A Therapist and Patient Perspectives On: Having an Authentic Therapeutic Relationship

Dr. Michael Maley’s Therapist Perspective

For the better part of a century, researchers and practitioners in the field of psychology have been espousing the critical nature and the healing benefits of the therapeutic relationships.  The relationship between a therapist and her/his client is the only factor that has been consistently shown to help clients heal from virtually every psychological disorder.  When a therapist can fully engage in this relationship, when the therapist shows vulnerability, shows that he is moved by his client’s struggles and traumas, and when the client experiences empathy from the therapist, the healing process is enhanced immeasurably.  Individuals who struggle with disordered eating and body image issues need this mutually empathic relationship more than perhaps any other kind of client.  Whether there has been traumas in the past, abusive or unavailable families of origin, or just plain misstatement between a client and her/his important caregivers, every client I have worked with who has these issues needs a safe place to re-experience (or perhaps experience for the first time) the comfort of a safe, unconditionally empathic relationship.  This is the kind of relationship Tina and I have learned to cultivate over our years of working together.

“Blind Spots”

Being Tina’s therapist has required me to stretch and grow in many ways.  This growth from a practitioner who shared relatively little about myself to one who is far more open and authentic seems to have been the right prescription for our continued success.  Working with Tina has made it necessary for me examine my own vulnerability and to look more closely at what we therapists call our “blind spots”.  In so doing, I have come to realize that my imperfections, my mistakes, in short my humanity, is as healing for my clients as any clever or well-timed “interpretation”during a therapy session.  In fact, there have been several times when these interpretations have fallen way short of their intended mark, and it would have been better to just be human.

Being Human Means Making Mistakes

Being human also means making mistakes, and I have made some doozies.  An honest, vulnerable, supportive relationship has helped to ensure that Tina and I have been able to weather these mistakes and to allow one another the room to be angry, disappointed, frustrated, and even to feel helpless and hopeless at times with one another.  After each one of our difficult experiences, we have been able to talk about the issue(s), process our feelings about them, and then to move on with a newer understanding of what it means to exist in our therapeutic relationship.

Anger Needs a Voice

Early on in our time together, Tina and I bonded over the issue of anger.  We had several conversations when we were working together in an inpatient treatment center about how one should properly and appropriately express anger.  The overwhelming attitude at the center was that anger should be caged or at least curbed, and that clients should find a “constructive”way to express it.  Often that meant not addressing it when it came up, and instead waiting until much later during a process group or an individual session.  I had an inherent problem with this line of thinking, because anger does not wait and if it is not expressed when it is felt it often leads to depression and a sense of helplessness.  Tina and I agreed that her anger needed a voice, and we worked hard to teach people at the center that expressed anger is not something to be feared but rather something to be honored.  Although there were several clinicians who clung to the idea of an “acceptable”way to express it, most became much more comfortable with an outburst here and there, and the occasional “f bomb”from me as well as Tina.

Therapeutic Relationship

I have been able to generalize from my experiences with Tina to both my personal life and of course to my work with other clients.  I have found that there are many people who wish to have an outlet for anger and who cannot seem to find this except in the context of a safe, healthy, well-boundaried relationship.  This kind of relationship often doesn’t exist for people, especially people who present for therapy with history of disordered eating.  I have learned that providing this space for clients is essential for the process of recovery.  Recently Tina and I had a conversation about childhood and how many of us do not get the care and nurturing we needed from our families.  As a person in recovery from an eating disorder, I realized that although my primary caregivers were physically available and were not abusive, I was not provided the room to tantrum and to be angry.  Doing so meant a withdrawal of contact, and translated in my childlike brain as a withdrawal of love.  I found that I needed a place to throw my tantrums and still be saved and loved.  Through our iterative process of examining anger and how to address it in a healthy manner, Tina and I have been able to understand what each of us needs in this therapeutic relationship, and it has made us each stronger.

Tina’s Patient Perspective 

There are always boundaries or a clear lines drawn in the sand in the world of therapy and in the therapeutic relationship between a patient and a therapist. Like any relationship that is healthy and works, both parties need to be open and show up authentically in order for it to thrive and last. However, from my perspective as a patient I sometimes think that therapists tend to use these boundaries as place to hide their own struggles and humanness from their patients. Then simultaneously want and ask their patients to be forthcoming, honest, open and to share their deepest darkest secrets and pains in their lives. My response to that is, thanks but no thanks. I’ve often felt from my own experiences with working with other therapists that they speak to “the idea” of building a trusting and honest relationship, without the willingness to be open, honest and forthcoming themselves. Indirectly, setting up this unspoken, authoritative dynamic, by the therapist sitting on one side of the line with all the answers and on the other side the “sick” patient sits with being only one with troubles in the room. Some may say this clear-cut boundary is in place to protect the patient. In my opinion, it’s a cop out and a convenient place for a therapist to hide and stay protected in order to not expose who they genuinely are as a human being.

A Real Person 

As someone who has suffered and struggled with the agony of an eating disorder I can tell you I was using it as coping mechanism to avoid dealing with the feelings of being disconnected, isolated, and alone. As a result, the last thing I need or want especially from my therapist is for him/her to not connect with me as a “real” person.  That type of so called therapeutic relationship only perpetuates and validates the familiar feelings that my eating disorder has fed upon, being isolated, alone and detached. It’s very simple, if you aren’t willing show me who you are then why the hell would I want to open up and show you who I am. If can’t get that especially from a therapist, then I have no desire to build yet another unilateral relationship as it is more harmful than helpful to my healing process.

Being Human

I can still remember thanking Michael for being so human at the end of my first session with him while I was in treatment. I immediately had a sense that I would finally be able to let my protective guard down. I desperately needed and desired to be able to open up to another person about how scared I’ve felt throughout my life and to reveal my own vulnerability without the threat of being emotionally shutdown. I’ve asked myself many times, why did Michael’s humanness touch me so deeply? Because growing up I was never allowed to show my own and my family never ever would expose theirs. There was absolutely no room for me to express any of my feelings and emotions. The only emotion permitted and expressed in my family was to be stoic and tough with the unspoken goal of keeping up the facade that everything was great when in reality my family environment was chaotic and destructive.

No More Pretending

Having Michael has a therapist has worked for me for one main reason, he has bravely shown me that he too knows what feels like to drop to your knees in pain with his own personal struggles. In turn, his vulnerability opened up a necessary gateway that has allowed me to understand and begin to stop hiding out in my eating disorder and to show up for myself in my life. I desperately needed someone to demonstrate and to teach me that it’s ok to feel afraid, angry, sad, make mistakes and to accept that there will times I am not ok and that I don’t have pretend to be anything other than myself.

Safe Haven

Over time, Michael and I together have created a safe, honest and trusting therapeutic relationship by our willingness to let each other be seen, heard and valued. This is not to say that our relationship has not had its share of smack downs where we have hurt, disappointed and wanted to give up on one another. Yet, these unpleasant moments have to, been a necessary and cathartic part for each of us.  Somehow, we’ve always been able to work our way through our human muckiness and each time once we’ve found a way out our connection has become more sustentative and healing for both of us. In turn, giving me the experience of knowing what it feels like to believe and trust in another human being.

Writer: Dr. Michael Maley & Tina Klaus          Website: Dr. Michael Maley       Twitter: @DrMaley   Blog: Don’t Live Small                     Twitter: @dontlivesmall

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