Connecting with clients

The founder of the person-centred approach, Carl Rogers, (1902-1987) discussed the importance of the six necessary and sufficient conditions in which counselling could be effective.

These conditions involved:

1. Establishing a psychological connection between the client and counsellor.
2. One person was incongruent (internal feelings not shown).
3. A state of being genuine and congruent shown by the counsellor.
4. An empathetic understanding by the counsellor.
5. Unconditional positive regard for the client was conveyed.
6. The client was able to some extent receive the empathetic understanding.

This was enough to form the basis of a therapeutic relationship, (Rogers, 1956).

In more recent times, an awareness of the internal processes of the client through the autonomic nervous system highlights the unconscious reactions to stress and the body's responses and patterns.

As well as the six necessary and sufficient conditions, the counsellor's nervous state of calm in a safe state of social engagement co-regulates the client's sympathetic (or dorsal state) of fight or flight or shutdown. The client may be experiencing overwhelming feelings or not feeling anything, whilst conflicting with their outward appearance. Being with the client and accepting their state is their body's protection from stress, offering acceptance and empathy with the client in the present moment. Both nervous systems interact and a safe connection can be formed, (Dana, 2021).

How can we create a safe space?

A safe space is identified by:

• eye contact
• welcoming facial expressions
• smile
• leaning inward
• open body language
• attentive and empathetic responses

Counsellors are skilled in active listening, open questioning, validating emotions, and using the core conditions of empathy, acceptance and being real.

All of these skills display a safe connection for the client, which is further extended by becoming aware of the inner senses of the client. Being attuned to their automatic reactions to a perceived threat and exploring this in a regulated state of calm in the moment connects the felt sense with the psychological world of the client. Co-regulation supports this safe connection and allows for an awareness of the nervous system, letting the client attune to their own safe space, (Porgess, 2006).

Conflicting inner and outer feelings, conditions of worth, external locus of evaluation and experiences of not being accepted as yourself impact a person's perception. A loss of identity, self-worth and value negatively impacts the self-concept. A normal reaction to this stress is to go into a protection state in the autonomic nervous system, in order to feel safe. A constant state of hyper-vigilantness, anticipating danger, could be a way of being for some people in stressful environments.

How can counselling help clients manage this stress? 

Counselling can support a client to become aware of their unconscious reactions to stress, through a safe connection, bringing attention to their internal processes. It can help them understand how an individual's reaction is a normal response in a stressful situation to keep them protected and safe, which may now be the cause of distress for the person in the here and now. Understanding the different states and accepting the natural bodily reactions develops an awareness of choice.

Through awareness, understanding and acceptance, change is possible with co-regulation. Being attuned to the client's nervous state, while remaining in a social engagement of safety, can help the client to regulate their system and be aware of when it shifts from sympathetic, (fight or flight) dorsal, (shutdown) or parasympathetic, (safety and social engagement).

Psycho-education can support the client to discover what state their body is currently experiencing and that it is normal to move from one nervous state, into another one. When sleeping, the body is in a shutdown, dorsal state and moves into mobilisation, (flight) once awake to fulfil daily tasks or needs.

If you experience a traumatic situation, the nervous system will automatically shift into a protective state. The transformation of differing nervous states is a continual process, outside of awareness, but if the nervous system is stuck in one state, support is needed to slowly be able to connect and change in a safe space.

References

• Dana, D., (2021) Anchored: How to befriend your nervous system using polyvagal theory, USA, Sounds True.
• Porgess, S.W., (2006) "The Polyvagal Perpective", USA, Bio Psychol, 76, 86-90 [online] available: https://dx.doi.org/10.3949/ccjm.76.s2.17 (accessed 26/05/2023)
• Rogers, C.R., (1957) "The Necessary and Sufficient Conditions of the Therapeutic Personality Change", Journal of Consulting Pyschology, 60 (6) 827-832.