Categorized | Therapy

Psychotherapy and the Therapeutic Relationship: What are they and how can they help?

“The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering. ” C. G. Jung, 


May is Mental Health Month (APA). I’m dedicating today’s post to the subject of psychotherapy and the therapeutic relationship. What are they all about and how can they help?

Although psychotherapy has been a part of the American and European cultures for almost two centuries now, the actual process of psychotherapy still feels like an enigma to many people. What is psychotherapy? What can it do for us that we cannot do for ourselves or that family and friends cannot provide?

Patients often come to psychotherapy through the positive recommendation of a friend or family member. Nonetheless, they enter treatment with some unease about the therapy process and its effectiveness. Their inexperience and the traditional therapy setting does not make them feel comfortable with the talk therapy. They enter an office that looks much like someone’s living room or home study. There are no medical machines to signify that psychotherapy is both a science and an art. There are only two chairs or a couch, a box of tissues, a painting or two and the therapist’s degrees hanging on the walls, and a bookshelf. The only instrument in the room is the therapist who listens while you talk, responds from time to time, and depending upon his/her school of psychotherapy, may even give you some advice. For sure, the way of talk psychotherapy is as mysterious today as it was when it first began.

The talk psychotherapies began in the late nineteenth century with Viennese physiologist Dr. Josef Breuer. His patient, Anna O., was unable to speak her native German, but she could speak French and English, or drink water, even when she was thirsty. Breuer discovered that if he hypnotized her, she would talk of things she did not remember in the conscious state, and afterwards her symptoms were relieved. Hypnosis permitted her to recall the conflict that led to her symptoms. But, it was talking about the conflict, putting language to it, that took the air out of her symptoms, so to speak. Breuer called his treatment method the “the talking cure” (, A Science Odyssey). And, with the help of Sigmund Freud’s conflict theory of personality, the talking therapies were born.

The Therapeutic Versus the Casual Relationship

Today, talk therapy refers to a range of psychotherapies derived from the talking cure. But, psychotherapy has come along way since that time. There are now many different schools of therapy and treatments. Additionally, the field of psychotherapy better understands treatment variables that positively influence therapy outcome, like the type of relationship bond that is formed between therapist and client. Research shows that a therapist’s empathy and ability to develop a therapeutic relationship of change, healing, and emotional development is just as important to therapy outcome as his or her education, training, and experience. And, this seems to be true across a number of therapy approaches and treatments (Therapeutic Relationship and Outcome of Psychotherapy).

The therapeutic relationship differs from the casual support that we give and get from family and friends that consists of support, advice, and guidance. Some of this casual guidance may actually be helpful to us. But, typically, it consists of poor listening, telling us what to do, and urges to compete with us emotionally. We can walk away feeling unheard, misunderstood, and even worse than we did at the start.

The therapeutic relationship is unique; it is unlike any other relationship that we will ever encounter, especially if the therapist is highly skilled at forging this type of relationship bond. The bond is formed by the way therapists listen to their patients and interact with them. Unlike family and friends, psychotherapists use their whole beings to take in what we are saying to them. They let their intuitions arising from their gut and extensive knowledge, training, and experience guide the psychotherapy process. Through skillful connecting and deep listening, they help patients to put language to their whole experience. Needs, desires, and feelings of patients are brought into awareness, which gives relief, new understanding, and grist for solving their problems. Patients gain better self-understanding, grow emotionally, and begin to use their whole beings too to process what is happening to them. They have learned to become steadfast and patient in the face of change and suffering.

Research shows that the therapeutic relationship helps to regulate patients’ emotions, which opens them to new understandings that lead to change. Through various physiological markers, like sweat gland activity (GSR) and the brain’s utilization of blood sugar (Positron Emission Tomography or Pet Scan), psychotherapy researchers have found that as people learn how to regulate their emotions, they begin to change, as reflected in the stimulation of the brain’s prefrontal cortex. This seat of higher-brain functions help in making sense of experience and giving meaning to it, organizing and planning behavior toward a goal, tolerating  frustration and delaying gratification of impulses, and using imagination toward reality-based possibilities (Talk Therapy: Off the Couch and Into the Lab, the Scientific American).  

What To Look For In A Therapist

Clearly, the ability to form an empathic therapeutic relationship is as equally important as a therapist’s education, training, and professional experience. Don’t overlook this ability when choosing a therapist. It may take a few sessions  to find out if there’s a good fit between you and the therapist. That is okay. You take a car for a drive a couple times before you buy it, right? Do the same when it comes to choosing therapists.

The following guidelines by Dr. Peter Breggin, founder of  The Center for the Study of Empathic Therapy, Education and Living,  provide therapist attitudes that are key to developing a good therapeutic alliance. Use them as a guideline to know what a positive relationship between you and the therapist should look and feel like.

The Guidelines:  As Empathic Therapists –

  1. We treasure those who seek our help and we view therapy as a sacred and inviolable trust. With humility and gratitude, we honor the privilege of being therapists.
  2. We rely upon relationships built on trust, honesty, caring, genuine engagement and mutual respect.
  3. We bring out the best in ourselves in order to bring out the best in others.
  4. We create a safe space for self-exploration and honest communication by holding ourselves to the highest ethical standards, including honesty, informed consent, confidentiality, professional boundaries, and respect for personal freedom, autonomy and individuality.
  5. We encourage overcoming psychological helplessness and taking responsibility for emotions, thoughts and actions—and ultimately for living a self-determined life.
  6. We offer empathic understanding and, when useful, we build on that understanding to offer new perspectives and guidance for the further fulfillment of personal goals and freely chosen values.
  7. We do not reduce others to diagnostic categories or labels—a process that diminishes personal identity, over-simplifies life, instills dependency on authority, and impedes post-traumatic growth. Instead, we encourage people to understand and to embrace the depth, richness and complexity of their unique emotional and intellectual lives.

When the therapeutic relationship is a good fit between therapist and patient, there is nothing more healing than the psychotherapy relationship. It’s unlike any you will ever have with another person. Still, today, patients from the past call or write just to let me know how psychotherapy has changed their lives for the better. They have enriched and blessed my life for sure, and it seems that our relationship has made their lives better as well.

I hope you liked my post today. Please let me know by selecting the Like icon below. You can also Tweet or Google+1 this post to let your friends know about it. And, remember, psychotherapy is a wonderful, deeply fulfilling experience when you have the right therapist. Warmly, Deborah!


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6 Responses to “Psychotherapy and the Therapeutic Relationship: What are they and how can they help?”

  1. avatar Samir says:

    hi dr.,
    i’ve a serious problem of OCD and anxiety. can i get some help? thanks.

    • avatar Dr. Deborah Khoshaba says:

      Hello Samir, I have an article on Generalized Anxiety Disorder that touches on OCD symptoms. If you haven’t read it yet, I suggest that you do. I give recommendations for treatment. Thank you Samir. Warmly Deborah.

  2. avatar AKHTAR KAMAL says:


  3. This is another great article. It not only helps those seeking psychotherapy to understand the process, but also helps the therapists themselves to keep in line their difficult efforts to help others. Also, clients developmentally profiting from the emphathic therapeutic process may well learn how to be more empathic with their family members, friends, and loved ones.

  4. avatar Jessica says:

    I just read 3 of your articles empathetic strengthening coping with a passive agressive man(my bf of 11 years) and sensitivity to rejection, you write so well and easy to understand ,everything I could use and relate to my life at this time that has been out of control as I’m turning 40 and realizing I have so many personality disorders as well as my boyfriend I wish. Could work with you but I do have a therapist and psychologist but m therapist just either agrees with me which yes is nice b/c he is relating back to me my problems and I guess validating them and he talks for about 1/2 the session about his life and stories and he doesn’t give me help on things I need work with ,I just read how to pick a therapist you had written and that is what I want in a therapist but more importantly what I absolutely need and quickly b/c my life is unraveling and I’m holding myself together at this point with tape and glue,I’m afraid I’m teaching my 17 year old son the wrong ways and I just want desperately to be happy and whole Ii wonder if you can help me find someone where I live to talk to and that will suit my needs (and takes insurance LOL) I have so much to find out get answers too be helped with learn about I need help so so badly. Hope p get back to me thank you so much

    • avatar Dr. Deborah Khoshaba says:

      Hello Jessica, Welcome and thank you so much for finding my posts helpful and for the nice complement. Jessica, good therapists once in a while share a story that connects up to their patient’s story but if your therapist is spending most of the time talking about his or her past–that’s not a good sign. Where do you live? I can see if I know a therapist in the area so I can refer the person to you. I’m happy to help if I can. Jessica your desire to be whole and happy is the first step to getting there. And, remember, don’t be so hard on yourself. You may over relating to the personality disorders at this time so that you are thinking you are many of them. I hear your stress right now in your words. You hang in there and take good care of yourself. Forty years old can also become the best time in your life, once you work through what is happening in your life right now. I’ll wait for your response. Warmly Deborah.


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