Ann Arbor Psych Blog

11/18/2020

The Therapeutic Relationship: 4 Common Questions- Answered: Part I

Written by Annen Weber, LPC

The therapeutic relationship in counseling is a beautiful and complicated thing. When the relationship is a good fit and the client feels they can trust the therapist to handle their issues with care and without judgment, therapy can prove to be an incredible foundation for the client to grow and thrive. If you are entering therapy for the first time and come across this writing, this may provide some answers to questions you have going in. If you are seasoned in therapy, you may simply find it interesting. Either way, here are five common questions asked in therapy:

  1. “How do I know if we are a good fit? Will it hurt the therapist’s feelings if it isn’t?”

This is a fantastic question. Before you shell out hundreds to thousands of hard-earned dollars it is important to question whether the therapist is going to be a good fit. The first step in determining this is to contact the therapist via email or phone. Many therapists will offer about 10 minutes of consultation so you can ask about their style and methods and determine if it is worth setting up an appt. Here at Ann Arbor Psychiatry our admins will help determine a fit based on the issues and availability. Our Prescribing Nurse Practitioners may refer you to one of the clinicians for talk therapy as well. Once you are in session you will get a feel for how you jive with the therapist. Your therapist should be compassionate, alert, professional and non-judgmental. While you may be nervous in the initial session (this is COMPLETELY NORMAL, btw), you should be able to tell if this is someone you will be overall comfortable with over time. 

Does your therapist listen to you? If you come in and tell them you want to address a certain issue such as Weight Loss but they spend the entire session focusing on anything else but that, they may not be a good fit. Let me add an exception to this rule: there are times in therapy where diversions take place- for example- a client’s issues with weight loss may be extremely connected to childhood issues which will need to be worked through so in such cases those diversions contribute to a very productive session. However, this usually happens after a relationship has been established and trust has been built. 

Is the therapist from a similar background? Do you feel you can connect to the therapist? For some people, they prefer a therapist with similar life experiences as them or from a similar culture or background, and that is totally OK. Some clients don’t care about the race, culture, gender or background and can spill all gory details about their lives with whomever they are placed with, and that’s OK also. 

The therapist’s feelings should not be hurt if you don’t feel it is a good fit. Any good therapist cares about your well-being and wants the best for you. If you are someone that needs a completely structured session chalk-full of homework assignments such as a straight CBT therapist, then a more laid-back and eclectic therapist may not be the absolute best fit for you. A good therapist will also let you know if they feel ill-equipped to help you and will often refer you to someone who may fit better. Just please don’t blatantly insult the therapist or throw tomatoes at them on your way out (if you must throw something, we prefer you throw chocolate).  

  1. “Are there any off-limit topics?”

This is a loaded question. It is my personal belief that a client should be able to discuss anything on their mind and not worry about being judged negatively by their therapist. A good practice for any therapist is to practice Unconditional Positive Regard toward their client- a concept by Carl Rogers- that any therapist should accept and support what the client says and does. I must qualify this though- this does not mean the therapist will encourage negative behavior (however we will not shame you or treat you negatively). Also, if you are planning to harm yourself or others we have a duty to warn and report said behavior to authorities. We also are mandated to report child abuse. Unconditional positive regard toward you as the client means we will remain compassionate and positive toward you no matter what because we support your development. You are in therapy because you want to grow and shed the negative and we want to help you, so we regard you positively at all times. 

There are some therapists that will not discuss sex with their clients and that are uncomfortable with topics so personal. This could be due to religious beliefs or other reasons, and I guess in that case they are not a good fit for vast amounts of clients but may be a good fit in rare cases. Most other therapists, myself included, believe humans are deeply complex beings with thoughts, feelings, and ideals as numerous as the stars above. It is because of this complexity that a therapist needs to be comfortable discussing any topic the client needs to. 

Please don’t be offended if the therapist shows surprise at something said, laughs at something humorous or asks questions about something. For example- when I have clients that identify as ‘non-binary,’ ‘trans’ or similarly, I always ask them to define that for me. The terminology regarding sexual orientation and gender is vast and ever-changing and to better help the individual client I need to know what their identification means to them personally. 

  1. “Why won’t my therapist give me direct advice?”

This is another super loaded question with several answers. There are cases in which we do advise. Examples: 1. If we believe you may need psychiatric care 2. If you contact us during an anxiety attack and need direct advice for handling it in the moment 3. If you come in for short term counseling with minor issues and have made it clear you are seeking advice about things rather than longer term therapy 4. Therapists seeing children will give direct advice to the parents to help set up the system which will benefit the child’s long term therapy.

There are cases in which we don’t advise. One example would be advising a client to break up with their significant other. If the significant other is abusing the client we may advise in this circumstance to get the client out of danger but in most other cases we won’t directly advise the client to break up with someone. There are many reasons for this, one being that most of the time clients don’t take direct advice. Better we ask questions to help the client come to terms with their feelings so the decision to stay or leave their SO is genuinely theirs. We want our clients to grow and make decisions more confidently and independently, and that won’t come if we are constantly throwing advice at them. 

  1. “Do you ever wish you could be friends with your clients? Why can’t we become friends?”

This is a common question and it is a fun one! Yes, every therapist has clients in their practice they would just love to hang out and be friends with. On more than one occasion I have thought to myself “Damn- if only I could have met this client years ago before I joined this profession!” I have a lot in common with some of my clients- some have the same sense of dark humor that I do, while others love horror movies or Nintendo just like I do. That being said, as much as it would rock to hang out with one of those clients, it can’t happen. Not only would it be unethical, it would hurt the hard work done in therapy. Here’s why:

The therapeutic relationship depends on the client’s ability to disclose any and all things buried in their history or in the forefront of their minds. A client struggling with something serious such as past sexual abuse needs a safe and confidential place to work through the issue. Often when a person discloses something such as sexual abuse to their friend the friend is sympathetic. However some friends may become awkward and unable to handle the information and this will strain the friendship. A therapist is trained to handle such information with compassion and care, and the client can rest assured their confidentiality will be kept.

Confidentiality is often the biggest ethical factor in therapy. If a therapist runs into a client in public, the therapist won’t acknowledge or address the client unless the client has addressed the therapist first. You may not want your boss, friends or family knowing you are in therapy so we are trained not to approach you unless you approach first. If a therapist and client were friends the therapist would never be able to contribute much in conversation with the client’s peers present for fear of violating confidentiality. Also, the client may potentially alter their behavior with their friends and family while around the therapist due to fear of being judged by the therapist. 

If the therapist got to know the client as a friend it would create a bias on both sides: the therapist is going to see behaviors in the client they were unaware of and question the direction they took with the client in therapy. The client would end up learning things about the therapist that may change their entire view of the past relationship and this could undo the hard work in the prior therapeutic relationship. These are just examples of why your therapist cannot be your friend. 

Therapy is work. While it can be fun and sessions enjoyable, the therapist is there to help guide you as you learn more about yourself. At times the therapist may need to confront you directly and challenge your thinking and ideas. Sometimes these challenges and confrontations hurt and are painful, but they are small seeds that can provide huge growth as you wrestle with them. This type of work cannot be done in the context of a friendship with the therapist. 

One final reason is the inability of a client to return to the same therapist if a friendship has developed. If you are like me and it took several therapists before I found a good match, it would be harmful if I needed to return to my therapist but couldn’t because we crossed that boundary. I would have to start over from square one with a stranger. 

 

The therapeutic relationship, while not a friendship, can provide strength for a client and even benefit the therapist. It is a working relationship that while boundaried, can be treasured by both the client and the therapist. By understanding the nature of the therapeutic relationship and respecting its boundaries, therapy can help you grow in a capacity you never thought possible.