The Therapeutic Relationship

One of the biggest predictors of treatment outcomes is the quality of the therapeutic relationship, but what exactly does that mean? There are many different therapeutic approaches, so what can you expect from the therapist in front of you? Let’s demystify things!

If you’re participating in the newest forms of cognitive behavioral therapy (e.g. ACT, FAP, DBT) here are some things to know about the nature of the therapeutic relationship:

We’re With You

Therapists are subject to getting hooked by thoughts and struggling with emotions too. It’s like both you and I are climbing our own mountain; the difference is that from my position on my mountain, I have a better vantage point for seeing the obstacles that lie ahead for you (Eifert & Forsyth, 2005). I also have training and experience, which is helpful. Rest assured that I have the utmost respect for you, because I know how difficult the climb can be. You also don’t have to worry about me, because I’ve got people on neighboring mountains guiding me on my journey.

This is a Real Relationship

The therapeutic relationship is a real relationship. Rather than showing up as a blank slate we therapists show up as genuine people. Now, we’re genuine people that are committed to always acting in your best interest - but we’re genuine people nonetheless. When you form a real relationship with your therapist, whatever relationship patterns you exhibit out in the real world will show up in the relationship with your therapist. That may sound intense (it is) and it’s beneficial because therapists can have the most impact on behavior that happens in the session!

Let’s say your goal is to be more vulnerable so you can have deeper connections with others. In session, you become emotional as you describe a conflict with your partner and then quickly change the subject out of discomfort. Your therapist (having already secured your permission) might gently interrupt you to highlight that moment and the resulting sense of disconnection. They may ask if you’d be willing to stay with the difficult topic a bit longer and allow your emotion to show. By practicing vulnerability with your therapist, you’re honing an ability that you can then use in your other relationships. 

We Use Self-Disclosure

Behavioral therapists may use self-disclosure, but only when we feel what we’re sharing is beneficial to you. In addition to sharing our reactions to you (as mentioned above) we may also share stories from our own life to normalize what you’re going through or model ways of addressing problems. In the real world, self-disclosure is part of what creates human connection - and we’re invested in connecting with you. We also check in about the impact of what we’ve shared has on you and make sure the sessions are focused on your growth.

It’s Okay to Disagree

We see disagreements as an opportunity to learn to navigate the inevitable ebbs and flows of relationships. The therapist assumes responsibility for keeping the therapeutic relationship on track. That means we agree to bring up any relationship concerns we’ve got before they have a chance to damage the relationship. We also model effective ways of communicating. Working through these disagreements can help increase insight into your triggers and response patterns, improves collaboration, and ends up strengthening feelings of trust.

We Like Feedback

Relationships aren’t one sided. That means that we also want feedback on how therapy is going for you.  We like to know when something is working and we especially like to know when something is not working. Feedback helps your therapist be more responsive to you as an individual and gives you the opportunity to practice having a voice in your relationships. If something is bugging you: (1) start by describing what you’ve noticed (just the facts) (2) express how you feel about those facts (3) share with a suggestion if you’ve got one. “I notice that you often assign homework, but then we don’t talk about it at the next session. I end up feeling less motivated to do the assignments. I was thinking that making time at the top of each session to review the homework would be helpful for accountability.”

If there is anything else you’re unsure about when it comes to the therapeutic relationship - please ask! We genuinely care about you and are invested in the relationship!

Eifert, G. H., & Forsyth, J. P. (2005). Acceptance & Commitment Therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger Publications.