A requirement of my psychotherapy training was to be in my own counselling. I remember vividly how difficult I found the search for the right therapist. The counsellors differed in modalities, length of training, and costs. However, every counsellor I looked at talked about the therapeutic relationship. It seemed to be one of the common givens in all of the profiles I saw. As a client, I wondered if this was a buzzword. No one seemed to really describe what the importance of the therapeutic relationship is.
So why is it that we, as therapists, emphasise the importance of the therapeutic relationship to our clients so much? Well, I hope with this blog I can shine some light on this question.
What does the research say?
As an integrative therapist, I learned through research and practice that no one therapeutic modality is more effective than others. One client may respond well to psychodynamic therapy, wanting to explore defense mechanisms and their unconscious. Other clients may be more interested in exploring the here and now and reaching more acceptance of the present. Those who want to make big changes in their lives could respond well to existential therapy. As an integrative therapist, I adapt the therapy to the goals and needs my clients bring. But if the modality doesn’t necessarily predict the effectiveness of therapy, what does? Well, most research has found that, among all different modalities, the strength of the therapeutic relationship can most predict a positive outcome.
We are always in relation
One of my favorite existential philosophers is Martin Buber. He wrote in depth about humans always being in relationship. It makes sense; we spend the first 9 months in the womb, physically connected to our mother. In our first years, we cannot survive without our caregiver(s). Even if you do not consider yourself a social person, you are still in relation with others around you. The relationship may be distanced or unequal, but according to Buber, you can never not be in relation.
So inevitably, you and your therapist are in a (therapeutic) relationship. I often think of the therapeutic relationship in Irvin Yalom’s terms. He explained that the therapeutic relationship is a microcosm of our social worlds. This means that the way you relate to me in sessions can give me a good idea of the difficulties you face in relationships in the outside world.
If you miss most sessions, avoid my questions, and present as withdrawn, I get a good insight into how your friends, partner, or colleagues may feel. In this case, the therapeutic relationship can give us the opportunity to explore the avoidance. We could discuss why you missed sessions and explore what parts of you need healing to be able to engage more (if you wish) with the world around you. I believe there is no such thing as a resistant client; there is only a resistant relationship.
If I notice you agree to everything I suggest and want to please me, there is a good chance that you often try to please others and do not listen to your own needs as much. Again, together in discussing our therapeutic relationship, we can explore your people-pleasing which could help you in the outside world. You could trial saying no to me and may find it easier to do this with others.
Integrative relational therapy gives you a safe space to learn by doing. If you feel angry with me as your therapist, I encourage you to tell me about this, so we can explore your anger without any judgment. Unfortunately, not everyone had the opportunity to show all feelings in their childhoods. Some emotions may not have been accepted, and we learned to hide them. However, the therapeutic relationship can offer you a containing environment where all of your emotions are allowed.
References:
Buber, M. (2008). I and Thou. Howard Books.
Yalom, I. D. (2009). The gift of therapy: Reflections on being a therapist. Harper Perennial.