed after sharing.

I would use the word clean it was accurate, no untidiness about it it was really good. (Garry) (c) Changes in the therapeutic relationships The therapists felt there was more intimacy and openness in the relationship. They also felt hope and excitement about what would emerge next. it feels really hopeful, if she is able to take responsibility [I feel] excited curious, what kind of effect it had on her. (Garry) A number of clients felt safer to share more of their vulnerable material. (d) Changes in the clients After the disclosure the clients seemed to be more self-aware and now she would.. come and say something about old and new relationships and a fear of losing him and would acknowledge this huge unmet need there(Linda) The clients also showed more internal locus of valuing themselves (e.g. taking more responsibility for herself and trusting her own internal barometer more).

Discussion
The initial naming of the stages that emerged was inspired by Tansey and Burke (1989). However, the emerged processes within the stages were more relevant to person-centred practice and resonated with Greenberg and Gallers (2001) theory. The emerged process was also inspired by the account of Elsie, one of the therapists who commented: as soon as somebody comes in I go into a different mode because I am there for them I totally focus on the other person I am listening to them and I am picking up all kinds of things from them, not in a deliberately conscious way but it just happens. I allow myself to soak up whatever comes I dont go into my head that opens the door for exchange I dont even see it as you and me I am just focused so the messages are coming...it is not thought through, it is like a process that has got a mind of its own and it is circular 27

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I dont do anything with it until it does something with me when it gets strong I feel something and I dont try to stop it it is clear, I need to get it out of the way really and it just finds it way out the timing is worked out by the process coming, I have got this information, so you wait and you watch it, you receive it again my tuning into that person is always guiding what and how and when say it back to the person 1. RECEIVING According to Greenberg and Geller (2001) the first step of congruence involves preparing the ground. The therapist arrives at the session holding the intention of being fully there with the client. The therapist suspends own concerns and clears the space inside. The research found that prior to seeing clients, therapists prepared themselves by tuning-in to themselves, becoming aware of internal flow of feelings which Tudor and Worrall (1994) considered as the first requirement when using congruence. The therapists in this research became also ready and open to receiving whatever comes from the client. This connects with the receptivity aspect of connecting at relational depth (Mearns & Cooper, 2005). The therapists were ready and willing to use themselves with clients through holistic listening: an attitude of, as Elsie put it, being ready to soak up the client. All elements mentioned above link with Greenberg and Gellers (2001) concept of therapeutic presence which is the essential prerequisite for congruence. In this receptive state, where therapists, like Elsie, were totally absorbed and focused in the moment, the therapist experienced a significant discomfort which included bodily sensations, thoughts or feelings. Mearns and Cooper (2005) confirmed that if the therapist is receptive and attuning to clients she was likely to receive these experiences. The discomfort felt striking and persistent. Lietaer (1993) would say that this was an indication of its relevance for the clients process. 28

The discomfort had a profound impact on the therapists as they felt anxious and fatigued. Although Kramer (2000) saw anxiety as an indicator that something important was happening in the therapeutic relationship, it left the therapists feeling vulnerable and deskilled. Greenberg and Geller (2001) warned also that anxiety can block therapists awareness which can become fused with the bodily tension. 2. PROCESSING The therapists in this research used a number of coping strategies to deal with the discomfort. The strategy most often used was alert watchfulness which linked with Kramers (2000) suggestions of observing anxiety signals changing as the interaction moves on. The literature does not mention this but the therapists used other coping strategies such as distancing, reducing anxiety, planning, reacting and being more proactive. Processing also included engaging their cognitive side and trying to make sense of the discomfort. This links with Tudor and Worralls (1994) self-awareness in action and Woskets (1999) period of incubation. Supervision was also used; this agrees with Tamaner Brodley (2001) who said that the discomfort needed to be worked through prior to using it with clients. 3. EXPRESSING Greenberg and Geller (2001) said that this component includes the expressing the discomfort in a facilitative and disciplined way. Therapists in this research used the discomfort to facilitate the clients process which involved finding an appropriate and safe way to communicate it. This linked with Mearns and Coopers (2005) concept of expressivity and with Tudor and Worralls (1994) third requirement inherent in congruence. Appropriateness linked with Tudor and Worralls (1994) fourth requirement for congruence. It involved therapists considering their own blocks and Hill and Knox

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The therapists use of self: A closer look at the processes within congruence

(2002) warned that the disclosure has to relate to the clients rather than the therapists needs. The therapists were considering the clients process which linked with Greenberg and Gallers (2001) recommendation to sense if the client was open or too vulnerable to receive the disclosure. The quality of the therapeutic relationship was also considered and Wosket (1999) pointed out that that the relationship needs to be sufficiently established to tolerate the challenge of the disclosure. The therapists were aware of potential risks which linked with Jordan, Wallker and Hartlings (2004) reminder of the ethical obligation not to harm. The therapists were continuously checking whether their feelings related to those of their client. This corresponds with Gendlins (1962) advice to take a few steps of self-attention before disclosure. They were also checking for accuracy which connected with Turocks (1980) concern not to misinterpret the feelings and to keep listening to receive the same message from the client. In terms of timing of the disclosure, the therapists were sharing in the moment, in the following session or after supervision. It felt important to find an appropriate moment to share as Hill et al. (1990) pointed out the timing is more important than how much is actually disclosed. This links with Kramer (2000) who said that he keeps quiet when the client is in a flow not to disturb the client. The therapists were preparing what to say which was also supported by Kramer (2000). Mearns and Thorne (1999) advised, however, not to wait too long with the disclosure. They warned about the dangers of splurging congruence where the therapist holds a feeling over a long period and discharges it usually out of a punitive motivation. Greenberg and Geller (2001) also warned about making sure the disclosure involves a core feeling (e.g. hurt) rather than secondary (e.g. anger). The therapists reported owning their feelings when disclosing following Rogers (1970) advice to communicate their own experience rather than judging or evalu-

ating the client. For Greenberg and Geller (2001) the disclosure should be made non-judgementally, non-blamefully and not from a one-up position. Hanson (2005) suggested making disclosures that were brief and concrete so the client could understand and accept. This was also apparent in the therapists disclosures. Although the therapists did not mentioned this, Wosket (1999) talked about a gradient of responding. She would start by letting the client know that she noticed something giving the client the opportunity to comment and then, if still needed, move to more direct disclosure. Greenberg and Galler (2001) suggested also comprehensiveness and saying not only what was felt but also what was being felt about what was being felt. 4. CONFIRMING The research findings show that the participants tended to ask and confirm if their disclosure was helpful to client, as consistent with Kramers (2000) recommendations. Therapists were enthusiastic about using discomfort and talked about it as The Therapy. This finding agrees with Rogers later publications (1980) where he considered congruence as a core aspect of therapy. However, this finding is not confirmed in more recent reviews of research on congruence. Klein et al. (2002) and Orlinsky et al. (2004) found that approximately only 30 per cent of studies were showing links between levels of congruence and positive outcomes. Cooper (2008) also added that studies that ask clients to describe most important aspects of therapy did not indicate strong links between congruence and outcomes. Even though the evidence in regard to congruence is not conclusive, Steering Committee (2002) indicated that congruence was a promising and probably effective element of the therapeutic relationship. In this research clients confirmed that the disclosure connected with their experience and the therapists also sensed the connection which Cooper (2005) referred to as a feeling of interconnection (p.18). 29

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The therapists reported feeling a shift which was consistent with Tamaner Brodleys (2001) comment that the disclosure dispelled the therapists discomfort. The therapists felt more openness in the relationship which was supported by Jourard (1971) who found that the personal openness of the therapist facilitates the openness of the client as the power imbalance between the therapist and the client is reduced. There was an increase of intimacy which agreed with Wosket (1999) who commented that relational self-disclosure often fosters intimacy in the relationship. The therapists felt also more hopeful about the work which was supported by Mearns and Cooper (2005) who noticed feelings of satisfaction when working at depth which helped the therapists to keep motivated to engage on that level. The clients sense of safety increased which agreed with Mearns and Cooper (2005) who said that experiencing the therapist at relational depth gives the client a sense of safety through which she or he could begin to explore difficult aspects of self. Also for Greenberg and Geller (2001) sharing own experience was a crucial factor in establishing trust and helping the client to feel safer to tolerate relational anxiety. The therapists reported that clients became more aware and reflective about themselves. This was confirmed by Doster and Brooks (1974) who found that clients were more self-exploring after the therapists selfdisclosure than in sessions with non-disclosing therapists. Greenberg and Geller (2001) also commented that immediacy allowed clients to be more present with themselves and reflect more on underlying issues. The therapists noticed also that the clients developed more trust in their internal locus of evaluation and felt more confident in sharing about themselves. Mearns and Cooper (2005) confirmed that through relating at depth, clients might develop the confidence and skills in relating on that level. Similarly Jourard (1971) pointed out that therapists sharing their own experience served as a model for the clients to be themselves. 30

Conclusions
According to Norcross (2002) the therapeutic relationship is one of the most important contributors to a positive outcome in therapy. Counselling psychologists base their work on this finding and consider facilitating therapeutic relationships as one of the fundamental aspects of client work. A core part of this work involves counselling psychologists use of self, which within the person-centred approach is referred to as congruence. Grafanaki (2001) said, however, that most research offers very limited access to internal processes within congruence; it is still one of the most complex issues to study within the person-centred approach. The findings of this research contribute to this area and show the stages and the processes within congruence. Therapists described processing their experiences through the stages of receiving, processing, expressing and confirming. These findings are in line with Greenberg and Gellers (2001) stages of processing congruence which involved preparing the ground, receptivity, inwardly attending, expressing and contact. Greenberg and Geller (2001) also wrote about the therapeutic presence, the pre-requisite for using congruence within the person-centred work which was also evident in this research. In terms of implications for practise, the findings from this research imply that to be able to use the self in the therapeutic relationships, counselling psychologists need to learn to be present and tune-in internally. This can be developed through, for example, a daily meditative practice. Counselling psychologists also need to have a high level of self-awareness and integrity in order to deal with these processes in sessions. It often involves having to work whilst internal blocks are activated, which could lead to the misuse of power in the relationship. According to Wyatt (2001) it is the responsibility if each therapist to self-reflect and monitor these issues via supervision and personal therapy. There are, however, limitations to the findings of this research as they stay closely

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The therapists use of self: A closer look at the processes within congruence

to the researchers philosophy and way of practising. The participants were recruited using personal connections and perhaps they, through wanting to be helpful to their colleague (researcher), shared experiences that fitted with the researchers agenda. In the same way, the researcher recruited the participants and analysed the data in accordance with her own worldview and approach to therapy which has been included from the outset of this research. Looking from another standpoint, however, the findings of this research have support from Siegel (2010) who examines the formation of the therapeutic relationship from the point of view of brain science. For him the key elements of forming the therapeutic relationship involve the therapists presence (openness to oneself and the other) and attunement (to ones own flow of feelings and to the other). When tuned in to the self and the client, it is possible to resonate with own and others internal state. This is shown, for example, in Elsies account. Siegel (2010) concludes that we are biologically predisposed to resonate with one another (via mirror neurons) and in that way it is possible to have an impact on and influence one anothers internal states. This is one of the key aspects of therapy illustrated in this research.

Acknowledgements
This study was conducted in 20042006 as part of the first authors Qualification in Counselling Psychology and the second author was her supervisor. Joanna would like to thank her supervisor and also the therapists that took part in this study.

About the Authors


Joanna Omylinska-Thurston Chartered Counselling Psychologist; HPC Registered; Liverpool Psychology Service for Cancer; Royal Liverpool and Broadgreen University Hospitals Trust. Joanna is currently undertaking the Top-up Doctorate in Counselling Psychology run jointly by the Caledonian University and the University of Strathclyde. Pamela E. James Chartered Psychologist and HPC Registered Counselling Psychologist; Emeritus Professor of Counselling Psychology; Independent Practitioner.

Correspondence:
Email: joanna.omylinska@btinternet.com

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Joanna Omylinska-Thurston & Pamela E. James

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