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.”