Relationship between therapist and patient

relationship between therapist and patient

A solid patient-therapist relationship is a crucible of wellness. And the path out of depression begins with a compatible therapist. You need a therapist who is willing to tell you that you are full of it. with creating a new consciousness that will help his or her patient move. The Relationship between Therapist and Client. Article (PDF Available) in SSRN Electronic Journal · January with Reads. DOI: /ssrn

Caught between two sets of conflicting impulses, those suffering this consequence may find themselves psychologically paralyzed, unable to make much progress in either direction.

On one hand, they may want to escape from the abusive therapist, from the destructive relationship, and from the continuing effects of the abuse. They may wish to break the taboo of silence that the therapist has imposed, to speak out truthfully about what has happened to them. They may seek justice and restitution in the courts. They may try to prevent the therapist from abusing other patients by filing formal complaints with professional ethics committees, the hospital or clinic if any employing the therapist, and licensing agencies, in part to see if to what degree these organizations are serious about protecting patients from abuse.

They may try to make sense of and work through their experience of abuse so that they can move on with their lives. But on the other hand, they may believe that they need to protect the abusive therapist at all costs. Abusive therapists are often exceptionally adept at creating and nurturing these dynamics. Exploited patients may learn from the therapist that the most important thing is to keep the sexual relationship secret so as not to harm the therapist's career.

They may have been led to believe that the sexual relationship was an act of great self-sacrifice on the part of the therapist, a moral and ethical act that was the only way that the therapist could "cure" whatever was wrong with the patient.

Ambivalence of this kind is often found among those who have experienced other forms of abuse. Incest survivors, for example, may experience contradictory impulses to flee the abusive parent, and yet also to cling to and protect that same parent. Similarly, some battered women will desperately want to escape to safety but also feel an overwhelming impulse to submit to the batterer, to take all blame upon themselves, and to keep the battering secret from all others.

Cognitive Dysfunction Many people who have been sexually involved with a therapist, whether the sex started before or after termination, will experience intense forms of cognitive dysfunction. There may be interference with attention, memory, and concentration.

The flow of experience will often been interrupted by unbidden thoughts, intrusive images, flashbacks, memory fragments, or nightmares. These cognitive impairments may interfere significantly with the person's ability to work, to participate in social activities, and sometimes even to carry out the most routine aspects of self-care. Sometimes the pattern of consequences may fit the model of post-traumatic stress disorder.

Emotional Lability Emotional lability reflects the severe disruption of the person's characteristic ways of feeling in a way that is similar to cognitive dysfunction reflecting the severe disruption of the person's characteristic ways of thinking. Intense emotions may erupt suddenly and without seeming cause, as if they were completely unrelated to the current situation.

relationship between therapist and patient

The emotional disconnect can be profound: Emotions begin to feel alien and threatening, as if they were unwanted intruders into the inner life. Cognitive dysfunction can involve interrupting the flow of experience with unbidden thoughts, intrusive images, etc. The person begins to feel helpless, as if the emotions were completely out of control, as if he or she were at the mercy of a powerful, intrusive enemy, an occupying force. Emptiness and Isolation People who have been sexually involved with a therapist may experience a subsequent sense of emptiness, as if their sense of self had been hollowed out, permanently taken away from them.

The sense of emptiness is often accompanied by a sense of isolation, as if they were no longer members of society, cut off forever from feeling a social bond with other people. She wrote in If I am alone, I will cease to exist. Guilt People who become sexually involved with a therapist may become flooded with persistent, irrational guilt. The guilt is irrational because it is in all instances the therapist's responsibility to avoid sexually abusing a patient.

It is the therapist who has been taught, from the earliest days of training, that engaging in sex with patients is prohibited, no matter what the rationale.

It is the therapist whose ethics code clearly classifies sexual involvement with patients as a violation of ethical behavior. It is the therapist who is licensed by the state in recognition of the need to protect patients from unethical, unscrupulous, and harmful practices, and it is the licensing boards and regulations that clearly charge therapists with refraining from this form of behavior that can place patients at risk for pervasive harm.

As the research summarized in subsequent sections will show, gender effects in this area are significant. It is possible that gender may be associated with the ways in which this irrational guilt develops and is sustained. Psychiatrists Melanie Carr and Gail Robinson wrote: The almost universal expression of guilt and shame expressed by women who have been sexually involved with their therapists is a testament to the power of this conditioning" p.

Psychiatrist Virginia Davidson, analyzing the similarities between therapist-patient sex and rape, wrote: Women victims in both instances experience considerable guilt, risk loss of love and self-esteem, and often feel that they may have done something to "cause" the seduction.

As with rape victims, women patients can expect to be blamed for the event and will have difficulty finding a sympathetic audience for their complaint. Added to these difficulties is the reality that each woman has consulted a therapist, thereby giving some evidence of psychological disequilibrium prior to the seduction. How the therapist may use this information after the woman decides to discuss the situation with someone else can surely dissuade many women from revealing these experiences.

  • Sexual Issues

Impaired Ability to Trust When therapists intentionally and knowingly violate their patients' trust, as they do when they decide to become sexually involved with them, the effects on the patients' ability to trust can be profound and lasting.

Therapy may rest on a foundation of exceptional trust. I felt sorrow for her and others who have devoted valuable time focused on the past in lieu of living for the future. And, I struggled with my own desire to hold the doctors accountable for not calling it a day and evaluating themselves as to whether their efforts were working -- or not. See, I think of shrinks -- the good ones, that is -- as teachers. We're there to learn how to look at ourselves and live life in a healthy way And like anything else where we pay for "lessons," there should be levels, with criteria to measure whether one is making progress or not.

But to swim around in the vapors of the past for no real gain or to not have a marker that deems the time and money well spent, is crazy at best and irresponsible at worst.

Eventually, someone needs to ask -- and answer -- the question, "What's the point? At some point, someone must question if the effect of all that talk is paralyzing. At some point, someone needs to assess whether there has been any change and if not, make one.

relationship between therapist and patient

Personally, I benefited immensely from what both of my shrinks taught me because they did just that. As a result, looking back, this is what I learned about what makes a therapeutic relationship successful, effective and worth the time, effort and money. You need someone who is willing to tell you that you are full of shit.

What Makes a Successful Therapist-Patient Relationship?

Otherwise, the game keeps going around and around and the patient goes in circles, only to end up right back from where he or she started.

In many cases, the net outcome is that you create situations where current behaviors are justified with explanations from the past, and the cycle never ends.

Seeing the past is important, but not at the expense of stifling the future. A good shrink will balance what needs to be brought into the conscious mind with creating a new consciousness that will help his or her patient move forward.

What Makes a Successful Therapist-Patient Relationship? | HuffPost Life

The premise of such a relationship is that the therapist is in the position of authority, while the client trusts them sufficiently to accept them as authority. In such a relationship it's much easier to influence and manipulate the other person than in everyday relationships between people who perceive each other as equal in knowledge and abilities.

A dance of subconscious Sometimes people choose the career as therapists because it gives them authority, power and status in the eyes of others. Such people might convince themselves that they are more capable than other people and that they have the right to influence others.

This attitude doesn't necessarily have to be obvious to others. Sometimes a therapist's wish to make the world a better place will result in attempts to change others without allowing them to grow at their own pace. This is often a result of an unconscious need to get rid of their own childish feelings. Just as in love relationships we often choose partners who are in some ways similar to our parents, to fulfill the unconscious wish to change or save our parents, in a therapist's position we can project this savior's attitude to the rest of humanity.

Subconsciously, we might hope to make a difference, deserve love or approval, make things easier for ourselves just as we hoped to do in our early families. If clients don't change at the speed and in the direction we want, this can provoke childish anger and criticism. An example of similar behavior are animal rights or environmental issues activists, who sometimes try to change other people by violent methods, seeing them as evil, instead of as people conditioned by their education and insufficiently informed.

Such people often identify themselves with what they are trying to protect, while projecting anger toward those who they see as "victimizers". This anger has its origin in their relationship with their parents or other authorities. Even if the motivation for their actions is positive, if they act on their childish feelings they are neither able to see the others' perspective, or to understand that their violent behavior will naturally trigger defensive reactions rather than agreement.

A smaller but not insignificant number of therapists believe consciously that they have the right to exercise power over other people. Such persons usually create rather rigid, hierarchical organizations around them with elements of personality cults, and they openly take a dominant attitude towards their clients, requesting things from them and prohibiting things to them, which doesn't help clients to improve their lives, but helps maintain the power structure.

Such requests can be explained by different moralistic ideas, but it is important that they are not logically and naturally connected to the solution of a client's problem. For example, requests to adhere to certain ritual procedures and formalities, not to explore different approaches and not to question the therapist's dogmas.

Sex Between Therapists and Clients

Modalities of exercising such influence can be different: The common result is that clients are slowly lead into an unequal position while feelings of impotence, dependence, fear, guilt or inferiority are created within them, instead of them feeling worthy and able to steer their lives and create happiness on their own.

For this to be achieved, the client must have complementary emotional issues: Since some people grew up in exactly such an atmosphere, it is not difficult to induce them to accept it once again.

Actually, what many people are looking for in a therapist or a coach is authority and decision-making: This is why some clients show less trust to those therapists who treat them as their equals and as able people, than those who want to dominate.

Favorite illusions All of us believe to be right and like to be right. A coach or therapist is no exception. However, just like anybody else, therapists are limited by their experience and their beliefs.

One of the key problems with many approaches is the assumption that therapists know the answers, while clients know little or nothing about their problem. Answers are more frequently sought in either rational knowledge or emotional intuitive impressions of the therapist, than in the client's inner resources and subconscious mind.

Not only is it impossible to analyze thoroughly all, or even majority, of known ideas and therapeutic approaches, but due to other life obligations, therapists often have little time to immerse themselves deeply even into a relatively narrow scope of interests.

Everybody enjoys certain segments of knowledge, while those that are emotionally less attractive usually appear far less important.

relationship between therapist and patient

Consequently, every therapist will look for the answers in their area of expertise, and they might not want, or won't be able to, think of the entire spectrum of different possibilities. This is natural and almost unavoidable, but it can become dangerous in case of suggestive approaches, or in case of therapists who are prone to exert their influence and authority over others. Sometimes a therapist who is an expert in a particular issue, or who may be excited about some recent findings or ideas, leads clients into believing that they have that very problem.

The client can long for somebody to take over a part of the burden of decision making, or to offer new, interesting belief structures which give hope for "instant", effortless solutions.

Clients might long for somebody to whom they can surrender their lives and whom they can idealize, just like parents. Difficult life problems naturally provoke childish feelings, so a person who is seen as an authority at that moment can easily become a parent substitute to the client.

Thus clients can go through a similar process as small children who wish to trust their parents in order to feel safe: Based on this, they may start to trust that the therapist always knows what he or she does.

If the therapist at this point says something wrong, abstract or difficult to prove, the client might start to search for justifications for such ideas, something like: I never thought about it before! For example, if the therapist says that the problem lies in the fact that the client did not forgive somebody - and who of us does not bear any grudge against important people?