Outcome studies in psychotherapy have shown that “The therapist is a key change ingredient in most successful therapy.” Researchers have also identified a number of traits in psychotherapists that facilitate clients’ progress and change.* In The Fear of Intimacy, I outlined my approach to psychotherapy and described personal qualities in therapists that I consider essential to forming and sustaining an effective therapeutic relationship.

The psychotherapeutic alliance is a unique human relationship, wherein a devoted and trained person attempts to render assistance to another person by both suspending and extending him or herself. Nowhere in life is a person listened to, felt, and experienced with such concentrated sharing and emphasis on every aspect of communication.

 Instead of playing the role of expert, the ideal therapist would strive to be an authentic person, someone with whom clients felt comfortable enough to be open and self-revealing.  He or she would serve as a role model for the client, demonstrating through his or her responses and behavior, how to struggle against destructive forces within the personality and how to live less defensively.

The “ideal” therapist would be a person of unusual honesty and integrity. This is not simply a matter of trying to tell the truth: the therapist must have developed considerable self-knowledge, recognizing and accepting an objective view of both negative and positive traits in his or her personality.

Effective therapists do not attempt to fit their clients into a particular theoretical model; instead they try to learn from them and, in effect, gradually develop a uniquely personal psychological theory for each individual. They are able to subordinate their own interests, while directing their attention and efforts toward understanding their clients. They are highly skilled in helping individuals reconnect to themselves and to their lives. Like an artist, the therapist is sensitively attuned to each client’s real feelings, qualities, and priorities, and is able to distinguish these from the psychological defenses that prevent the person from achieving his or her full potential as a human being. These clinicians are able to see what a client’s personality could be beneath the overlay of his or her defense system.  With that perspective, they challenge any defenses that prevent the client from becoming that person. At the same time, they are accepting and compassionate: both stances are crucial in terms of offering people the maximum opportunity for personal development.

Ideally, therapists would use their awareness of what is going on within them as clues to what is going on within their client.  They would be able to sense a person’s state of mind intuitively rather than just responding intellectually. For example, one therapist may have read in a textbook that a catatonic patient is typically experiencing angry, explosive feelings underneath an immobile or frozen exterior; whereas another, more intuitive, therapist who is close to his or her own feelings, may actually be able to feel this patient’s underlying rage. When therapists have access to their emotions, they are able to respond sensitively to the struggles of the individuals they are working with. It is often the case that those who are intellectually defended or somewhat removed from their feelings experience discomfort when clients express strong emotions. By their negative response or lack of response, they can unintentionally inhibit the further expression of deep feelings.

Effective therapists are aware of destructive ties or fantasy bonds that clients may develop with their parents or partners that interfere with genuine relating and adaptive adult responses. They are nonintrusive in their responses and interpretations while exploring with a client the relationship between past experiences and present disturbances. They are also cognizant of the areas where clients are turned against themselves — where they are acting on their critical inner voices.  They are sensitive to the wide range of addictive patterns manifested by clients and have the courage to help expose and interrupt these patterns.

In an important sense, the therapist can be conceptualized as a “transitional object” in that he or she provides the client with an authentic relationship during the transition from depending on self-nourishing processes to seeking and finding satisfaction in genuine relationships in the world outside the office. As such, therapists must remain human (be interested, warm, caring, and empathic as well as direct and responsible) to temporarily “hold” or sustain the client as he or she moves away from sources of fantasy and self-gratification toward real relationships. 

To be able to offer this kind of support at these critical junctures, therapists need to develop both professionally and personally to become free from projections and counter-transference reactions that are destructive to the therapeutic process. It is important that they go through a dynamic individual therapy experience themselves, which would include some type of depth psychotherapy or feeling release therapy in order to emancipate themselves from such projections

Generally speaking, successful therapists tend to have an optimistic outlook and a strong belief in the possibility of personal growth and change, yet they do not underestimate the strength of the defense system and are sensitive to people’s fear of change, particularly at crucial points in the therapeutic process. Lastly, because therapists are aware of the inherent destructiveness of defenses and their projections into the larger society, they refrain from favoring social conformity over the personal interests and individuality of their clients.

*Blow, Sprenkle, and Davis, (2007).

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