Your therapist is not your friend. Friends are the people to whom we turn for encouragement, a hug, or the distraction of someone else's troubles. We need others in our lives to provide such caring, enlivening experiences. But we get in trouble when we expect to receive those experiences from a therapist.
My approach to therapy is rooted in the idea that the patients need to have a particular kind of relationship with me in order to learn from experience and thus change what is not working well in their lives. Here is a summary of how I believe a therapeutic relationship is put together in order to be the most helpful to the patient:
- The relationship will become very intimate, meaning that the patient can become more and more comfortable over time sharing thoughts and feelings and memories without worry about censoring or editing. Feelings of belonging, acceptance, and being very deeply cared about tend to develop. Sometimes love develops between the therapist and patient. While both the patient and the therapist have profound emotional responses to the bond between them, the focus of the therapy is on the patient's experience. In my way of working, I seldom disclose much to the patients about my own experience of being with them. While that information is essential for me to know in order to be able to analyze what is happening, I keep that private. A therapist who lets his or her own life, issues, or problems intrude into the therapy is robbing the patient of the experience of being the focus of the work, and thus seriously undermining the value of the treatment.
- The therapy relationship is carefully "boundaried." My sessions start and end on time. I do not welcome non-emergency calls or e-mails between sessions. My bar for considering something an emergency is pretty high. I do not speak to my patients if I happen to see them outside of their sessions. My goal is to provide a very predictable, consistent environment that is conducive to building trust. My clear limitations of time and space are modeled after the boundary between generations that a child encounters. A big part of being a competent person in the world is to be able to accept the reality that we cannot cross some boundaries, and we cannot always have what we want. Accepting my boundaries helps bring about that goal.
- The therapy relationship involves an exchange. In exchange for helping my patients find greater satisfaction with their lives, I receive monetary payments. I like to be paid for my work. I expect that the amount each patient pays me will represent a significant amount in their lives and circumstances. The issue of the payment is a topic of ongoing concern in the therapy. One's money can be a symbol of one's power, or of one's ability to make one's way in the world. Many patients start out resentful at the cost of therapy, but by the end, they tend to have a very different attitude, and they are often more confident about attracting money to themselves in the world.
- It is not my job to provide encouragement to my therapy patients. It is my job to tell the truth as I see it. If I tell a patient, "Come on! I know you can do it!", I am imposing my own ideas and inviting a rebuttal. What would be much more helpful would be to help the patient understand how it is that discouragement has taken over. A therapist who offers encouragement is probably a therapist who holds a fantasy of being able to make the patient be the way the therapist would prefer they be. In my way of working, the ideal is for the therapist to have no wishes at all for what might happen, because that is none of the therapist's business. The therapist's business is to help the patient figure out what the patient wants and how to go after it in life.
- Hugs or other physical contacts with patients are problematic in therapy with adults. The patient in my office will feel held securely but in a psychological sense. In many ways I become like a mother who rocks her infant, pouring heart and soul into understanding and knowing a tender young being. But there is no need to actually touch the patient physically. My view is that therapists who touch their patients have not had their own issues sufficiently handled in their own therapy. What may be personally gratifying to the therapist can be totally damaging and confusing to the patient.
by Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.