“My patients?” “My clients?” “The dudes I work with?”
How do I describe my clientele? I struggle with this. “Patients” refers to the medical model and indicates a status differentiation that I dislike—none of us have figured “it” out. “Clients” comes across as if we’re sitting down to haggle and hash out negotiations (something I used to do and now despise).
Interestingly, the two states in which I hold licensure care about this: Minnesota legislature preferring “patients,” while Wisconsin opts for “clients.”
Why the emphasis on summing up the relationship between therapist and “person with whom the therapist is working” (damn, that’s a clunky one)? Well, time and time again, research and countless anecdotes have made the point that the therapeutic relationship is the most important factor in successful therapy. Studies have suggested as much as 30–50% of therapeutic success is directly attributable to the therapeutic relationship—so it seems important.
Part of the problem is that we have shitty ways of defining relationships. The word “friend” doesn’t fit either. “Customer?” I’m continually brainstorming and open to suggestions…
It’s the human connection between two people that I very much believe allows help. I often describe my work as two relatively intelligent guys sitting down to understand and work through some dissatisfaction. That’s it. Throughout that work, there is difficulty and enjoyment, laughter and tears, excitement and fear. Seeing a patient or a client does not describe this process very well.
I’ll plead the Fifth on the specific question of, are the people I work with “friends?” Something about self-incrimination. And of course, the disclaimer in my Disclosure/Informed Consent form reads:
“THERAPIST/CLIENT RELATIONSHIP: Although our sessions may be very intimate psychologically, it is important for you to realize that we have a professional relationship rather than a personal one. Thank you for not inviting me to social gatherings, offering gifts, or asking me to relate to you in any way other than in the professional context of our counseling sessions. You will be best served if our relationship stays strictly professional and if our sessions concentrate exclusively on your concerns. You will learn a great deal about me as we work together during your counseling; however, you must realize that you are only experiencing me in my professional role.”
Now that I have myself sufficiently covered ethically and legally: YES, there is very much a “friend” component of the therapy relationship, but the word “friend” does not encapsulate the therapeutic relationship either. This is largely due to the fact that our friends often come with baggage, expectations, and self-interest. This is not the case with therapy. There is no baggage, and that’s a large part of why it works. Again, two dudes sitting down to understand what’s going on and figure out what to do. Without baggage, understanding can happen as objectively as possible. And without baggage, moving forward can happen in the best interest of the person sitting across from me.
So why is this friendship aspect such a sticky point? Well, ethics would spout all sorts of concerns about dual relationships, inappropriate therapeutic boundary violations, sexual attraction, and counter transference, etc. Ok, cool. But let’s step out of the courtroom or classroom into reality and consider how the therapeutic relationship (and simply rapport itself) is built.
I can’t think of a more fundamental aspect than trust to be at the root of rapport. So how is trust built?
Through mutual vulnerability and acceptance, understanding, sharing, taking up a concern for another’s well-being—all repeated consistently over time together. Perhaps going so far as to suggest a mutual liking and kind regard of the other person.
Sounds an awful lot like characteristics of a friendship, doesn’t it?
My therapeutic approach can be labeled as existential. This is purposefully general and doesn’t really say anything other than a person (self) interacting with people (others) in the world—a distinction and interaction as basic as it gets. I strongly believe that if the greatest minds in the world cannot come to a determination of what consciousness is or what the human experience is, how the hell can I subscribe to a specific therapeutic modality? How can I be so damn sure that a traumatic relationship with your father is the reason you can’t get along with your sister? All sorts of elaborate correlational stories of our past relationships and experiences can be concocted to understand our present undesirable situations. But are they accurate and true? And are they even helpful?
Of course, the benefit of adopting a specific modality is that it can offer direction. It can offer an ease of not having to be an actual understanding person to the person sitting opposite you. A distance is created with the therapist holding the direction the other person is seeking. Suddenly, the aspects of friendship can be sidestepped or feigned because there is a research-backed approach and process to follow. Just stick to the path, and you’ll get… where exactly?
“Where?” is the exact question that cannot be answered without trustful understanding of each other. And here we arrive back at those aspects that mirror friendship.
So let’s take a quick look at some activities that go on in the therapy room:
Venting: I’ve had numerous “dudes (and dudettes) sitting across from me” apologize because they feel all they are doing is venting. So what? Venting provides insight into that honest inner voice and is often accompanied by honest emotional behavior. Good! This provides an accurate context of what’s going on for you.
Giving advice:
Therapists shall not offer advice. Bullshit! ChatGPT gives advice, but god forbid someone with an often-too-revered formal education and, hopefully more important, trusted understanding of the situation should be able to offer a possible course of action?
Talking about mundane/non-therapeutic, non-goal-oriented things:
Isn’t most of life mundane? Isn’t therapy about life? Must we always stick to the five-step plan and not venture off to uncharted territory, which may just offer helpful patterns, insights, and ways of navigating life that might offer a string unraveling a better life?
Confidentiality:
Time to get serious for a moment, because this IS a defining aspect of the therapeutic relationship, which sets it apart from friendship. Barring a few exceptions, what’s discussed in the therapy room stays in the therapy room.
And thank the heavens this is a protected aspect ethically and legally, as it does so much to create the framework from which understanding and trust can develop. The rest is up to the two people sitting there.