On Choosing a Therapist
When it comes to selecting a therapist there are many things to consider. Traditionally, a patient might consider the therapists credentials, their therapeutic modality and interventions, and perhaps familiarity in life experiences, to name a few. But the alphabet soup of therapist credentials and interventions, EMDR, EFT, CBT, ACT, SEP, etc. can add to the confusion. More recently, our algorithms preemptively curate our desires for specific interventions to treat our aliments. We are served up self-affirming diagnoses, such as a highly sensitive person, high masking Autism Spectrum Disorder, and even misophonia by highlighting symptoms, but mostly dislocated from important experiential context. How do you know you are looking for the right things from the right therapist?
The most important variable is often the one overlooked: the quality of relationship between the therapist and patient. Outcome research on what makes therapy effective consistently demonstrates that the relationship with the therapist is the best predictor of meaningful psychotherapy. That’s it.
What is a Therapeutic Relationship?
Meaningful psychotherapy curates a real, genuine relationship between two people within a container of care, understanding, and authentic relating. It is the primary mode of therapeutic action, especially as the relating deepens. In time, the patient’s relational patterns emerge, social defenses are engaged, and inevitably ruptures in relating occur. What occurs in the therapeutic relationship is a tell for what goes wrong in other relationships. Within these breakdowns, moments of meeting arise, the therapist can respond to the immediate relational pain in a new, flexible, and corrective way for the patient. This challenges the patterns of relating within the patient and can help restructure the implicit relational scripts. For example, upon the therapist being late to the appointment, the people pleasing patient conceals their disappointment through surface banter. Sensing the possibility of disappointment, the therapist inquires in a curious, non-defensive posture. It’s an invitation to express openly their authentic feelings within a safe, connected environment. New possibilities of relating are forged and the patient can safely disclose relational disappointment without the fear of the other’s defensiveness or relational withdrawal.
A meaningful therapeutic relationship is assymterical by design. The patient shares a tremendous amount of information about their internal life: thoughts, wishes, feelings, fears, desires, and disappointments. While the therapist shares very little about their own lives or internal experiences. This offers a frame of focused attention without the social impingements of other types of relating, friendships, etc. Fashioned in this way it deepens safety, trust, and encourages relational risks necessary for internal growth and self expansion. The therapist avoids social chit-chat to minimize imitation of typical social scripts. How the patient shows up relationally is used to guide the process. Matters of trust, fears of closeness and dependency, patterns of self sufficiency, control and withdrawal help the therapist join in the shape of relational patterns. The most effective therapists know how to connect and relate to a wide range of self presentations and relational configurations. They are comfortable letting the conversations unfold in time, appreciating the complexity of the human mind as opposed to confirming their own ideas. The therapist appreciates the art of a good question that can activate the patient’s curiosity. They also turn their ear towards what is unsaid, listening for gaps, contradictions, and surprises. It’s more like experiencing a poem, and less like interpreting biographical events.
Additionally, the therapeutic relationship can hold ambivalence and paradox in ways that honor complexity and build tolerance for the inevitable uncertainties in life and relationships. The therapeutic relationship designs itself to hold contradictory experiences, such as love and hate, hope and despair, and dependency and autonomy. Life and relationships are played out on the stage of ambivalence. As humans, we want connection and independence, we feel fear and excitement, we are selfish and self-denying. The therapist’s capacity to hold the complexities of the other without prematurely collapsing into parsimonious interpretations creates space for the patient to come in fuller contact with aspects of oneself. This reconfigures symptoms into the greater whole of the human experience, reducing shame, confusion, and disillusionment.
A therapeutic relationship should help you understand the hidden patterns that shape your thoughts, feelings, behaviors, and relationships. These hidden patterns reveal themselves in the relationship between therapist and patient. Meaningful psychotherapy should be more than symptom relief, together you should explore and experience the deeper narratives beneath your struggles, hardships, and setbacks.
Interested in meaningful psychotherapy that can help you know yourself more fully and deeply to feel emancipated from the internal binds, we’d love to talk.