The therapeutic relationship

The idea of the “talking cure” has only been around for about a century. At its core is the development of a therapeutic relationship. This relationship is a special kind of intimate dialogue, with  specific guidelines and limitations. I think that there’s something to Freud’s notion of transference and counter-transference. Transference is when clients “transfer” feelings about a significant other (parent, lover, close friend) onto their therapist. Counter-transference is when a therapist is unaware of his own feelings about a client, to the extent that it unconsciously influences the relationship.

It’s incumbent on the therapist to be aware of these dynamics when they occur: to be conscious of her own feelings, and to recognize the unrealistic nature of some client expectations about the relationship.  When this occurs it’s not uncommon for a client to mistake a therapist’s accurate understanding and caring attitude for the kind of love and acceptance the client longs for in his personal life. If a therapist develops romantic feelings for a client, or if he can’t successfully address and resolve the client’s misplaced feelings, he needs to refer the client to another therapist or terminate the therapy.

The first thing a client should expect of his therapist is confidentiality. Knowing that what you say to your therapist won’t be disclosed to others (outside of supervision) allows you to admit things you might not otherwise admit to anyone. Speaking generally, the second thing a client (in most therapies) should expect of her therapist is that she won’t be judged for the things she admits to in therapy. Of course, people who’ve done abusive or horrible things can’t expect therapists to ignore or excuse what they’ve done, and confidentiality isn’t an absolute guarantee in all therapeutic relationships. Therapists are required to report sexual or physical abuse, and specific threats of intended harm to another person.

The therapeutic relationship is built on trust. In some cases this can be won quickly, if the therapist is genuinely caring and accurately empathetic. With other clients trust is earned gradually, over time. It may take a while before a client discloses the real reason he entered therapy. In my early days as a therapist I was surprised at how quickly some clients disclosed intimate details of their lives to me, a man they barely knew. I came to realize that, although some clients already had someone in their lives with whom they could be (non-sexually) intimate, others were starving for what they encountered in therapy: a genuinely caring person who listened carefully to what they had to say, and seemed to understand them and their problems.

I’ve known a lot of people who were hungry for emotional intimacy, for someone in their lives with whom they could get “emotionally naked” without fear of being judged or lectured-to. Those who have such a person (or persons) in their lives – whether a friend, sibling, spouse, aunt, spiritual counselor, whomever – recognize emotional intimacy when they encounter it in therapy. Getting closure at the termination of treatment can be easier with such clients, because they have one or more persons in their lives who meet their intimacy needs. With clients who first discovered intimate dialogue with their therapist – to whom it was a revelation – there’s a danger that they’ll want to prolong treatment, to continue the dialogue. With such clients I’ve validated their ongoing need for intimacy after termination, and coached them on developing trusting, emotionally intimate relationships within their circle of family and friends. To paraphrase an old milk ad, “You never outgrow your need for intimacy.”

The therapeutic relationship isn’t a friendship, although it might feel like one to the client. The relationship may be characterized by warmth and genuineness, as in a friendship; but it’s up to the therapist to remain aware that it’s a professional, not a personal, relationship. A good friendship benefits both friends more-or-less equally. As a therapist, you’re there for the client’s benefit, not your own. You can’t necessarily be expected to be completely objective about a friend, while a therapist always strives to maintain her objectivity. Lastly, a therapist is always aware that the relationship is time-limited. At some point, it must end.

An effective therapist plans for termination from the first session, asking questions such as, “How will you know when the goals we’ve discussed have been adequately met?” or “Do you want to agree to ten sessions, then we’ll decide if you need more?” or “How many sessions do you think it might take for you to meet your goal?” In a sense, the therapist is there to facilitate behaviors that will at some point make her further assistance unnecessary.

The time to terminate therapy is usually a mutual decision. Termination issues are worked on in the final sessions, with the goal of “closure” – which may include not having  any “unfinished business” between therapist and client. When I’ve heard clients credit me with the changes they’ve made, I’ve handed the credit right back: “You did the hard work. I just helped out.” One of the most rewarding things a therapist can hear from a client who appears to have reached his treatment goals is, “I want to thank you for your help, but I’ve gotten what I needed from therapy. This will be my last session.” A general goal of every therapy is to increase the client’s autonomy. If a client has become dependent on his therapist and wishes to unnecessarily extend therapy, the therapist’s final goal is to convince him that she’s no longer needed.

Finally, I need to clarify something I said earlier: that the therapist isn’t in a therapeutic relationship for her own benefit. I mean that this is something she needs to keep in mind, not that therapists don’t benefit from their intimate dialogues with clients. My own life has been enriched by the candor and courage of many people who’ve trusted me to help them help themselves. Some I have genuinely admired. I’m very grateful to the people I worked with in therapy, who taught me new things about what it means to be human.

 

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