Dr. David Metzner

Like a poor dancer, from time to time I end up stepping on someone’s toes. Seldom intentionally it just seems that I will say or do something that turns out to ruffle someone’s feathers. Although I maintain several excuses for my behavior, rarely do I really have a reasonable defense for my actions. This may well be one of those times.

The Medical Model

I decided to start this blog with a post on main concepts of psychotherapy. In looking at this subject t is important to keep in mind that therapy is based on what is known as the medical model. Under its very broad umbrella falls several categories of helping or caring professionals whose responsibilities include:

• Physicians, psychiatrists, and other medical professionals
• Mental/behavioral health therapists
• Specialists whose focus are specific areas of the human condition.

Whether treated in a medical office, a mental health center, or by a private therapist they all share in common the principles of the Hippocratic Oath., including:

• I will do no harm
• I will do my best in practicing my craft
• I will hold in the highest respect the nature of my treatment of my patients

We also label these relationships. The more common labels are the doctor/patient or therapist/client relationship.  Why is this important? These descriptions define our roles in the relationship. Taking this a step further, it also can describe the exercise of power within the relationship. We have been conditioned to believe that doctor trumps patient and that therapist trumps client.

The Therapeutic Relationship

In mental health, there is a phrase used to describe the therapist/client relationship. It is the therapeutic relationship. This relationship is limited and focused so as to include only those areas considered a part of treatment.  It is also used to describe the nature of the relationship between the professional and the client/patient.

To this day, even as efforts to improve the nature of the relationship are underway, it remains one of separate but equal status. The professional, by the very nature of being a professional holds a position of power in the relationship.

It is a re-examination of the very nature of the therapeutic relationship that follows. By now, I spent almost 15 years being educated, trained, and practicing my vocation: psychologist. It was during this time that I devoted a great deal of time refining, what my role as a therapist was. While the answer to this question is a moving target, this much is clear to me.

1. The professional/client relationship is first and foremost a relationship.
2. Its uniqueness lies within certain established boundaries.
3. Inherent within these boundaries are certain spoken and unspoken rules.

I want to explore each of the above areas with you. To hopefully give you some insight into what this all means and more importantly empower you to gain the most benefit from a therapeutic relationship.

Background

There is a very long and rich history surrounding the therapeutic relationship that goes back centuries. More recently, Carl Rogers, founder of person centered psychotherapy, outlined three essential ingredients of a successful therapeutic relationship – unconditional positive regard, genuineness and empathy. We will return to these a bit later. For now just know that in general the therapeutic relationship, consists of work done with a professional to alleviate, eliminate, or alter physical or psychological conditions.

An example of just how limiting the therapeutic relationship can be is an ethical boundary used by many therapists. When out in public and happen to encounter a client, a therapist will never acknowledge the person unless they do so first. We will limit your conversations to certain prescribed mental health topics.

While there are efforts underway to humanize this relationship, it remains one of the more difficult areas of treatment. Clients often complain that their therapist seems distant and rigid. As the client you are urged to disclose the most painful aspects of your life, while the therapist can display interactions that border on feeling impersonal.

Contributors

If you are a client in a therapeutic relationship or a therapist who senses that the nature of the relationship needs something more there is good news. It is that most therapists do have the best interest of the client in mind. They use their knowledge and experience to bring about meaningful change. There are even those who will refer a client to someone else if an impasse in treatment is reached.

Conversely, there are some professionals within the therapeutic community that have enough problems of their own, so that it can seem as though they are treating themselves when practicing therapy with a client. The tip-off usually is that they need to be in charge. That their particular method of treatment is right for you. Or, in some other ways they overstep understood boundaries. These and other behaviors are red flags that should be heeded. As difficult as it can be, remember you are paying the bill.

Education

What makes the education of a professional unique is that a significant part of that educational experience includes enculturation into it.  I found that there was a great deal of time invested in making cookie-cutter clones of the “ideal” psychologist. For example, in my educational experience of becoming a psychologist there was one quality that was continually driven home, a something the “better” psychologists practiced: the use of your professional self.

At the time this seemed to make sense.  Different from my personal self, this professional self allowed me to objectively look at a client, make an assessment, and implement a plan of treatment. The problem with this approach is that it is quite like the lyrics from Pink Floyd’s “Another Brick in the Wall.” It further cuts one off from a person to person relationship.

Image: https://www.flickr.com/photos/deltamike/751707089