Why does psychotherapy work? There are many reasons, but today we are going to focus on one in particular — the therapeutic relationship. One of the biggest predictors of success in therapy is a good relationship between the client and therapist.
However, like any relationship, there are occasionally ruptures in the relationship.
Sometimes there are misunderstandings and miscommunication issues. These are a normal part of any relationship, including the therapeutic relationship. Some common issues that might come up are financial issues, personality differences, misunderstanding therapeutic techniques or progress, disagreements over goals, etc.
Other times a phenomenon called transference occurs. Transference happens when a client relates to the therapist as if they were some other important person in their life, like a family member or a significant other or even a perpetrator. The therapist then becomes a type of mirror, with the client projecting feelings, thoughts, fantasies, and defensiveness onto the therapist that rightly belong to someone else. This is mostly done on an unconscious level.
Far from being a symptom of mental illness, this is something we all do in everyday life. Have you ever had a really strong reaction to someone seemingly out of the blue, either positive or negative? Perhaps something about this person’s words, mannerisms, appearance, or actions reminds you of some other influential person in your life.
Transference is a normal and very important part of therapy. Since the therapist is essentially a stranger (chances are you know very little about your therapist’s life outside of your sessions), a lot of things get projected onto them. Relational patterns get repeated within the therapy relationship and, if those things are talked about, can lead to great insights and transformative action.
Often, therapists refer to talking about the “here and now” or “what’s in the room.” By this, they mean processing the emotions and thoughts about the relationship between the therapist and the client that are happening in the moment. This type of disclosure is welcome and encouraged in therapy. The “tear and repair” of the relationship serves to make the relationship stronger and brings about significant change for the client as they apply these new relational tools to outside relationships (p.13).
Talking about the therapeutic relationship can feel awkward at first. This type of communication is not something that many people are used to doing on a day-to-day basis, especially in professional relationships. It might be hard to imagine telling your doctor, “I felt very hurt by how you asked me about my weight and physical activity.”
When a relationship difficulty occurs, the client has some responsibility for their part in resolving the issue.
- Bring up the issue. Sometimes clients can feel anxiety about confronting their therapist with an angry feeling or concern about therapy. However, bringing up relational issues is a welcome conversation for most therapists, as this can bring new vibrancy to the therapy process.
- Express anger in an appropriate way. Violence, name-calling, verbal abuse, and raising your voice are not okay in any setting. Talk about why you feel angry and what you need from your therapist. Most of the time, under the feelings of anger are feelings of hurt or fear. Try to tap into what those feelings are about.
- Understand the difference between validating feelings vs. validating thoughts. While your feelings of anger, disappointment, hurt, fear, or insecurity are always valid, sometimes the thoughts that led to these feelings might not be rational. Your therapist will help you explore the issue in a way that might challenge some irrational thoughts. This doesn’t mean that the therapist is saying your feelings don’t matter. On the contrary, your therapist wants to help you understand where those feelings are coming from.
- Be open to making connections with previous relationships and experiences. Far from making your reaction or feelings invalid, this serves to normalize the reaction and possibly find better ways to cope. We are all shaped by our experiences.
- Be willing to work with the therapist to develop understanding, find a solution, and restore the relationship.
Resolving relational issues in therapy is not only the responsibility of the client, but also the responsibility of the therapist. Here are a few things you should expect from your therapist:
- You should expect your therapist to welcome discussions about the therapeutic relationship.
- You should expect your therapist to be able to explore the issue without becoming defensive.
- You should expect your therapist to validate your feelings, while helping challenge thoughts that might not be rational or helpful.
- You should expect your therapist to accept responsibility for their part in the interaction.
- You should expect your therapist to be willing to work with you to resolve any issue and make changes if necessary.
Processing issues in the therapeutic relationship can be a difficult part of therapy. However, the benefits of working through a relational difficulty in a healthy way with your therapist are worth sitting with a little discomfort. Not only will the therapeutic relationship become stronger, but the insight gained from the discussion can positively impact outside relationships as well.
Clara E. Hill & Sarah Knox (2009) Processing the therapeutic relationship, Psychotherapy Research, 19:1,13-29, DOI: 10.1080/10503300802621206