Sunday, April 29, 2012

Psychotherapy as a Model for Positive Relationships

One of our regular readers wrote in a comment that she's read how the psychotherapeutic relationship is supposed to  model a healthy relationship for the patient.  I hope I got this right, I can't seem to find the comment.  

So I think I missed that lecture in residency.  It seems to me that while psychotherapy is about having an honest, trusting relationship (and that is usually a good thing),  it is very different from the relationships we have in our real lives. 

Psychotherapy is about the patient's life.  In some ways, it's a rather narcissistic endeavor (and I don't mean that in a pejorative way, but it just is).  Mostly it goes one way, and aside from the patient asking "How are you?" and perhaps a polite exchange about the therapist's life if the relationship lends itself to that, the session focuses on the problems and concerns of one person, without the expectation that the patient listen patiently or provide support, kindness, insights, or interpretation to the other party. 

Healthy real-life relationships are two-way streets.  And real life people have issues, demands, and problems.  The psychotherapist is a little bit actor, who doesn't generally volunteer his own distress, and who  may certainly have his own very screwed up life!

Oh, but you want to say that the therapist, by listening attentively and being supportive is modeling good listening skills, empathy, and kindness.  Ideally, that's true.  But the therapist is modifying his reactions based on the fact that he's learned a particular style of listening, understands that being non-judgmental is part of the deal, and responds in a way that is therapeutic for the patient.  So he doesn't argue about politics, doesn't get indignant if the patient makes a degrading remark about something the therapist values, and when he confronts the patient with behaviors or thought patterns that need to be changed, he does it from a place that is gentle, respectful, and he backs down if the patient gets upset and can't hear it. In other words, the therapist sometimes quashes his own emotions and reactions for the sake of the patient.   Real life people in two-way relationships just aren't wired to be 'all about you' all of the time.  While a friend may see that you are upset and let you go off ranting (and thank you to my friends who do this for me) and listen nicely and therapeutically for a bit, this is too much to ask from anyone all of the time in a long-term relationship.  People disagree, they argue, they have their own opinions, and they show it when they get offended or angry.  One should not expect the people in their lives to react as their therapists do, in measure ways.  Nor should they hold themselves to that standard when engaged in a relationship with others.  It's nice if you can do it for a little while for a friend/spouse/relative in distress who needs a comforting ear.  But don't go home and try to be your shrink.  It's hard and you won't have any friends. 

Ideally, a psychotherapist is very responsive and reliable.  There are exceptions (oh for the shrink with ADD, or who runs overtime with an emergency, or who is just a bit disorganized), but generally, the doctor shows up.  Probably a good thing to expect in one's important relationships, but it doesn't always work out that way, and there is some motivation for the shrink in that this is "Work" (and many people who are irresponsible in their private lives do prioritize "work") and the shrink gets paid.

On the positive side, in real life intimate relationships, you get to be together for more than an hour, it doesn't cost you big bucks to talk, there's some possibility that you aren't being pushed to talk about things you'd rather not, a hug or a kiss or a reciprocal statement of love can be very wonderful things, as can a card or a gift (chocolate is often good) or an offer to go out for coffee or a drink or a walk, when you're feeling distressed.

Therapists generally don't throw plates against the wall when they get upset with a patient, so if you need that type of adaptive behavior and restraint to be modeled for you, then I agree, the therapeutic relationship does show some healthier ways of responding.

Tell me what you think?   What have your patients said they've learned from you, and what have you learned from your therapist? 


Liz said...

i struggled with getting an individual therapist a few months ago. i attend dbt at a nearby college, and they offer (cheap) counseling from graduate students. this is great, but i have one friend who is currently an msw, one friend who is currently getting her msw, one friend who is a counseling graduate student now. these are three of my best friends, and i can talk to them, for free, pretty much whenever i want. we've support each other through some really hard times, among us, two families struggling with addiction, one divorce, death, etc. i finally settled that it WOULD be nice to have someone i could tell anything to, and i wouldn't have to worry about how my words influenced her or frightened her. it was a good choice, and i'm glad i made it. it is narcissistic, but i'm okay with that-- i'm glad to have this safe place and this one relationship where it's pretty much all about me. it makes me a better friend to the women in my life because i have someone else i can share the really hard stuff with...

Ilovecats said...

I have a frenemy who expects me to be a therapist - she goes on and on about her problems forever, every single time. I made the mistake of crowing to my husband over finally being rid of her, without knocking on wood, then she called me again a couple of weeks ago. BINGO on how someone will have no friends if all they do is expect others to support them emotionally and give nothing in return.

I feared that this lady would go around backstabbing me if I directly ended the relationship in a respectful discussion. I just failed to feed the relationship for 2 years, after finding out what she was about. Hopefully the phone call 2 weeks ago was an aberration, and she is gone! Too bad I didn't get paid for all the supportive listening.

I only ask superficial things of my therapist because I try to keep good boundaries. So I may ask about pets, what are you guys doing for the holidays, how would you handle this situation, etc.

I had a therapist who would go on about her son's political career, for 40 minutes each 50 minute session. She tried to get me to go work for her son as "therapy" since I am distraught to be on disability income due to being functional only a few months a year. I probably would have enjoyed doing legislative research, but he would have been fed up with my unreliability rather quickly.

Now, if that therapist was my friend, she was still going on about her own life too much, but I may have taken her up on the job suggestion & talked to her son. It was just wrong, given the situation, I thought.

Anonymous said...

my guess is that the original comment was buying into a widespread "theory" that therapy can undo childhood crap by recreating a positive parental-type relationship. While I do think that having a secure and safe and sane relationship with a therapist, as needed, is a good thing, I don't believe that having a good therapist makes up for a bad parent or whatever.

I have a great therapist but I do take her in context of being a therapist and I don't expect her to be a friend. Same reason, i would not discuss politics, religion, etc with her, because I would not want a conversation that wasn't open and honest in that area, and I would be shocked if a therapist gave that in the context of therapy.

Jane said...

It's true that friends are not therapists...but, historically, the very first therapists to come into being on this Earth were friends and family. Before the time of professional therapists and psychiatrists, people relied on friends and family for comfort. Later, they also learned to rely on clergy. I'm sure confessing to a Catholic priest is therapeutic. So can praying for forgiveness and using God as your personal therapist. God would be the ultimate therapist...depending on what God the person believes in. He forgives everyone who repents, He knows all of your problems, He loves you, He has rules and guidelines for how to live a good life and win eternal salvation, and He will listen to everything you have to say without interrupting. No wonder religion got to be as powerful as it is.

Yeah, it's true that a therapist's style is artificial and is motivated by expected monetary payment. But I could see how it could teach you to have a healthy relationship. Because the qualities of a therapist are the qualities that good parents need, for example. A parent has to be nonjudgmental and gentle with their small children (and even adult children). Parents cannot be too critical, or they will crush a child's self esteem. They have to listen to their kids and comfort them, unconditionally, when they are sick or afraid of the dark.

I had a friend who told me she did not know how much she could love until she had a baby. Her baby was very collicky.But this didn't bother her. She stayed up at night, comforted her, and she felt like she wanted to be with her baby forever...even though she was losing a lot of sleep. She learned a lot of patience from having children. And I think she is a very good therapist to her kids. She listens to them and gives them unconditional support. When they screw up, she doesn't write them off or decide not to be their parent anymore. She forgives them and tries to show them a better way.

Therapy is not like a normal relationship. But there is still enough of it in there that I could see how therapy could teach people to have good relationships.

Anonymous said...

The whole therapeutic relationship thing is a joke to me. It's like thinking you have a relationship with your waiter because he smiles and brings you food. Dinah did a very good job of describing the ways in which a therapist puts on a face to make a living just like anybody else.

Sunny CA said...

Thanks for posting this. I was the one who asked (at the end of the doggie TV comments). Anon may be right that I was stating in a different way:
"my guess is that the original comment was buying into a widespread "theory" that therapy can undo childhood crap by recreating a positive parental-type relationship."
I will be interested to read more reader comments.

My own psychiatrist has never said a thing about attempting to model a healthy relationship or a positive parental-type relationship.

I don't doubt that my psychiatrist has a trained method of interaction, but he is sincere. His empathy is genuine and he does care. However, I know he does not volunteer his distress and I would be shocked if he suddenly did.

I will ask the second part of my question again (from the former query.) How does a patient with less than perfect relational skills go about improving them? My "issue" is that I take too much "crap" from other people or stay in bad situations, then usually don't feel anger until it gets to a really high level, but when I do finally anger, the anger I express is excessive. My psychiatrist has worked to try to get me to access my feelings in real time, but there is still a delayed reaction I go through. Once I do get mad over something, I find it hard to turn off and then I may not want that person in my life. Short of staying in therapy for the entire remainder of my life, how do I continue to try to improve?

Jane said...

wow...sunny...i feel like i'm exactly the same way with delayed reactions. It takes a lot to get me riled up, but when i do...!

i don't know what that is. i'm sure there is some term used by psychiatrists to describe this. but yeah, i guess we will just have to learn how to access our feeling in "real time." Don't know what the strategy would be for that though. Lemme know if you solve this problem with your psychiatrist. I'd love to hear the cure.

Liz said...

i have a similar trait-- it often takes me some processing to figure out if i'm frustrated or irritated, or, heaven forbid, angry. it doesn't happen often, though. i'm not sure why, but i'm a million times more likely to become infuriated with myself than at anyone else. i'm trying to learn to be mindful of current emotions. it's helping, somewhat. i sit quietly for a minute, and listen to what's going on in my heart and mind. then, i respond. not sure if that's clear or not, but that's what i try to do.

i also have really good friends who are adept at reading me; sometimes, their question, "what's going on?" used to help me, because they used to notice i was irritated before i did :-).

Krystyna Rawicz said...

I can really empathise with the "delayed reaction". It's helpful to remember that we very cleverly learnt that delayed reaction as a way to survive and be able to continue functioning.
I find journaling with coloured felt tips a great way of trying to access what I am feeling but not experiencing. I let my hand be drawn to a colour (not my head) and see what shapes and words are there, without it having to make sense.
When I look back, it often gives me insight into what's going on sooner than the old "delayed reaction" way. Its about finding a safe place to experience what youneed to experience. A bit like the therapy space.

Sunny CA said...

I think my psychiatrist called it dissociation; detachment from emotions as a result of childhood abuse. The result is being unable to identify or express feelings; in particular, the negative feelings like anger, sadness, hurt, fear, shame. Another result is a high tolerance for emotional pain. My psychiatrist has painstakingly pointed out in situation after situation I have described, what he feels in reaction to the situation to contrast with my frequent lack of an emotional response or demonstration of an emotional response. I have tried to get in touch with my feelings. I am almost 61, so doubt I could live long enough to be completely over this, but I would like to make progress continuously.

Jane said...

@sunny: sorry about the childhood abuse. Hope therapy works out.

Sunny CA said...

Thanks, but I feel pretty lucky at this point. I started with my psychiatrist 6 years ago and about 6 months ago, my psychiatrist gave me the option of ending therapy. I have been going less frequently since then, but have not really ended. I have made a huge amount of progress, but I just don't think I will ever be past it totally. I wasn't aware I had a problem when I started except that I had a psychotic episode (with hospitalization) at age 54, which was kind of a hint that something was wrong. It took some time before my psychiatrist was able to demonstrate to me what my problem is. I did not think I had a problem. That was a huge step. My psychiatrist is terrific. I couldn't ask for better help. I am much more in touch now than when I started.

My question above really is asking what else can I do to be proactive about getting in touch with my feelings and feeling my feelings in the moment as I go along rather than have an emotion "bomb" go off after many months of few or no feelings.

Anonymous said...

I sometimes wonder what my therapist is like in "real life." What her thoughts, emotions, opinions are about various topics.
But this curiosity is fleeting because I really don't want to know these things. I don't need to know this information for her to help me.
(Now if she was a fundamentalist Christian Republican there would be a problem with us doing therapy together, but I am fairly confident she is a Jewish Democrat who once had a habit of going to yoga classes.)

I have had friends who are social workers and have seen first hand just because someone is a therapist does not mean they are mentally sound. Not by a long shot.

Anonymous said...

speaking of ADD, how do therapists with ADD who are excellent at the "skills" sit still through a day of hourlong sessions?

Sarebear said...

I haven't read the comments yet, but I see your points. I don't think the whole relationship models healthy relationship, but I think at times depending what you are discussing, he/she can model a healthier way of relating, a healthier . . . outcome? to something you fear in your daily relationships.

My example should illustrate:

There came a point in our theraepeutic relationship where I felt it was broken. I didn't see how it could become unbroken, but I kept going anyway. Through time, effort on both our parts, and working through the relationship issues, it became unbroken. He specifically said once we were in a better place again, that he was hoping his modeling of how one works through feeling like a relationship is in distress, towards healing that relationship, would help me in the future should I feel broken relationships with othes . . . that I would hopefully be less likely to catastrophize when/if such things happen in my regular relationhips.

I could see that, it made sense to me.

On the other hand, with your post and many of the points it raises in mind, I wonder how motivated a person I feel broken with would be to fix things, to work through the pain, to try to see the other's point of view, would be. It's been my experince that people I tend to feel broken with don't seem to feel any desire whatsoever to try to understand the other person, their point of view, their feelings.

AND, my therapist has seen this with my relationship with my MIL. She's given up on me, on our relationship. She still talks to me if I'm around her, orshe calls us for some other reason (never for a reason that's about us), but there's no effort on her part to relate to me, anymore. In my effrts to work on this relationhip, we even got to the point where she said she'd given up on me, or the relationship, or something. That HURTS, deeply. After about a decade of doing my best to try to understand her, even if I didn'agree with her, an try to improve our relationship, she just gves up. Even before she gave up, she years befre had reachd a point where she'd try to find out what I was feeling, but then would shut down and not contribute her point of vew or perspective, which isn't too many steps remved from giving up . . makes i real hard t understand someone if they won't communicate .. . I did nothing BUT try with her, and see what I got.

You can't fix some things. So whatyou say about how the therapist is motivated to work on things with you (did you say that I forget lol), and stuff, makes me wonder if he can EVER realistically model how healthy relationships work; then again, if it is a healthy relationship, the other person would have some motivation for working on things with you . .

So maybe he can model some things, for relating with somewhat healthy to healthy people, or for howto learn to let stff from toxic people bounce offof you (yeah, black and white nd labeling there) .. . but it takes two to tango, and sometimes the other person won't tango. They won't even line dance.

Sarebear said...

Woops, I must add, that the "broken" aspect to my marriage recently, actually shows me that sometimes people ARE willing to work on things, and stuff. (It still amazes me though.) Then again, he wouldn't be like that if he didn't have some motivation to be like that.

I guess I did my ole disqualifying the postive in forgetting that BIG example.

Sunny CA said...

Your therapist sounds good. I am glad that worked out and glad your husband is motivated to heal your relationship with him. That is terrific.

Regarding MIL:
Some people are toxic and abusive and don't belong in our lives. I don't think it is possible to fix all relationships with all people. My psychiatrist urged me to get rid of relationships where I was being used and abused and reach out to make new, healthier relationships.

I did get rid of the unhealthy relationships. I have made new friends, and am still working on that. I work on not just finding good friends, but being one.

I realize you are rather stuck with your MIL, but that does not mean she has to be your friend. Consider that it may be unhealthy for you to have a close relationship with your MIL. She sounds pretty negative to me with the little you are sharing. That's a relationship in which you'd want to stick to talking about the weather and how pretty her house looks today and how great the food is that she prepared, when you must see her. She does not have to understand you or ever love or like you, and vice versa. It is like trying to be friends with a rattlesnake.

There are Newcomers groups all over the USA who welcome people wanting to expand their network of friends. Most are women and many are not new to the area, but women wanting to meet other women. I joined my local Newcomers group, which has many (mostly free!) activities each month. There's book discussion group, a documentary group, bridge playing, walking, bunko, coffee groups, out-to-dinner, out-to-movie, etc. I found a lot of wonderful women. This was way better for me than continuing in relationships in which I was the continuing the abuse of childhood. There are other ways to meet people: volunteer work, church, clubs centered on an interest. Each person needs to find what works.

Sarebear said...

Sunny, thank you very much. That is very thoughtful, kind, and means alot to me that you would take the time to and want to convey your thoughts and information to me.

The Newcomers groups sound interesting, I'll have to look into that! I've also looked up groups that match my interests on or something I forget, like knitting, book clubs, board game clubs, etc., although most are down in Salt Lake.

Sophia said...

Psychotherapy can be viewed as a model relationship in that your flaws are accepted, you can have a close relationship to someone without them expecting you to put out, and that person isn't going to hit you up for drug money. Atleast this is how therapy should be going - I've heard a horror story or two.

Being a therapist gives me the kitten and marshmallow feeling. Knowing my therapist likes her job also gives me the kitten and marshmallow feeling, especially considering what a pain in the ass I can be. I want a print of that picture to put in my future office, by the way. Or cubicle, because with my luck I'll find myself at an agency that has communal therapy rooms after graduation.

Therapist/client is one of several types of relationships we have. My relationship with my kid, for instance, is quite a bit different than my relationship with my hairdresser. Therapy can be a good training ground for learning boundaries, communication, empathy, and so forth. But it's not remotely like any other relationship you're going to have.

Therapist/client is probably the weirdest relationship of them all - particularly if your therapist is a psychiatrist, seeing as that keeping private life under lock and key seems to be pounded into psych residents' heads (Though I imagine some of you psychiatrist folks ease up after a few years). Therapist says little, you spill your guts about stuff you're embarrassed to even know about yourself, much less someone else knowing said stuff. Plus you pay them. Hm. I feel like I'm starting to describe sex work...

Kidding, of course.

Anonymous said...

There is a friendship there, that exists merely in the hour I am there for therapy each week. I have picked up and remembered little snippets that my therapist has shared with me about their personal life. It is a nice idea to think that they have a "perfect life" with all of the answers outside of therapy, but let's get real - they don't. So I will live in la-la land and pretend they live this absolutely perfect/happy life and put into practice everything they preach to me.

What have I learned about relationships in general in therapy? Once I really started to learn - put the pieces together about the whole narcissism/codependency concept and how it related to the relationships in my life, it was a huge breakthrough. And my therapist sat back in their chair and listened to me connect the dots... dots they had given me 6 months earlier but didn't mean much at the time and I couldn't conceptualize it. That's a great feeling - and that's what I have learned.

Sideways Shrink said...

That you have been able to continue past a "broken" place with a therapist shows real strength on your part. It shows that you were in what is called the working phase of therapy and not just borrowing ego strength from your shrink. You were able to maintain yourself while the relationship was in confusion and was not sustaining you. You could see it through to the other side and undoubtedly learned something about yourself in that process.

"Anonymous", I think, misunderstands the key ingredient to reworking parent-child relationships through intensive psychotherapy. Certainly, the therapist must provide a safe environment, but the therapy patient, or analysand, must let go of their fear of being rejected by the shrink as "crazy" or "neurotic" or "wacko" for whatever they say. The patient must be well enough, but desperate enough to actual attach onto the therapist a whole bunch of feelings that are really about about someone else--for me, it was my mother, my father, my husband. Because I knew my analyst was a mother of 3 children I could share with her my terror of whether I should get pregnant, what kind of mother I would be (as crazy as my own?). My analyst never answered the questions exactly except with questions, but my honesty, born out of desperation (medications did not work for me) I did a lot of work on my primary relationships.

Sitting on both sides of the couch/leather chair. I believe the power of therapy is sitting on the couch. Sure, the person in the chair can mess it up, but as a person who wants to make the relationship work because I like to see change (and no one person makes my income) I try to pre-screen for patients who I will work well with and vice verse. However cynical someone might be, no shrink wants to bring a new patient in for a couple of new patient visits if it seems that it will not work out--particularly as prescribers. There are plenty of voice mails that are left each week to sort through.

Finding the right patient match is not usually so hard. Add in some student loans and overhead and psychiatry is not exactly a money making endeavor......

Sarebear said...

Thank you, SS. It was thoughtful of you to remark on my experince this way.

A new, important rule for us, the therapeutic relationship, came out of this experience, as well as other benefits as you say! I also had a hidden, subconscious source of anger and other emotions that caused the anger, at him duing that period, that took some psychological detective work to figure out; surprisingly, I figured much ofit out myself, but theproceess of doing so was prompted but things I'd said and he'd responded to during therapy in the previous couple months. We ofcourse exploed this whenI shared my discoveries.

It was . . . delightful . . .and, fulfilling . . . and, efficacious . . . and other things, to learn that there's responses other than catastrophizing during distressin relationships, that may work (depending on the willinness and motivaton and communication of the other involved party, of course).

So I guess owthat I've realized these things, I come down on te side of, what he did there with m DOES indeed model healthy relationsip skills; there's no guarantee they'll work with everbody, but they are good to have. It also modeled the contrast between my catastrophizing/extree distress and a moe realistic, productive, pragmatic, positive, healtier view of "broken" relationships or relationship speed bumps.

Ugh, if I'm having troble affoding a new keyboard, I can't justify donatingto the NAMI walk. Sorry guys! It won't keep up with my 90wpm typing nymore.

Anonymous said...


What happens if your pre screening lets through a patient who you don't feel you don't feel is a good match/don't like working with? If they don't quit on their own, do you get rid of them as in refer them out or drop hints? I don't mean patients who are abusive to you or don't pay their bills.

Anonymous said...


Anonymous said...

.... is such a lonely word.
Everyone is so untrue.
Honesty is hardly ever heard.
And mostly what I need from you.

I can always find someone
to say they sympathize.
If I wear my heart out on my sleeve.
But I don't want some pretty face
to tell me pretty lies.
All I want is someone to believe.

I used to like that song a long time ago. It was good to get drunk to.

Sideways Shrink said...

I like people and it rarely happens that a patient I have "screened" is someone I end up feeling is not a good match for me. Sheldon Kopp, a therapist who was influenced by Carl Rogers and Buddhism talked about the whole first session almost as a screening session. I endeavor to engage people/patients with two basic premises: I accept them, but I am also present and spending my life/time with the person doing this activity. You can't really pay someone to accept you, so I screen people so I can be present in the way that the endeavor of acceptance requires.
If, I felt I was unable to help a patient for some reason, I would talk to them about who I felt could better help them. It would not be and has never been because I did not like them or we were not a match personally.
The reality is that people leave their shrinks far more that their shrinks fire them. That is honesty from me.
This is a good waking up song and less schmaltzy Billy Joel:

It seems such a waste of time
If that's what it's all about
If that's movin' up then I'm movin' out.

You should never argue with a crazy mind
You oughta know by now
You can pay Uncle Sam with the overtime
Is that all you get for your money?

It seems such a waste of time
If that's what it's all about
Good luck movin' up cause I'm movin' out.

Elbee said...

My relationship with my therapist (ideally) teaches me about trusting other people even when you reveal yourself for who you really are (intimacy).

Sunny CA said...

I like your statement. I feel it reflects my relationship with my psychiatrist.

I haven't had Sarebear and Sideways Shrink's experience of having a "broken place" with my psychiatrist or feeling extreme anger towards him. Perhaps I don't need that or perhaps I have not gotten there yet. What I have been able to do is disclose things about myself that I have not shared before. In turn he has seen things I have not been aware of, so there's been growth in self-awareness.

Anonymous said...

If I go for a colonoscopy, I guess that qualifies as revealing and intimate but since the doctors and nurses are dressed, it doesn't increase my sense of trust or of feeling that there is a relationship. Therapy feels the same way. If I reveals something that I have not revealed to anyone else I don't end up feeling safer about other relationships. I left because it felt like, sure I could tell this person all sorts of things but it wasn't making me feel better and it did not give me any greater faith in humanity. I also really believe, and have seen, that doctors respond in a caring way but like anyone else, they would rather be on vacation than listening to patients. They also say Oh hell, its Monday morning.

Sunny CA said...

To the last anonymous
I am sorry if you have had doctors that you feel lack sincerity, but I don't feel it is the rule, but the exception. My psychiatrist is now 71 years old, so could have retired years ago if he did not want to be doing what he is doing. Perhaps there are patients who bore him or who he genuinely dislikes, but he has said that he "vets" prospective clients so that he can have fulfilling working relationships. I do feel genuinely cared about by him. Yes, he is a trained professional and I am paying him, but he's not faking his care and concern. Just suppose, anyway, that you are right, and psychiatrists would rather be on vacation than helping patients. If they can help you understand yourself, help change the way you interact in the world, and help change your life for the better, what does it matter? It is supposed to be a supportive professional relationship, not a marriage. I don't think it is all about "telling this person all sorts of things" and having the act of telling result in "feeling better". One goal in the "telling" is to discover patterns of behavior that need to be changed, discover ways to work on or leave relationships that are not serving us, and to become more in touch with who we are as a person and use that to guide future directions. I have made personal progress with my psychiatrist that just would not have happened any other way. At the end of the day, that is what counts, not how he feels about it.

Anonymous said...

I'm glad it works for you. I can't get into this trust thing and I really do believe they'd rather be anywhere else, just like anyone else.I can't do it. I can let a plumber in to fix a leaky faucet. I don't care if he swears the whole time. At least I know how he feels, I pay him and he leaves. No need for fake smiles and how are you today?

jes said...

I really think it depends on the dynamic that exists between the therapist and the patient, as well as the approach taken by the therapist.
For patients with severe social difficulties, the therapeutic relationship, even in its 'idealized' form, can serve as an important foundation block to building trust with another person that eventually can be generalized to 'real' two-way relationships. Also, if the therapist takes a more relationship-based humanistic approach, adopting a more open two-way exchange of thoughts and reactions, this can provide a kind of model for real-life exchanges, even if the focus is on the patient.
That being said, a lot of therapists err on the side of caution when it comes to examining the ongoing and fluctuating dynamic of the relationship with the patient, which is perfectly justified. As with pretty much everything else in psychotherapy, this is really a sort of 'it depends' scenario based on a number of factors - patient characteristics, therapeutic approach, therapist-patient chemistry, etc.
I understand how the view that the therapist is 'putting on a face' can hinder the idea that therapy can bolster future relationships, but none of us show 100% of ourselves 100% of the time. Like every other relationship, it is adapted to the situation and context, which in this case means that the therapist doesn't get to behave in the same manner as they would with a spouse or friend. If the relationship is rooted in sincerity and trust, however, I don't think the therapist is necessarily 'putting on a mask'; rather, he or she is adapting his or her personality and training to the needs of the patient. Is it a 'mask' when we try and focus on happy thoughts and memories when visiting a loved one in the hospital? If so, then we are really wearing some kind of 'mask' most of the time.

Anonymous said...

I may have missed something in your post but as a long-term client having worked with many therapists my immediate impression from the title was quite different.
I don't think my shrink should be my friend - as in the examples you present- but that it offers ME the opportunity to become a person who can have positive relationships. Developing this quality and/or skills is what I work towards (as just part of the process).
Currently -honestly, today - I am struggling to confront my counselour with some complaints. Probably not an uncommon therapeutic issue, but for me a huge and important effort.
Yesterday I decided I didn't have to "change" and could just keep letting my complaints percolate. Today, I think there would be a lot of benefit to tell; to "practice," or to "model" a behavior I believe can assist me in my (therapeutic) goal of maintaining "Positive Relationships."
Of course, your perspective is from the other side. I hope my comments aren't repetitive or misplaced. Just felt moved to write.

Anonymous said...

Okay, I will pretend I am sitting in your living room. ;) I just came across this old post doing a google search but it is something I am struggling with right now. I have been in long-term therapy and I don't believe it is a healthy relationship at all. That's not to say it hasn't helped me enormously but it's also very unrealistic in many ways but I'm not the one writing the books or doing the teaching in school. Clients might make progress but I don't think it comes close to modeling a healthy two-way relationship.