The Therapeutic Relationship

The therapeutic relationship is an extremely important part of therapy; it is the context in which healing takes place. As a client, you need to feel understood, comfortable and safe enough to reveal the details of the difficulties that you're having, and to have the confidence to try a new way of solving your problem.

Your relationship with your therapist is an unusual one, in that you will reveal a lot about yourself, but your therapist will not. Normally, anybody who knows that much about you would reciprocate, and disclose something about themselves, and this would leave you feeling more secure. You may know some biographical details about your therapist, for instance their age, their nationality, their marital or parental status, but you wouldn't normally know much more than that.

The fact that you have disclosed so much to this person who has not disclosed much back can leave you feeling a little vulnerable, and for this reason, there are well-defined ethical guidelines that therapists must observe to ensure your safety in this somewhat unbalanced relationship.

To some extent, different types of therapy will mean that the therapeutic relationship looks a little different. For instance, in therapies like cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT), the therapist is more directive, whereas in motivational interviewing or psychodynamic therapy, the therapist may take more of a back seat to you. I work somewhere in between, letting my clients set the agenda, but directing the course of the session when I feel it's helpful for the client's recovery.

What can you expect from the therapeutic relationship?

No matter what sort of therapy you are working on, there are some things you should be able to rely on in the therapeutic relationship, and it should concern you if these are not being observed in your therapy:

Professionalism – Your therapist should conduct themself professionally at all times. They may be warm and friendly, but they are not your friend. Rather, they are a mental health professional assisting you with your difficulties in a work context. They should observe similar professional boundaries to any other health professional, by being polite, appropriate, and focused in their interactions with you. In addition, your therapist should not normally have any other role in your life than as your therapist. If there is a good reason that somebody with another role in your life is also your treating psychologist, then this should be discussed in detail with you as soon as the dual role becomes apparent, and a plan should be made to manage the cross-over of roles.

Empathy – Your therapist should be able to empathise with you, and show that they understand or are trying to understand your difficulties from your point of view. This does not mean that they will always agree with you, but even if you are disagreeing, your therapist should have, or being trying to develop, a sense of what things are like for you. Empathy is never perfect, and we all fail to attune to others from time to time, but overall, without empathy, a therapy is not likely to be a success.

Knowledge – Your therapist should have adequate knowledge and expertise about your difficulties, and should be offering you a therapeutic intervention that has evidence supporting its effectiveness. Therapists don't know everything, and are often stretching themselves to acquire new knowledge, but they should not be treating you if they are obviously out of their depth. You should have confidence in your therapist's knowledge about your particular difficulties.

Focus – Your therapist should be focused on resolving the difficulties that you have come to therapy to resolve. This focus may shift over the course of your therapy as your circumstances change, or as you gain greater awareness of your difficulties, but your therapy should feel like it's focused on resolving things for you that are relevant to your reason for being in therapy.

Flexibility – As you go through therapy, especially if it is long term, your circumstances and your perspective will change, as will your therapist's understanding of your situation. While retaining a sense of focus, it is also important that your therapist is somewhat flexible in shifting the focus of therapy, or addressing something that's come up for you that is a priority. A balance between focus and flexibility is ideal.

Openness to Feedback – Your therapist should have a great deal of training in communication skills, emotion regulation and giving and receiving feedback. This should make your therapist approachable if you need to offer feedback about something that hasn't worked out for you, or something that you would like to change. Provided you raise your concerns without aggression, you should be able to count on a calm and considered response from your therapist.

Willingness to Resolve Difficulties – If a difficulty arises with your therapist, you should normally be able to count on your therapist being willing to resolve the difficulty. There should be reasonable attempts made by your therapist to hear out your concern and consider whether there is a solution that is appropriate to the therapeutic context. Therapeutic relationships are like other relationships, however, in that there can come a time when working through the difficulties takes too much time or effort, and your energy is better spent by leaving the relationship.

Finite – All therapies should be working towards an ending that involves you moving on and operating independently in the world, without the assistance of your therapist. Depending on the difficulties you are looking to resolve, this may come after only a few sessions, or after a long series of sessions. At any point in your therapy, both you and your therapist should have at least a rough sketch of what might be happening for you that would show you that the end of therapy was getting closer. Ideally, the therapeutic relationship would not end abruptly, but would taper off as both you and your therapist feel confident that you have outgrown your need for your therapist.

If any of these things are of concern to you in your current therapy, then it might be worth addressing them with your therapist, or looking for a new therapist. At the end of the day, like all relationships, the therapeutic relationship is a matter of individual preference, and you will do better in therapy if you have a good fit with your therapist.