Therapy has undergone a lot of changes in the past twenty years. The pressure for methods to be ‘evidence-based’, the prevalence of mindfulness and somatic techniques, and workplace appointed counsellors have all radically changed the way therapy is done from the days of old talk therapy. All of these changes have helped accessibility. However, they seem to be endangering a major foundation of effective therapy: the emphasis on the therapeutic relationship.
Traditional (psychodynamic) therapy got something right. Time and time again research shows that fancy techniques and theories are fine and well, but a stronger predictor of success in therapy is the strength of the relationship between therapist and client. It’s no accident traditional therapists focused a lot of explicit attention on this relationship. Humans seem to be enlivened by these types of discussions like no other topic. Consistently in my practice, if a session has fallen flat when going through some prescribed technique, turning the conversation to what is happening here-and-now between me and the client breathes life into the conversation.
In our normal social interactions so much goes unsaid—so many concerns, questions, assumptions, feelings. It’s not really normal to talk about these, to compare them, to attend to the little details and talk about the vibe in the room. So therapy offers a unique container to safely explore these unspoken dynamics, which can create an exceptional bond between therapist and client. It also is the most powerful way for clients to understand, in real-time, their patterns in relating to others. This includes breaking down the unconscious barriers that bring problems or distance in their relationships.
The modernization of therapy is endangering this work for a number of reasons. Manualized therapies pay lip-service to the importance of the therapeutic rapport, but very few of their techniques and psychoeducation center around these here-and-now discussions about the relationship. Also, the pressure for brief therapy, which has to be complete in a short number of sessions, doesn’t allow us to slow down and attend to subtle but important details. In a short period of time it’s also tough to develop the shared comfort to discuss vulnerable feelings with the therapist. And of course, workplace appointed counsellors aren’t chosen by the client, but are assigned and are usually trained to provide a course of therapy in a few short sessions. All of this fast-therapy amounts to an a seriously hampered therapeutic relationship.
So what do I practice and envision? Evidence-based protocols can be wonderful, they create structure and give us something to work toward. So I consider these the skeleton of therapy. Insights and techniques are like the muscles and soft tissues, giving clients the tools to practice making changes. But I never forget that the therapeutic relationship is the life blood of the process, it brings oxygen to the body, breathing life into therapy.