All of us have ideas of what psychotherapy looks like, often based on media representations from movies or television. These ideas frequently include a medical setting with a doctor treating a ‘sick’ patient. In these narratives, the doctor is often all-knowing and is primarily focused on diagnosing and “fixing what is wrong” with the patient. The patient is frequently shown as having very little say over what happens in their treatment.
In the real world, however, psychotherapy can be a very different experience. Successful therapy almost always requires a powerful therapeutic relationship between a client and their therapist. Here are some ways that the therapeutic relationship can work.
Read more: 3 Ingredients for an Effective Psychotherapy Experience
Relational Therapy
In its broadest sense, ‘relational therapy’ refers to any approach to therapy that recognizes the centrality of relationships to our mental health and harnesses the power of the therapeutic relationship. This is rooted in a recognition that people are evolutionarily and neurologically “wired” for social connection. A connection is essential to our survival and well-being from the first moments of life, and a great deal of human suffering stems from feelings of disconnection and the impact this has on self-esteem.
Can you fix me?
Therapists are in positions of power due to their professional role. The idea of being in the hands of someone who has the power to fix our problems can have a strong appeal, and many of us have been socialized to the notion that “doctor knows best.” However, this can be unrealistic and can significantly detract from a client’s sense of agency.
A competent therapist will draw upon extensive training and clinical experience. But this has limits that need to be identified during the therapy process. Clients frequently come to therapy with complex issues related to negotiating relationships, including needs for both independence and relatedness. Therapy offers an excellent opportunity to work on such relational patterns.
Therapists who identify as relational therapists tend to explore and collaborate with their clients, rather than attempting to tell clients what they should do. This may include focused questions and experiential learning in the ‘“here and now”’ of therapy. Identifying the role of power in and out of the therapy room is an important aspect of this. This includes the roles of client and therapist social identities (such as race, gender, class, sexuality, ethnicity, religion, physical ability) and experiences of privilege and oppression.
What is the ‘structure’ of therapy?
Clients who are new to therapy often wonder about the structure of therapy. They may not be sure whether they are allowed to ask questions, make requests, disagree with their therapist, provide feedback concerning the therapy process, etc. All of these actions are, in fact, encouraged and present opportunities to build client agency and strengthen the sense of collaboration in the therapeutic relationship.
Ruptures and Repairs
As in any relationship, relational ruptures occur in therapy, and given time is in fact inevitable. These may be significant disturbances or extremely subtle moments. Acknowledging these ruptures and working through them can be of great value to the therapeutic relationship. When ruptures have occurred, therapists can encourage a collaborative attempt to explore what has happened. At such moments it is a therapist’s responsibility to model openness to their client’s feelings – often hurt, anger or disappointment – and to genuinely seek to understand their role in their client’s experience. A relational therapist will always want to know, “how am I part of what you are experiencing here?” Only in such a context is it possible to respectfully explore whether historical relational patterns are also involved.
As in other relationships, ruptures that are left unaddressed may undermine the therapeutic relationship. In contrast to this, the process of respectfully exploring and repairing ruptures often contributes to a sense of safety and trust in the therapeutic relationship. This can both deepen the therapy work and serve as a model for other relationships.
Meta-processing
Throughout the entire therapy process, meta-processing can be of particular value to building the therapeutic relationship. The client and therapist can check-in regularly regarding progress towards goals, what seems to be working and not working, what feels important, what’s missing, etc. This does not mean a therapist can always meet all of a client’s wishes, but it does mean there is consistent dialogue, and the client is regularly exploring and communicating their needs, wishes, satisfaction, disappointments, and other thoughts and feelings about their experiences in therapy.
Read more: Upset with Your Therapist? Yes, You Should Tell Them!
What do you hope for in a therapeutic relationship? Share your thoughts in the comments below.
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6 comments
My expectation and hope for a good therapeutic relationship is having space to openly discuss my emotions whether it’s towards my therapist or other things in my life. This is a very useful blog for navigating that relationship.
Thanks for such an insightful and clarifying post. This is a great topic, as it helps clear up a topic that a lot of clients (especially people new to therapy) can feel in the dark about: what exactly is the therapeutic relationship and how is it different from talking to a friend? For me, I like when therapy provides a safe space for me to talk and process the events of my life and that my therapist is someone who doesn’t have the same kind of involvement as my friends do. This can really help me to see things in a different way. Thanks again!
Hi Zachary,
Really thoughtful and helpful post. In a therapeutic relationship, both at a clinician and patient, I look for trust and curiosity. As I client I want to feel safe and I want to trust that my therapist is listening to me and not just “bobbing her head.” Everything you discussed above are vital to building and preparing the relationship as things progress. Thanks again!
This is a great resource to demystify what happens in a therapy session. I often hear clients talk about their initial reluctance to initiate therapy because they don’t know what to expect and base their understanding on what they’ve seen on television or in movies.
Thanks Zachary a great post. It’s a pivotal relationship in ones life to have a strong and transformative experience with a therapist. Your points are very helpful in walking one thru what to expect and what’s important.
Great post, Zachary! The relationship between the therapist and client is the foundation in which all the clinical work will rest upon. As the relationship grows the foundation becomes stronger. This allows space for trust and understanding to evolve between the therapist and client. For me, I like when there is a feeling of safety and understanding from the therapist. Thanks for posting!