Psychotherapy: The Therapeutic Relationship

We may have little idea of what to expect when we begin psychotherapy, particularly if we have been referred by a doctor rather than sought it out ourselves. We may expect that, like other professionals, the therapist will give us advice, tell us what to do, or prescribe a remedy, and it can be disconcerting when he does none of these but simply listens, makes occasional comments, then says goodbye until the next time. Nothing we have experienced before can prepare us for this. We may spend the first few sessions describing our symptoms on the assumption that once we have given a full enough account he will tell us what can be done, but we tell him all we can and still nothing seems to happen, still he just listens and says goodbye when the time is up. We may begin to wonder what on earth is going on, and whether we are doing the right thing . . .

The non-transference dimension of the therapeutic relationship

We never knew exactly what went on between Freud and his patients, but perhaps what Freud said to them between the time they got off the couch and passed through the door of his consulting room was as much a part of his therapeutic influence as the "interpretations" he advanced while they were in the recumbent position. [Hans H. Strupp, in Wachtel 1977]

The therapeutic relationship can be divided broadly into two areas; what happens in the transference, and what happens outside the transference.

The personality of the therapist

We are going to pick up a great deal about the therapist in the early stages of treatment. We will consciously want to know a little about him or her, but more importantly our unconscious will be 'testing the water', wanting to find out what kind of person he or she is. Ideally we need to find in the therapist someone who has an open approachable personality, who makes us feel at ease in his presence, and in whom we feel able to place unlimited trust and confidence.

The therapist's professional stance

in between the patient and the therapist is the analyst's professional attitude, his technique, the work he does with his mind. [Winnicott 1960b]

The therapeutic relationship is paradoxical in many ways, and one of the paradoxes is that while it needs to be a relationship in which we can place enormous trust in another human being and share our most private feelings we also need it to be a strictly professional relationship.

The therapist needs to have had therapy

A good therapist will be in possession of a wealth of knowledge and experience. He will have an extensive understanding of what constitutes emotional health and how it can go wrong, and of the needs of a child in the first years of life and what happens inside the child if those needs are not met - the two are fundamentally the same. He can intuitively 'see' adult behaviour in terms of the underlying childhood experience from which it springs. But during the sessions all this knowledge will remain firmly in the back of his mind while he focuses his full attention on what is actually happening in the here and now.

For a therapist to meet all these requirements it might seem that he needs to be super-human, or a saint, but in practice what it means is that he needs to have had therapy himself. There simply is no other way to prepare for his task.

Copyright: Inside Psychotherapy

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