The Therapeutic Relationship
Is it too awkward to be a friend and a client?
We’ve probably all noticed that there are different types of relationships, even if we don’t have a word for it.
The relationship we have with our co-worker is different from the relationship we have with our inner social circle. The relationship we have with our boss is different from the relationship we have with our therapist.
We’re also sort of unconsciously aware that there are different rules of conduct that govern these different relationships. We’re probably not aware of ever having been taught those rules, we just have a sense of what feels appropriate under different circumstances.
For instance, it might feel flattering, but vaguely uncomfortable to have our boss ask our advice on personal matters, or want to talk about their hobbies and their taste in music with us.
I mention all this for two reasons.
One reason is that I know it can feel awkward for people I know personally to consider seeing me as massage clients. I want to speak to that because that feeling is based on something real, and I think it helps to have it named.
The other reason is that the therapeutic relationship is itself an important and complex part of the healing process, and there is a lot to say about it.
I’ll speak to that sense of awkwardness first.
That feeling is coming from the knowledge, either consciously or unconsciously, that we have a role in each of our relationships. My personal definition for the role I play as a friend is different from how I define my role as a healthcare provider.
So, when a friend becomes a client, I adhere to the rules that govern my therapeutic role when the interaction has a therapeutic intent. And I inhabit my friend role when in social settings. In the world of healthcare that’s called a dual-role relationship.
I think it’s a little easier for me because I learned about these things in school and continue to discuss them in my bi-annual ethics classes. For the client or patient it’s a bit harder, because there might just be a vague feeling that something is a little different.
As with most things, just increasing the awareness of, and talking about it is helpful.
And this brings me to my second point.
Now we know that the roles in the therapeutic relationship are different…but what are those roles?
This is rich and sometimes tricky territory.
One of the things that’s tricky about it, is that the role models that we most often see…are not the best models.
A very common model of the healthcare provider is one where the doctor has the power and authority and the patient submits themselves to the doctor’s expertise, because the treatment is beyond their understanding.
It’s a relationship in which the balance of power rests firmly with the doctor, and the patient mainly experiences varying levels of powerlessness and confusion.
This is called a power differential and it’s often considered an inherent part of a therapeutic relationship.
The idea of the power differential comes about because in the client/therapist or patient/doctor relationship the roles that each party occupies are very different. The years of education and practice that the therapist/doctor acquires seem like they give him (that’s deliberate use of the masculine pronoun) the ability to know what’s best for the patient, and to firmly guide them toward that course of action.
It’s a common model, maybe it’s one we’ve seen so often we’ve fallen into it ourselves…but is it healthy?
Done well, the therapeutic relationship is not just a way to deliver a treatment. The relationship itself is healing. I don’t think the above illustrated model is healing.
So, what could a healthy therapeutic relationship look like?
For starters, it’s one where, although the roles are different, the power (as long as neither party is cognitively impaired) is equal.
This doesn’t mean presenting the client with 2 or 3 possible treatments and leaving it up to them to decide. That creates a burden on the client and an unreasonable expectation that they can download all the schooling as well as 10 or 20 years of clinical practice in time to make a decision…at a time when their energy and attention is probably not at its best.
The client/patient won’t have the clinical decision making ability that the therapist/doctor has. That’s the doctor’s role.
The client exercises their power by choosing who they will hire and who they will fire on their path.
And the client exercises their power in knowing and telling their healthcare provider where this path leads.
Plus they have something the healthcare provider doesn’t have. They know what they are feeling, what their experience is like, and what’s working for them and what isn’t.
I think it’s important that we trust our health care provider, but we don’t want to follow them blindly, and we don’t want to value their guidance more highly than we value our own.
If we meet as equals with equal power, we can collaborate and co-create a solution, and we’ll have far more resources to work with together.