Psychotherapy is a very special situation.
When we buy goods from a shopkeeper or a service from a non-psychological professional (e.g. advice from an accountant), a good relationship between people is helpful, but it is not of paramount importance. Perhaps we would prefer to deal with a shopkeeper or accountant with whom we feel comfortable, but even if we do not, we will still be able to get the goods or services we need from the other.
In the case of psychotherapy, on the other hand, a positive relationship between people (which includes mutual trust and respect) is a fundamental condition.
In other words, without a good relationship, there can be no psychotherapy and therefore no psychological treatment.
In a nutshell, one has a good relationship with one's psychotherapist when one can answer yes to both of the following questions:
Do I trust my psychotherapist?
Do I feel respect for my psychotherapist?
The personal point of view
The first question ("Do I trust my psychotherapist?") concerns the personal aspects of security and trustworthiness. If the patient feels safe with the psychotherapist, if he (or she) feels trust in them, they will then be able to open up and deal with more sensitive issues.
If such trust is lacking, the person will not reveal his or her inner self to the psychotherapist and, consequently, will not be able to deal with his or her deepest and most personal issues, with the result that psychotherapy will not have the desired positive effects.
Everyone feels more comfortable with some people than with others. People like or dislike each other for indefinable reasons. This is normal, and the person who is looking for a psychotherapist must bear in mind that it is quite legitimate that he or she may feel uncomfortable with some specialists and more comfortable with others.
When distrust is the problem
Sometimes, however, the person who decides to start psychotherapy may have a tendency never to trust anyone. There might be a (more or less conscious) resistance against starting psychotherapy, as well as a generalised distrust, regardless of the good intentions of the people he or she meets.
If the person has a generalised distrust problem, he/she will presumably have a lot of difficulty in finding the right psychotherapist.
They might meet many different professionals, one after the other, without ever really feeling comfortable.
Or they might change several psychotherapists after only a few sessions with each one.
In this case, it is unreasonable to think that the person solves the distrust problem first, and then finds the "right" psychotherapist later. In fact, the mistrust problem prevents one from starting psychotherapy, and most probably also represents the underlying problem that needs to be addressed in psychotherapy and that prompted the person to seek help.
It is advisable then, after selecting the least terrible professional, to turn up one's nose and dive into the psychotherapy course.
Remember: Psychotherapy is a relationship and, as in any relationship, things might take time. It might take time to settle into therapy, it might take time to trust your psychotherapist.
As the person deals with their problem of generalised distrust, they will learn to trust others and, of course, also their psychotherapist.
toward
It can sometimes happen that in the initial phase of therapy the patient feels trusting towards the psychotherapist but, during the course of the process, something happens to damage this trust.
It may happen, for example, that the psychotherapist says something with the best of intentions, which is taken as offensive by the patient - who interprets his or her words as inappropriate, unprofessional, critical or perhaps even aggressive.
Or a behaviour of the psychotherapist - such as an unintentional delay or forgetting once to turn on the ringer of his mobile phone - might trigger negative feelings in the patient.
Perhaps the psychotherapist was really inappropriate, perhaps they really lacked tact, or perhaps the psychotherapist was professional and empathic and the patient misunderstood. That is not the point.
What I want to emphasise here is that the patient from a certain moment onwards starts to lose that trust which is so important for the success of psychotherapy.
Thus the patient, instead of feeling at ease with the psychotherapist, begins to feel distrustful and sometimes even angry with him.
In such cases, it is advisable for the patient not to be hasty in his or her judgements, i.e. immediately coming to the conclusion that the relationship with his or her psychotherapist is now definitively and irreparably compromised.
Instead, it is advisable for the patient to address the issue directly and clearly with the psychotherapist. Very often, it is exactly when negative feelings emerge in the relationship that development occurs. It is thus paramount that the therapist and patient hold on to whatever is going on.
If the topic is raised and explored together, can the psychotherapist-patient relationship be repaired and grow.
Moreover, the patient (if he or she does not already know how to do so) can learn how to deal with difficulties in an interpersonal relationship without running away.
a professional point of view
The second question the patient must be able to answer in the affirmative ("Do I feel respect for my psychotherapist?") concerns aspects of the specialist's professional competence.
If the patient recognises that the psychotherapist has the necessary competence to help them deal with their problem, they will have respect for the psychotherapist. I am, of course, speaking here of professional respect and not of 'existential respect', which is an attitude one should have towards all human beings as such.
Sometimes, after a certain number of sessions, the patient begins to feel tired of the therapy and less motivated to continue it. This is a normal circumstance: during a course of therapy, there are always moments of enthusiasm and moments of tiredness, as is the case in all human endeavours and relationships. The patient, however, may disregard these natural fluctuations and begin to doubt his or her psychotherapist.
The patient may harbour the doubt that the psychotherapist does not have the professional competence to deal with their problem. It is possible that this doubt may disappear by itself in the course of psychotherapy when the patient starts to achieve positive results. Or it is possible that the doubt will persist and irreparably compromise the psychotherapist-patient relationship and, consequently, block the psychotherapeutic work.
It is advisable for the patient to express his or her doubts with the psychotherapist in order to try to clarify with them whether the psychotherapist really has the competence to help with the patient's psychological problems.
A (possible) assertiveness problem
In the previous examples, I referred to an 'ideal patient' who knows what he or she wants and is very active and assertive in pursuing it: he or she industriously searches for a trustworthy psychotherapist by discarding those with whom he or she does not feel comfortable, verifies the psychotherapist's competence, expresses his or her difficulties, and deals with the moments when the psychotherapist-patient relationship breaks down.
People, however, are not always so clear with themselves and so assertive with others.
Sometimes, some people may be reluctant to express their preferences and doubts to another person, saying to themselves: 'Who knows, if I speak openly, my psychotherapist will perhaps be hurt or even angry". They may fear that if they express themselves freely, the other person may take offence and 'sulk' or become critical and aggressive.
These people worry a lot about the (emotional and behavioural) reaction of the other person, perhaps too much, and consequently prefer to keep their opinions and needs to themselves.
At other times, fear of expressing themselves freely with assertiveness may make some people reluctant even to seek therapy because they fear being trapped in a situation from which they cannot get out. For example, these people may worry that if they realise that the psychotherapist is not right for them, it will then be difficult to tell them and end the course.
If one finds oneself in this situation, if it is difficult to express one's doubts, opinions, and needs openly, if one is afraid to address open questions with one's psychotherapist, it will be helpful to remember that:
If the relationship with one's psychotherapist is not serene and positive, if there is no mutual trust and respect, psychotherapy will not be able to take place and therefore, if one really wants to embark on (or continue) the therapeutic pathway, it will be necessary to address the issues that damage the relationship.
The psychotherapist is a professional who is trained and trained to manage his or her own emotional reactions. He/she has undergone (hopefully strongly) a course of psychotherapy on him/herself that allows him/her to contain his/her negative feelings, not to become aggressive or rejecting with patients, and to self-support him/herself in case he/she feels touched by a patient's words.
Psychotherapy is a protected place where non-judgement is central. If one is afraid of expressing oneself freely, psychotherapy is therefore the ideal place to begin taking the first steps and experimenting with assertiveness.
The overall aim of psychotherapy is to enable the person to be fully and authentically him or herself, which implies exploring both positive and negative experiences. Consequently, issues such as anger, doubt, disappointment, fear, and frustration are always welcome in a psychotherapy space.
The psychotherapist knows the rule that: "It is the patient who chooses the therapist". If an incompatibility emerges between specialist and patient that might make the therapy difficult or impossible, the psychotherapist is prepared to deal with this. He usually has a list of professionals to whom he can send the patient.
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