Psychotherapy is a unique relationship; it is really like no other. It is not a friendship. It is not like a relationship with family members. Given its uniqueness, the psychotherapeutic relationship may take a little getting used to. Although there are different schools of psychological thought that view the clinical relationship somewhat differently, most would agree to some basic tenets that define that relationship.
It is primarily one-sided. In the literature on the psychotherapeutic relationship, this is referred to as “asymmetric.” The focus is for the most part on one person: the client. That is not to say that the therapist, take me for example, is silent or non-participatory. Quite the contrary: I say a lot in sessions, and I often make my thoughts, sometimes my feelings, known. But the focus is not on me: it is on the client who comes in for help. I take seriously that my job is to hold that focus.
We meet during a prescribed time and at a set place on a regular basis. Generally, I meet once a week with clients, sometimes more often. And, of course, that meeting takes place at my office. We meet during a certain time of the week for a prescribed amount of time. Even the understanding of an hour is different in psychotherapy: It is usually 50 minutes long. There is a very different structure than most people experience in relationships. As one client said to me, we stop talking not because we have resolved something but because of the clock. I acknowledged the truth of that and how that can be frustrating. The client and I do not have contact outside of the office. We do not meet for coffee; we do not socialize. While we may have some phone contact, our relationship is conducted primarily in the office during that set time.
The time that we meet, the regularity of that meeting, is referred to as the “frame” of psychotherapy. It is that frame that creates the structure to support the type of honest and intimate relationship that psychotherapy affords. The formality of our meeting, though potentially frustrating, can also be soothing. The frame helps create a sense of predictability – and predictability is an important ingredient in any healing connection. Often, in fact, people come into therapy because of ruptures in predictability (experiences let’s say with an addicted or raging parent that make for uncertainty and chaos).
And, of course, the psychotherapeutic relationship involves a transaction with money. Often the fact that someone pays for psychotherapy can be quite distressing to a client. In that case, it is certainly something valuable to talk about. People may feel that they are paying for me to care about them. What I often point out in that situation is that they are paying for my time; the fact that I care (and I do) about them is more a product of our relationship, of the intimacy between us, than something that is bought.
The psychotherapy relationship is primarily about honest and authentic communication. This is why I often dispense with formalities and etiquette. The hour is not necessarily about being nice and polite. Rather, it is about being real and speaking as honestly as possible. In fact, I believe that in the psychotherapeutic relationship a person has the opportunity to speak in the most honest way possible. The goal of psychotherapy is for that person to speak about everything that is on his or her mind.
And that is what we do together: we speak to one another. And we think (and feel) together. In this sense, we analyze everything. Sometimes this can feel a little too much and a client might voice that feeling. The basic premise that I hold is that there is meaning for us to discover in everything – from the fact that a person arrives late, to a slip of the tongue or the most significant decision that a person has made. We search to understand and find meaning.
Psychotherapy is a different kind of relationship. The overarching goal of that relationship is to arrive at a deep trust and intimacy, where the client reveals and discovers more about his or her inner life. There is just no other relationship like it.