Sitting down with a therapist for the first time can be an awkward experience. If anxiety is what brought you to psychotherapy in the first place, the act of meeting with someone to talk about it could exacerbate your symptoms. It takes a lot of courage to come in for therapy, and it helps when the person you are meeting with understands what is going on; someone who “gets” you. This understanding and health-driven human connection between client and therapist is the therapeutic relationship.
The therapeutic relationship is a fundamental component to what makes therapy work. It is the most cited factor in scientific studies that can lead to growth, healing, and change. Study after study shows the relationship between therapist and client is vital for psychotherapy to be successful. Not that other things don’t matter, but the therapeutic relationship really matters the most.
Bedside Manner vs The Therapeutic Relationship
So, what is the therapeutic relationship? In one word, it can be described as ‘fit’. The relationship between client and clinician in the therapy world is essential. In the medical world, when you visit a doctor to take a look at a rash on your arm the doctor will examine the rash with their eyes, possibly their hands, and maybe ask you some questions such as what you are allergic to or if you have brushed up against any poisonous plants lately. Based on their medical knowledge, they may provide a prescription to reduce or eliminate the rash. Hopefully, everything is resolved right there. It does not matter if you and the doctor are a good fit. You may have gotten into an argument with the doctor about your bill, or they may have poor bedside manner, but this should have no impact on the doctor’s ability to ascertain a diagnosis and offer treatment options, and certainly won’t impact whether the medication works. Conversely, it would be hard to meet with a therapist for 10 consecutive weeks to work on your fear of driving if you got side-swiped by your therapist on the highway two months ago. This may not be the best fit.
The Therapeutic Relationship Defined
The therapeutic relationship, also referred to as the therapeutic alliance, is the ability of the therapist to convey understanding of the client, belief in the shared work, and hope. It is understanding what the client needs and navigating the often shifting emotional waters to try and deliver the needed tools and guide their use. When the client can identify for themselves that the person sitting across from them, although never having gone through their exact experience, has communicated sincerely that they understand, then the basis for a genuine therapeutic relationship can be forged. It is these moments when the client feels understood that a therapeutic relationship is strengthened and secured. The construction of this initial bond is necessary before any real therapeutic work can typically begin.
As in any healthy relationship, some basic level of trust is required. Respect, encouragement, and support should play an integral role. What is different about a therapeutic relationship is that it is confidential, and disclosure of difficult and emotionally charged information does not disrupt the bond. When information like this is disclosed by the client, it is done so without the risk that the therapist will abandon or end the relationship.
The therapeutic relationship also critically encapsulates how the therapist understands and communicates that understanding to the client sitting across from them. Each therapeutic relationship will be different, although likely grounded in the core tenets of what an individual therapist believes to be most valuable as a mechanism for change. Some relationships could be more intellectually challenging than others, some may be more emotionally supportive than others, and some may feel more clinical. Depending on the needs of the client, any or all of the above may comprise the relationship.
Therapy Takes Courage
Returning to that first meeting, while for some beginning therapy can feel hopeful and exciting, it can also feel overwhelming and scary. One is typically tasked with offering up intimate details of themselves and their family members and to talk about the most challenging areas of their lives with a total stranger. By no means is this an easy conversation to volunteer for. The name of this initial session itself, which is referred to as the clinical or diagnostic intake interview, can seem rather cold and distant. Throughout this conversation, you may feel a range of emotions depending on many different factors.
Some things to ask yourself after this initial session are: Did I feel understood? Was this person easy to talk to? Can I be myself with this person? How did I feel in the room? Ideally, you will feel comfortable, safe, and understood, but the setup for this conversation can make this more complicated, as just described. Just like all people, some therapists are better than others at making a good first impression. While you should look for feeling comfortable after the first meeting, you may also consider allowing for subsequent sessions to get a clearer view of the potential for what the therapeutic relationship will or will not become. Additionally, it is important to remember that you are not committed after the first session. There is no reason you should feel compelled to stay with a therapist if the fit does not seem right. Choosing the right therapist (and firing the wrong one) is an important first step in advocating for your mental health and wellbeing.
