Academic journal article Social Work

Client's View of a Successful Helping Relationship

Academic journal article Social Work

Client's View of a Successful Helping Relationship

Article excerpt

Social work, along with other helping professions, has long sought suitable means for defining and measuring the success or failure of various interventions. All too often, however, the profession has attempted to do so from the perspective of involved professionals, investing less effort in documenting clients' own responses. Moreover, studies that ask for client viewpoints tend to do so through a list of variables created by the researchers, consequently neglecting the actual subjective treatment experience.

This study asked 11 women from multiproblem families in Israel to describe a successful helping relationship. The replies were analyzed using narrative research techniques and the results are presented here in conceptual categories generated from the data, with illustrative quotations from the interviews. We have presented results concerning the nature of the assistance elsewhere (Knei-Paz & Ribner, 2000), that is, the specific help received in the relationship that the client saw as contributing to a successful helping experience.

We see this method as contributing a uniquely rich and effective view of the other side of the client--worker dyad, one that is often lost when using quantitative procedures. As Rosenfeld and Sykes (1998) noted about this client population: "Only through learning about their experiences, perceptions, and understandings, can researchers learn what they and others like them need and how they can best be helped" (p. 294).

Successful Intervention

In their study of the effectiveness of various psychotherapies, Luborsky, Singer, and Luborsky (1975) illustrated their conclusions with a quote from Alice in Wonderland, "Everyone has won and all must have prizes." Most schools of psychotherapy, they maintain, predict similar benefits for patients and clients, making the task of differentiating among styles a difficult one. In this vein, Mahrer and Nadler (1986) noted that all therapists, when describing treatment success, tend to use uniform language, such as change, progress, improvement, or movement, with the understanding and use of each of these concepts modified by various theoretical models.

One way of attempting to group the attributes contributing to successful interventions is to make use of three perspectives. The first focuses on the use of specific factors--that is, clearly defined techniques and activities (Hill, Carter, & O'Farrell, 1983), with each school of psychotherapy emphasizing those specific factors that fit into its treatment philosophy (Parloff, 1986).

The second approach sees nonspecific factors as being the primary generators of client change (Dasberg, 1987; Laffrety, Beutler, & Cargo, 1991; Miller, Taylor, & West, 1980). These factors, principally related to the therapeutic relationship, include, for example, warmth, empathy, understanding, acceptance, and involvement, which Bent, Putnam, Kiesler, and Nowicki (1976) and Cooley and Lajoy (1980) identified as significant contributory factors to treatment success from the client's viewpoint.

The third perspective looks at the interaction between specific and nonspecific factors within the context of influences such as the skill of the therapist and the level of client distress. This approach, based on the assumption that no single technique can be proved more significantly effective than another (Jones, Cummings, & Horovitz, 1988), sees each client-therapist relationship in a singular interactional context in which numerous variables influence the potential for treatment success. In addition, both the client and therapist may evaluate the significance of change from independent vantage points (Butler & Strupp, 1986). This final perspective permits the viewing of each client's narrative as unique, influencing the therapist's choice of those specific and nonspecific factors to be used in treatment, as well as the client's evaluation of interventive success or failure. …

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