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What Is “Therapeutic Relationship” and Does It Exist?

One of the popular terms in therapists’ vocabulary I detest is “therapeutic relationship”. I find it illusory, pretentious, confusing and also dangerous. It has harmed many people, myself included, and yet it has been regarded as a major (if not THE major) healing factor in therapy. The “healing” value of a “therapeutic relationship” is one of the unquestionable dogmas in the mainstream psychotherapy that is very difficult to challenge. 

If you are considering therapy and have never been in therapy before, I don’t believe you imagine that the relationship with a therapist would help you solve your problems. It’s hard to see how this would even cross your mind. When someone has never been in therapy, they think of it as they think of any professional service, which is that a consumer (client) pays to a provider (therapist) for their expertise a.k.a professional opinion, which is absolutely correct because this is the definition of a professional service.

People might be confused about what kind of opinion a therapist should give them. Many first time clients expect a direct advice on what to do in a specific situation, which is not what therapy is designed to do. But the idea that a therapist is supposed to give some kind of input that gives them new insight into their experience and to suggest different ways of looking at their problems, which might lead to solutions, is the right idea. After all, by the virtue of their training, therapists are supposed to have more knowledge about human mind and behavior than everyone else. Therefore, it is just common sense to see psychotherapy in terms of getting a professional opinion on one’s situation.

So, a first time client begins therapy with a simple, straightforward, common sense idea that they will get helped through the therapist’s expertise. Somehow though, somewhere along the line, the therapist convinces them that discussing their situation is less important than discussing the “relationship” between them and the therapist, or, in other words, discussing the client’s real life problems is less important than discussing what happens between them and the therapist during their interactions.

This is what happened in my first therapy. The therapist, at some point, suggested that my “relationship” with him was the most important subject to discuss. Before that I didn’t even think that we had a “relationship”. I thought I was just consulting with a specialist. It didn’t cross my mind to put a “relationship” label on what I thought was a professional exchange between the two of us. Sadly, I trusted his expertise more than my common sense and allowed our artificially created “relationship” to become a centerpiece of my therapy while pushing my real life problems aside as something less important. Also, sadly, my experience is not unique. This is what happens to many therapy clients. They accept the idea of a “therapeutic relationship” being the most “healing” factor in therapy just because their therapists and other professionals say so.

What happens as a result is that the real problems in a client’s life that need attention get neglected and, with that, a client’s entire life outside of therapy gets neglected, as their energy flows away from life towards a “relationship” with their therapist. Paired together with transference and gaslighting, a “relationship” with one’s therapist turns into an obsession that eats up one’s life force and leaves nothing for living, let alone solving any serious personal problems. I don’t know what could be less therapeutic and more harmful than this. Not only it erases whatever positive effect therapy may have had in the beginning, but it also aggravates the traumatic symptoms a client might have wanted to alleviate through therapy initially.

Some people might say that what I am describing has not been their experience at all and that their relationships with their therapists were indeed the major healing factor in their therapy.

I am not here to challenge anyone’s experience. What you have experienced is certainly true for you. I would, however, suggest that you and I may define a “relationship” differently.

I think, when people talk about how the “relationships” with their therapists helped them in their healing process, what they actually describe is the therapists’ personal qualities that had a healing effect on them such as the ability to feel and express empathy and compassion, to show respect and kindness, to exercise good judgment and to demonstrate personal and professional honesty and integrity throughout their work. A therapist’s human qualities are indicators of their character, which determines how they conduct themselves with a client, and I would certainly agree that a therapist’s conduct is a major contributing factor in therapy’s outcome. But I wouldn’t confuse it with the idea of “relationship” because that idea has a distinctly different meaning. It emphasizes the mutual emotional dynamic between two people, not the specific qualities of the one person who provides service.

Confusing a therapist’s character and the way they conduct themselves with clients with the client-therapist “relationship”, I believe, is the reason why some psychotherapy research erroneously suggests that the “therapeutic relationship” is the most healing factor in therapy. What the research participants (former or current therapy clients) perceived as “relationships” with their therapists was, I think, the way therapists treated them, which, undoubtedly, affected their therapies outcomes. The way people treat us in all situations can produce either healing or harmful effect. So, naturally, when a therapist treats you with respect, kindness, honesty, objectivity etc, this will have a therapeutic effect on you. That, however, has nothing to do with the idea that your “relationship” with a therapist should become the centerpiece of your therapy.

The last point I want to make is that the word “relationship” is a bit too heavy, too big, awkward and, frankly, pretentious when applied to interactions and communications with any service provider, even when the service is designed to address the problems of a personal nature, unless you use it with an adjective “professional” that makes it clear what this relationship is and what it is not.

Since therapy is a complex process, anything that has to do with it is complex. I can go on and on exploring the subject of a “therapeutic relationship” further and connecting it to other therapy related concepts and ideas. I don’t want to do this because this has nothing to do with the most important thing, which is asking yourself if focusing on a “relationship” with your therapist at the expense of other areas of your life works for you or not. If it does, forget this article and enjoy your therapy. If it doesn’t, don’t allow your therapist or anyone else to convince you that it does.

 

 

 

 

 

 

 

 

 

 

 
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16 Comments  comments 

16 Responses

  1. Jennifer

    Excellent article. Thank you for this.

  2. Sue

    100% right on as usual, Marina. Thank you!

    “…Paired together with transference and gaslighting, a “relationship” with one’s therapist turns into an obsession that eats up one’s life force and leaves nothing for living, let alone solving any serious personal problems. I don’t know what could be less therapeutic and more harmful than this.”

  3. Ellen

    Great article!

  4. Ellie

    I now resent CBT after my shitty therapy experiences. And realized that I never needed CBT

    https://www.psychologytoday.com/blog/the-justice-and-responsibility-league/200903/four-drawbacks-cognitive-therapy

    • Marina Tonkonogy

      Thanks for the link. It’s not exactly relevant to a therapy relationship topic, but it’s an interesting info you’ve shared. I am planning to post articles on the pros and cons of each psychotherapy approach in the future.

  5. Ellen

    Hi Marina,
    Have you heard of or from anyone who has reported that being a patient in long term psychodynamic therapy or psychoanalytic therapy with the focus on the relationship between the patient and therapist was really helpful or successful?

    I have heard from a few acquaintances or friends of a good experience and a good “professional” relationship with mutual respect, but not a more personal relationship (where the relationship itself was the central focus of therapy).

    I am also wondering if there is such a thing as psychodynamic or psychoanalytic therapy that does not focus mainly on this contrived patient-therapist relationship, and what that would look like.

    Thank you.

    • Marina Tonkonogy

      Hi Ellen,

      No, I have not heard of any instance when a therapy that was centered around exploring the therapist-patient relationship was successful.

      In regards to psychoanalytic/psychodymamic psychotherapy, it is not focused on the patient-therapist relationship actually. It places a great emphasis on analyzing the patient’s transference, not the patient’s relationship with the therapist. Traditionally psychoanalysts have been trained to be quite emotionally detached from patients, and so it is not in the psychoanalytic tradition to ever suggest that a therapist and a patient have a relationship that extends outside their business arrangement. The cold and detached analysis of the patients feelings and reactions to the therapist is also unhelpful and can be potentially traumatic, but that is different from making therapy relationship focused.

      The notion of a more personal, emotional relationship between the therapist and the patient came into existence with the beginning of the humanistic/existential school of psychotherapy that was developed in the 60-s by Carl Rogers, Abraham Maslow, Victor Frankl, Fritz Perls and others who worked with them and who were inspired by their ideas. This school developed as a protest to the cold, mechanical psychoanalytic method. While their criticism of psychoanalysis was absolutely valid, they failed to offer a safe, more effective alternative. Their idea was to make the therapist-patient relationship more “real” and humane by becoming more emotionally involved with patients, which sounds wonderful in theory but, in practice, creates a great potential for abuse of patients. Of course, the mechanical and detached psychoanalytic method can be also very harmful but in a different way.

      Therapists who choose to make their relationships with patients a central point of therapy come from different schools of thought and practice different approaches. Their fixation on the “relationship” is not necessarily correlated with what kind of therapy they practice. It’s not a particular approach that determines whether the therapist will be primarily relationship-focused or not but the therapist’s personality. It is my strong opinion that any therapist who makes relationships with patients the major focal point of their work has some serious personal pathology and should not be practicing. I cannot imagine a healthy individual who would do this for any reason other than fulfilling their emotional needs, which is not what their patients need.

  6. Ellen

    I have had an experience with a therapist (who might be considered of the humanistic type) who seemed to view the personal relationship and transference/countertransference as the same thing. It was never clarified as to what was what or how to deal with these feelings in a productive way. Thank you for your response!

    • Marina Tonkonogy

      Yes, this can get confusing. Interpreting transference can be easily confused and mixed up with focusing on the relationship and this is a good point that I should highlight, maybe in another post. Since transference deals with the client’s reactions to the therapist, of course, this can be easily perceived as a relationship issue or presented as such. And, by the way, when transference is positioned a the center of the therapeutic process, it causes exactly the same harm as the relationship oriented therapy, because in both situations all other problems in the client’s life get neglected. It’s just that traditionally psychoanalysts framed this method in terms of interpreting transference, not in terms of working on “the relationship”. But one way or another the client is getting gaslighted because in both cases his or her perceptions are questioned and invalidated.

      As I mentioned before, a therapist of any theoretical orientation can do this, so I don’t want to demonize any specific school of thought, be it psychoanalytic, humanistic or other. I’ve seen cognitive-behavioral therapists stuck on the “relationship” method, as much as I’ve seen therapists from other psychological orientations. As I’ve said, this is the issue of personality, not the issue of theory. At the end of the day, therapists do what they personally prefer regardless of their specific training.

  7. Alena

    great article, describes precisely my (not very good) experience with therapy as well

  8. Maggie

    Thank you SO much for this really well written article. It has helped me a great deal to put, what I now realise, was a very toxic ‘therapeutic relationship’ into perspective.SLOWLY I am regaining my self esteem!

    • Marina Tonkonogy

      Thank you. I am always happy to know that my articles help people. I know what it’s like to be under the spell of seductive ideas like “therapeutic relationship” and how long it takes to recover from the damage done by them. Good luck to you in your recovery.