Progress In Therapy Depends On The Relationship But There Must Be Limits

Just what can you expect from your therapist in terms of how deep the relationship can and should go? I often act as a supervisor for other therapists and especially new therapists joining the industry and this is a question that often comes up. I have heard some horror stories on both ends of the spectrum concerning this. Firstly, there is the therapist who is too over involved with clients outside of therapy, sometimes in a codependent manner and meets them socially and for dinner. While this may bring some joy to the client (and indeed the therapist), you cannot escape the therapeutic relationship and crossing those boundaries can be harmful for the client (and some therapists) if the relationship goes wrong or is ended as it inevitably will be. It could spark abandonment issues held by the client. Ending of a therapeutic relationship should be a planned tapering off and leaves the client with the tools to prosper without therapy. Making a “friend” of the client will not help this process.

On the other hand, I have often seen therapists be so boundaried that they are like a rock to the client. Some therapy methods, especially psychoanalysis, call for the distant “sounding board” type method and for client to come to realisation through this. Time has mostly moved on from this method and thankfully, more engaging methods are replacing it. The truth is that clients are always curious about what lies behind the persona of a therapist but there must be limits to how much is revealed because therapy is about the client, not the therapist.

As a therapist, I am always happy when one of my clients has a “aha” moment. This is that very moment when everything comes together and you just know, it is going to initiate some form of positive change in the client’s disposition. I may have realised it was going to happen some time before it does, but key is the client realising it. This makes it far more memorable and is more likely to be sustainable. I am lucky enough to have been involved in a number of these moments over the years and some just recently which have made all the client’s hard work worthwhile. The weeks of questioning the ability to carry on, weighed down by the past and an imagined future all seem to be forgotten in this moment of realisation. It is one of the most rewarding experiences a client and therapist can go through together. However, it is not a given that this will occur, many things can go wrong before they go right and many variables can be brought to bear on the process.

One of the strongest indicators for success in therapy is the relationship between the therapist and client. This so-called “chemistry” is hugely important and cannot be over-estimated. Some clients will have been in circumstances where there has been virtually nobody they could trust, find reliable or confide in. The therapist then plays a crucial role in modelling the way relationships really can be. This “chemistry” is also something that cannot be taken for granted. Therapists and clients are human and even the “doctor” title doesn’t shield one from first impressions or misunderstandings. The more complicated the case, the more likely this is to happen.

That said, it is also the case that if both are clear that the relationship will be difficult after a few sessions, it will probably not get any better, meaning it is perhaps better to look elsewhere. On the other end of the spectrum, many clients see their therapist as a friend, easy to talk to, share secrets with and easy to be around. They often mistake the therapeutic process for friendship and are often disappointed when that “friendship” doesn’t develop in therapy or after therapy finishes. While it is always nice to have a friendly, open therapist, this is not seen as essential for the process to work.

The relationship with a therapist is not the same as friendship. Can a friendship develop after therapy? While not common, it can theoretically happen. The question is should it? Ethical guidelines frown on this for various reasons, including the idea that the transference aspects of the relationship, and the asymmetrical power differential established in therapy, never fully disappear. I have known cases where therapists and clients have developed romantic feelings for each other. While not uncommon on the client side, therapists need to look at the ethics part of this and refer if it happens. I have also heard cases of sexual interaction between client and therapist, which of course, is wrong on all levels and a breach of trust and an abuse of power. I discussed the issue of transference in this article and countertransference here. I know of at least two cases of these sexual encounters happening in the therapy room.

Above all, despite all the things that can affect the relationship between client and therapist, many studies agree that this relationship is crucial to the process. A recent article in Psychology Today stressed that transference and compatibility are the two biggest factors in the relationship and subsequently how successful therapy can be. While the article specifically looks at clients with depression, the factors can be said to be true for most disorders. Read more here.

As a therapist, I see it as essential to become somewhat involved (sometimes daily) with my clients on a work basis. Those going through crisis will need sometimes just a question asking how they are feeling. This does not mean that I go to dinner with them, socialize or become best friends with them but for me, the more traditional approach to therapy where someone sits there, seemingly totally unapproachable and maybe says three words throughout the session as one that does not work for me. I like to think that my relationship with my clients, that is one of honest, open positive regard and reliability is one that they can model and take away with them. I am not saying that the former approach doesn’t work in some circumstances and I have used it before when I felt that boundaries are close to being crossed, I just prefer another approach. That said, boundaries need to be in place and that is for the good of the client.

Those “aha” moments mentioned before do not come quickly, are not guaranteed and are usually the culmination of a lot of hard work on both sides. The therapeutic process is a means to this end but as with all things in life, can be affected by many things. Therapy must be seen as a positive interaction but essentially a temporary one that will at some point end with both sides going their separate ways. Clients who feel vulnerable enough to attach themselves to hope of some kind of relationship with the therapist are in effect, the ones who need the most help. It is always the therapist’s responsibility to ensure that the client can grow in a safe space.

“Welcome to my blog dedicated to mental health issues. I have been regularly writing about these issues for over a decade and the Online Therapist blog and app are a collection of my articles and podcasts on matters that affect people day-to-day such as relationships, codependency, narcissist abuse, parenting and depressionBrowse through the top menu to explore more. It is my aim to continue to write blogposts and create podcasts and make this content freely available as a resource. 

I hope you enjoy this blog.”

Dr Nicholas Jenner

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Dr. Nicholas Jenner

Dr. Nicholas Jenner is a counseling psychotherapist in online private practice working with individuals, couples and groups, dealing with codependency issues, severe depression, bipolar, personality disorders, anxiety, PTSD, eating disorders and other mental health issues. He has been practicing online for many years and recognized early that online therapy was a convenient method for people to meet their therapist. Working outside the box, he goes that extra mile to make sure clients have access to help between sessions, something that is greatly appreciated. He also gives part of his spare time up to mentor psychology students in a university setting.

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This Post Has 2 Comments

  1. As I was reading this I thought…thank goodness for zoom therapy…as that stops anything untoward happening which might otherwise happen in person between therapist and client.

    This is a very tricky balance to get right between therapist and client as it is often one of the closest and intimate relationships you have with someone… yet its not a two-way thing.

    So the therapist gets to know all about the client, but the client doesn’t get to know the therapist.

    I guess in a way this stops any “friendship” growing, because you cannot be a friend with someone you don’t know.

    So in a sense the therapist is “like” a friend to the client, as a lot of the same qualities you would have in a friendship are there like trust and honesty… but it is geared all around the client, not the therapist.

    But still the “chemistry” or connection the client and therapist have is so important and has to be right for therapy to go well.

    I have to say that being a therapist must be one of the hardest jobs out there because you need to be friendly enough and foster a warm and trusting connection, yet at the same time stay detached.

    I do not know how they do it, but I guess they have to keep work and private separate as much as possible and compartmentalise.

    As for having friendships after therapy has ended…I can imagine it being tricky because you are then trying to change the relationship dynamics that were therapeutically set, to then one of an equal footing, which I can’t see many therapists or clients doing.

    Although not entirely impossible I suppose relationships, many relationships only work a certain way.