The Uniqueness of the Therapeutic Relationship

By: Dr. Denise Renye

The therapeutic relationship is unique, it’s one of a kind and not to be found anywhere in the typical social world. It doesn’t follow “normal”  rules. Social norms simply do not exist inside the consulting room, especially with psychoanalytically informed work. If you had lunch with someone who wouldn’t answer questions but instead reflected feelings and provided interpretations around your relationship with your mother in regard to how you relate with food, it would be just plain weird, intrusive, and potentially intriguingly off-putting.

There is really nothing comparable with the therapeutic relationship in other social settings and because of this, sometimes the nature of the relationship can be confusing, especially to patients who may be new to therapy or those who are working on the understanding of boundaries.

If a psychologist is in private practice, there is a business aspect of the therapeutic relationship. Oftentimes, emotional navigation of this aspect of the therapeutic relationship is a potential  avenue into deeper parts of one’s psyche. Let me explain. Everything that happens in the therapeutic relationship is fodder for a deeper understanding of the self. For example, the way someone navigates the exchange of money or how they navigate scheduling –asking for their wants and needs around time, frequency of visits, etc. –is important. The “how,” which occurs between patient and clinician, is potentially the very key to understanding some of the patterns this patient is living. The relationship is where the therapeutic work occurs. The relationship is where the healing occurs –in relation with each other.

Whereas with other healing professionals – doctors, chiropractors, acupuncturists, massage therapists etc. – scheduling and payment typically takes place outside of the allotted appointment time, with the type of therapy I practice, scheduling and payment happens during the session. Why is that? Are therapists trying to minimize their time with clients? No. (But if you feel that way, please bring it up during your session…we’ll definitely want to hear about it!)

Everything surrounding therapy – payment, scheduling, questions about accepting insurance, logistical issues, etc. – is part of the therapy. That’s because therapy is built upon a relationship. The relationship is where and how healing happens. For some, a therapist is the first or perhaps only secure attachment figure in their life. A secure attachment figure is someone who provides a safe physical and emotional environment for interaction. They are people clients can count on, someone they can express their innermost thoughts to, a person that holds space for feelings and processing feelings without shame, blame, or judgment. The healing happens in the space between the hearts and minds and spirits of the patient and the therapist. The relationship is the healing container.

The therapeutic relationship rewires a person’s brain and helps clients repair lost trust, restore security, and provides support around regulating emotions, meaning modulating expression in accordance with the situation. And this takes time, consistency, reliability and the willingness to show up in this sacred relationship.  

Because the relationship is vital for healing, that means every interaction with a therapist is a part of therapy because it’s a relationship, not a business transaction. Yes, there are business aspects to this relationship, payment is exchanged, but it’s not as if the therapeutic relationship gets switched on and off. It’s ever present. However, there is a boundary around the relationship. It would be unethical to have a friendship outside the therapeutic relationship. You’re not buddies. The relationship is different and unique. That boundary is referred to as the therapeutic frame and it’s what allows clients to feel safe being vulnerable. There’s an understanding of anonymity and safety within the therapeutic frame, but as part of the frame, the more business-oriented things are also very relevant, necessary, and something to be discussed in session.

There are larger practices that have an administrator handle all of the business aspects, but for therapists who have their own practices, there is typically no separation. So again, the therapeutic relationship is where the healing happens. Talk of money, scheduling, and all. If you find yourself feeling frustrated by the process, bring it up. You might be surprised about what sort of healing awaits.

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