John A.Martin, Ph.D. California Licensed Psychologist
The Therapist-Client Relationship
Both scientific research and clinical data support the idea that human beings are born with the innate capacity to relate with one another in a mutually gratifying manner. Empirical studies in early parent-child interaction - including published research of my own from over 15 years ago (see vita) - have demonstrated that even very young infants have a native ability to make connections with other human beings, connections that are characterized by reciprocity and mutuality of influence.
From the very beginning, our interpersonal relationships are remarkably complex dances; perhaps surprisingly, even young infants seem capable of fully participating in them. Our ability to create and maintain highly-complex, interpersonally intertwined systems therefore appears to be pre-logical, pre-cognitive, pre-verbal. Thus, in a sense, our interpersonal nature seems to be less about learning than it is about intuition. Each of us is influenced in part by our own internal sense of what constitutes relationship, in part by feedback from our partners, and in part by feedback from the experience of being in the relationship. Despite the apparent complexity of these multiple sources of influence, we are, it seems, born to have relationships.
Dancing in psychotherapy…
It seems fair to assume then that both the therapist and the client in the client-therapist relationship were born with this ability, that they each have the capacity to engage in a fully functioning relationship with the other. It therefore also seems fair to assume that, unless there are interferences of some kind, a mutually gratifying relationship ought to evolve between them.
So in the early stages of psychotherapy, an important part of the therapist's job is to set the stage for the evolution of this fully functional relationship. Ground-rules and boundaries are of course part of what is needed. And in addition, therapists also need to foster an attitude of openness, teamwork, and curiosity in the relationship, willingness to question, and a willingness to grow. Therapists also need always to strive to be fully available for relationship, and to be acutely aware of processes occurring within the relationship and its participants that interfere with its functioning. In short, the therapist needs to embrace the role of an accomplished, professional dance-partner.
When therapy gets tough…
At times, a therapy might seem especially difficult, or a client might seem difficult. I have come to believe that there is no such thing as a difficult client or a difficult therapy - there are only difficult therapeutic relationships. And since all relationships are systems of mutual influence, both therapist and client contribute to the difficulty.
Sometimes the difficulties seem unavoidable. The challenges involved in maintaining a therapeutic alliance with clients suffering from one or more of the many Axis II personality disorders, for example, are well known and easy to identify. But at other times, the problems are more subtle: There can be a general feeling of lack-of-direction, of stuck-ness, or of having come to some sort of an impasse. Behavior of client and/or therapist might be characterized by stiffness, tentativeness, unfriendliness, over-solicitousness, a feeling of 'disconnecting', irritability, emotional distance, excessive formality, excessive cheerfulness, awkwardness, boundary-testing… there are countless signs that something is "out of balance" in the relationship.
Therapists are often inclined to look exclusively at clients for the source of problems in the therapy. In psychodynamic terms for example, "analysis of the transference" can reveal habitual interpersonal patterns and styles, learned in early relationships, that clients transfer into the client-therapist relationship. Most of us were trained to look to the client for interferences to the development of mutually gratifying relationships. It's easy to lose track of the fact that each client-therapist relationship is in fact mutual and that the therapist is part of every interpersonal transaction. Thus the therapist's contribution to difficult therapeutic relationships - that is, the role of counter-transference - is easy to overlook.
In years of practice and in supervision both of trainees and peers, I have found that willingness to shift the primary focus of our attention away from transference in the direction of counter-transference phenomena – and willingness to self-reflect on the meaning of these phenomena – is the single most fruitful source of understanding of the problems in difficult therapeutic relationships. As we become more at-ease with openly exploring our own counter-transference reactions to our clients, difficult client-therapist relationships frequently (and almost magically) right themselves. Even in the special case of Axis II personality disorders, a therapist's fluency with openly managing counter-transference phenomena frequently seems to be the pivotal point on which everything else in the therapy turns.