The psychotherapy process is above all a dynamic that is established between the psychotherapist and the patient (s).
However, that doesn’t mean it’s just a conversation; Beyond the words of the dialogue, there is something more: a therapeutic relationship which allows a kind of training to be established. The psychologist “trains” the patient in new ways of behaving, feeling and thinking.
However … What should the relationship between psychologist and patient look like? In this article, we will make a brief commentary on this.
The relationship between psychologist and patient: main requirements
Although even today going to the psychologist is a relatively unusual action and still slightly stigmatized by the population, fortunately it is more and more common that when a person suffers from a psychological problem, turns to help. professional. Through interaction, the professional and the user establish a link through which to work.
This bond to which therapy is aspired, sometimes referred to as a “relationship”, must be developed over time in order to be able to provide optimal service.
By therapeutic relationship with the professional bond that is forged between therapist and patient and that it aims to address one or more specific aspects or problems that hamper the quality of life of the patient or his environment and that the former wishes to change. This relationship must always be based on mutual respect, and above all centered on the figure of the patient or the user.
If the therapeutic relationship is positive, it facilitates the obtaining of results regardless of the technique to be used, the subject does not feel confused and easily shares his thoughts and emotions with the professional and promotes the will to change. It seeks to generate a climate and an environment in which the patient can feel protected.
At the level of the therapist, it is necessary to show a certain level of closeness in which the subject can come to feel accepted and heard. The presence of empathy and cordiality in the professional also helps. Authenticity is also relevant: the ability to be yourself and to answer sincerely the questions that are generated in consultation. Finally, we must underline the absence of judgment towards the patient, active listening, the interest of others and the search for their well-being as building blocks of this relationship.
One thing to keep in mind: a psychologist is a professional who offers a service and bills it. This implies that we are in the middle of a professional type relationship, in which while it is inevitable and desirable that a bond or even an affection appears, this bond should not be confused with another type of relationship. Thus, the relationship between the psychologist and the patient is not neither friendship nor of any other nature than professional.
If this is the case, it is for a good reason: the relationship between the two people seeks to make the patient successful. solve a problem that cannot be solved by itself, And needs professional help in which the psychologist must be objective in order to find a way to achieve the well-being of the patient. Likewise, one party has all the information about the other, while the latter knows virtually nothing about the other.
Transfer and counter-transfer
Two of the best known and at the same time the most important concepts in terms of the relationship between psychologist and patient come from psychoanalysis, these are the terms transference and countertransference.
Transference refers to the patient’s projection of patterns of behavior, parenthood, affection or desire that he or she felt towards another person in the figure of the therapist. While the transfer itself it is to a certain extent positive because it allows this information to be outsourcedThe truth is, taken to extremes can make you think of there being some strong feelings that cannot be matched due to the type of relationship the two people have. In other words, the transference can be considered as the set of reactions generated by the therapist in the patient.
The transfer is understood as a positive element that allows us to work on various subjects that would not arise otherwise. However, it should be understood that transference can also lead to the appearance of excessively intense feelings towards the therapist, to the point of falling in love or hating. These should be worked on in therapy.
On the other hand, we can find the countertransference, or the set of emotions and feelings that the patient can arouse in the therapist **. Although there is obviously some countertransference in most therapeutic processes, the professional must first be able to identify these emotions and then act as objectively as possible, And if necessary, should refer to the patient. This countertransference is generally rated as negative, as it limits the objectivity of the psychologist and can have an effect on the therapeutic relationship itself.
One of the elements to assess in the relationship between psychologist and patient is the level of directivity of the former in the session. The psychologist is a professional trained for years in the field of the human psyche and its alterations, have in-depth knowledge of behavioral patternsBut that doesn’t mean you just have to tell us what to do. There will be times when a psychologist will be more managerial and more clearly indicate the guidelines to be followed in the intervention, while at others the role will be more passive, acting as a guide leading the patient to find his or her own. answers.
There is no one way of acting more valid than another at the universal level, but it will depend on the patient, his problems and his personality, as well as the level of collaboration between the psychologist and the patient or the objectives. of the intervention. . There will be patient profiles that somehow demand to act. In general, it is currently planned promote autonomy of the patient and that he is able to find his own answers.
Valuing the language
Another aspect to consider is the language we use. It should be noted that psychologists will deal with a large number of people from very different backgrounds and levels of education. for that the language must be adapted so that it is understandable by the patient, doing it naturally.
Also the use of technicalities can be something that reflects knowledge on the part of the professional, but we must remember that the patient is in consultation seeking to solve a problem and not to admire our cultural level.
One human soul touching another human soul
While it is important to be clear that the relationship between the psychologist and the patient is a professional type link, given in a therapeutic context and in which the psychologist must be objective, this does not imply falling into a relatively common mistake: coldness.
It is not uncommon for many professionals, especially if they are just starting out even if it is not necessary, to keep a somewhat aloof attitude and only think and manifest in terms of treatment or focus on the patient. problem. But if the intention of many of them is to make a separation that does not confuse the patient between what is a professional and personal relationship, excessive distancing makes it much more difficult to feel understood by the professional and even trust him.
And we must not lose sight of the fact that the main basis of any good treatment, one of the main elements of any type of therapy, is the establishment of a good therapeutic relationship.
Feeling understood and valued by the professional is already therapeutic in itself and should be encouraged by both parties. An open and close attitude, which reflects an unconditional acceptance towards the patient and an active listening to what is said and worries are actually some of the aspects that are closer and in turn more productive to fostering change in the patient. We also don’t forget who becomes a psychologist he does it because he wants to help others so that they can live their life without limits and without excessive suffering allowing a normal life.
Doubts about the therapeutic relationship
As you know, a lot of people with different problems go to a psychologist’s office. The psychologist has tried to respond to the requests that come to him for which he sees himself as competent, trying as much as possible to be a useful help for the resolution of the problems, as expressed or not, by which he is consulted to him. (referring to other professionals in case of not seeing competent). However, it is common for patients to have doubts due to a misunderstanding of certain elements own psychological therapy.
Below, we will look at a number of problems and doubts that some people have had when consulting a professional psychologist.
1. Client vs patient: what am I?
While psychologists generally tend to refer to people who come to him as patients, it is also not unusual for them to refer to them as customers or users. Some people may interpret this denomination as strange, but this question has an easy explanation. Etymologically, a patient is considered to be a subject who suffers from a disease and who needs external action to resolve his problem. In this procedure, the subject is a passive entity who receives the solution to his problem.
However, in psychology, individuals who go to the consultation will have to make a series of behavioral and cognitive efforts if they are to resolve their problems, with the psychologist being a guide or a helper to achieve this goal but always keeping the individual an active role in his recovery. This is why some professionals prefer to call people who come to their clients or consult users before patients.
This is only one way of referring to those who go to the consultation, and whether they are called patients, clients or users in practice, the processes and the functioning of the therapy and the sessions will be the same (the main ones methodological variations being due to the different currents that exist in psychology).
2. Lack of comforting response to emotional expressions
This aspect, although it may be taken by insensitivity on the part of the therapist, should not be. It should be noted that the psychologist he must try to be objective and observe the situation from a distance in order to be able to help the patient in the most effective way, although it is true that the professional must establish a relationship of trust with the person who comes to the consultation so that he can speak sincerely.
In addition, cutting off the patient’s emotional expression can be counterproductive because altered emotional states can allow attention to focus on the motive behind them and awaken the patient’s own understanding of phenomena of which he was previously unaware.
It should also be borne in mind that throughout the day, a psychologist sees several cases of people with very different problems, so he must know how to put an emotional distance with his patients so that their personal life and their own psyche, in addition to those of later patients, are not affected.
However, it is true that some professionals try to keep this in mind so that they appear to have a certain coldness, which in turn it may be counterproductive not to feel the patient that their emotions are legitimate. It must be remembered that the psychologist takes care of people.
3. The one who talks the most is me
It is common for many psychologists to wait a relatively long time before speaking, with some uncomfortable silences in the sessions. These periods of silence aim to give the patient time to develop his speech. and to dare to express ideas that would not count on a shorter period. Thus, it is intended that he will explore and declare the thoughts that come to his mind regarding the questions raised above, however absurd he thinks they may appear. This may reflect content of great importance for processing.
They also allow the professional to think about the most useful methodologies to apply based on the information that the patient reports, to restructure what he knows about the individual in question and to deepen his understanding of the case.
It should also be noted that the professional’s directivity level varies according to the following theoretical current. Despite this, it is essential that the professional actively listens to what the patient is saying.
4. My psychologist tells me things that are not what I see
This issue emerges in many cases as one of the issues that patients / clients / users understand the least. It is common for the patient to explain a problem to a therapist and the therapist will link it to something that is apparently secondary to the first.
In these cases, it is possible that the therapist considered that the problem consulted was the cause of another phenomenon considered to be of minor importance by the patient. This way, it is intended to work on the underlying cause of the problem to which, Try to attack its possible cause more directly.
5. Therapy makes me uncomfortable
This aspect can be very conflicting. A lot of people come in for a consultation with a particular problem that they have a specific perspective on. However, the actions that the professional can advise may conflict with the user’s expectations, which may be one of the unfavorable and contrary to his wishes.
It should be borne in mind that even though some of the recommendations of the professionals may be unpleasant for the recipient, the therapist will always try to find the best possible method or the one that has proven most useful in most cases to help. solve your problem. Examples of this are therapies such as live exposure in cases such as phobias, which although they can elicit rejection in patients, have been shown to be the treatment of choice with a high success rate.
6. Same problem, different treatment
There are many theoretical currents in psychology, varying the approach and techniques used (although there is generally a lot of eclecticism). outraged each person has a different life, circumstances and even brain configurations.
Thus, what for a patient may be an effective treatment from the start, in other cases may be ineffective and even harmful depending on the case. The professional has tried to adapt the treatment as much as possible to the particular circumstances of his user / client / patient so that it is as effective as possible, always taking into account the generally most effective treatments and the variant of strategy in the event. of non-functional.
7. Psychotherapy does not serve me
Many patients come to this conclusion after a few sessions of therapy. The truth is that generally it takes some time for therapies to have a consistent effect. Also keep in mind that the psychologist will not make the problems go away. It is professional help that guides us and facilitates problem solving, but not without the need for our own efforts to achieve change.
However, if all this is taken into account and after a relevant period of time the therapy is not effective, it is essential to report this to the psychologist. In this way the professional can clarify the doubts that the patient may have of respect, vary the therapeutic approach (remember that the configuration of each psyche is different and that what some find useful in overcoming a problem is not. for others) or refer a other professional with a different perspective on the problem who may be more relevant to the case.
In the same way, it should also be considered that the professional he must be able to know the thoughts and events that the patient is going through. Withholding data that may be useful for the recovery of the patient or client can make it very difficult for the professional to develop a useful strategy for resolving the issues referred to the consultation.
In addition, the accomplishment or non-accomplishment of the tasks and challenges that the professional indicates and the generalization in daily life of professional indications (which may be difficult to achieve), will allow the patient to progress or not in his recovery, there can be big differences in achieving desired results.
Throughout this article we have attempted to clarify some of the doubts and misunderstandings that some patients have with professional psychologists. Consulting a psychologist is a space for orientation, help and treatment of many different problems. A good professional will try to do their best for their patient, to treat them and to recover.
However, this does not mean that in all cases patient doubts are due to ignorance or misunderstanding. As in all professions, there are individuals who are more or less competent in the performance of their duties, as well as cases of professional misconduct.
- Norcross, JC (ed.). (2002). Psychotherapy relationships that work. OUP.
- Rogers, D. (2015). More validation of the Learning Alliance inventory: the roles of the working alliance, relationship and immediacy in student learning. Teaching in psychology. 42 (1): pages 19 to 25.
- Spencer-Oatey, H. (2005). (Im) Courtesy, face and perceptions of the relationship: unpack its basics and interrelationships. Educational research. 1 (1): 95 to 119.
- Wierzbicki, M .; Pekarik, G. (1993). A meta-analysis of discontinuation from psychotherapy. Professional psychology: research and practice. 24 (2): pages 190 to 195.