How should the relationship between psychologist and patient be?

The psychotherapy process is, above all, a dynamic that is established between the psychotherapist and the patient (s).

However, that does not mean that it is simply a conversation; Beyond the words of the dialogue, there is something else: a therapeutic relationship that allows something like a training to be established. The psychologist "trains" the patient in new ways of behaving, feeling and thinking.

However... How should the relationship between psychologist and patient be? In this article we are going to make a brief comment about it.

• Related article: "4 Fundamental Therapeutic Skills in Psychology"

The relationship between the psychologist and the patient: main requirements

Although even today going to the psychologist is a relatively unusual action and still slightly stigmatized for part of the population, fortunately it is becoming more and more frequent that when a person suffers from some type of psychological problem he goes to help professional. Through interaction, professional and user establish a link through which they can work.

This link to which one aspires in therapy, sometimes called "rapport", must be worked on over time in order to be able to offer an optimal service.

We understand by therapeutic relationship professional bond that is forged between therapist and patient and that it is aimed at treating one or more aspects or specific problems that hinder the quality of life of the patient or her environment and that the former wants to change. This relationship must always be based on mutual respect, and especially centered on the figure of the patient or user.

If the therapeutic relationship is positive, the achievement of the results is facilitated 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 willingness to change. It seeks to generate a climate and an environment in which the patient can feel protected.

At the therapist level, it is necessary to manifest a certain level of proximity in which the subject can come to feel accepted and heard. The presence of empathy and cordiality in the professional also helps. Likewise, authenticity is also relevant: the ability to be oneself and honestly answer the questions that are generated in consultation. Finally, it is worth noting the lack of judgment towards the patient, the active listening, the interest for the other and the search for their well-being as basic elements of this relationship.

A professional help

One thing to keep in mind: a psychologist is a professional who is offering a service and is charging for it. This implies that we are in the middle of a professional relationship, in which although it is inevitable and It is desirable for a certain bond or even affection to appear, we should not confuse this bond with another type of relations. Thus, the relationship between psychologist and patient is not neither of friendship nor of another type that is not professional.

If this is so, it is for a good reason: the relationship between both people seeks for the patient to achieve solve a problem that he does not see himself able to solve on his own, and requires 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 of the parties has all the information about the other while the latter knows practically nothing about the other.

Transfer and countertransference

Two of the most famous and at the same time most important concepts regarding the relationship between psychologist and patient come from psychoanalysis, these being the terms transference and countertransference.

The transference refers to the projection by the patient of the patterns of behavior, upbringing, affection or desire that he felt towards another person in the figure of the therapist. While the transfer itself is up to a certain point positive since it allows to externalize said information, the truth is that taken to the extreme it can lead to thinking about the existence of strong feelings that cannot be reciprocated due to the type of relationship that both people have. In other words, the transference can be considered as the set of reactions generated by the therapist in the patient.

Transfer is understood as a positive element that allows us to work on various topics that might not otherwise arise. However, it must be appreciated that the transference can also lead to the appearance of excessively intense feelings towards the therapist, to the point of falling in love or hatred. 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 awaken in the therapist **. Although a certain countertransference will obviously appear in most therapeutic processes, the professional should be able to identify these emotions first and then later. act as objectively as possible, and if necessary should refer the patient. This countertransference is usually valued as negative, since it limits the psychologist's objectivity and can have an effect on the therapeutic relationship itself.

• Related article: "The transference and countertransference in Psychoanalysis"

Directivity level

One of the elements to assess in the relationship between psychologist and patient is the level of directivity of the first in the session. The psychologist is a professional who has been trained for years in the field of the human psyche and its alterations, possessing extensive knowledge regarding behavior patternsBut this does not imply that he is simply going to tell us what to do. There will be times when a psychologist is more directive and indicates more clearly the guidelines to follow in the intervention, while in others the role will be more passive, acting as a guide that leads the patient to find their own answers.

There is no more valid way of acting than another at a universal level, but it will depend on the patient, her problem and his personality, as well as the level of collaboration between psychologist and patient or the objectives of the intervention. There will be patient profiles that require one way or another to act. Currently, it is generally intended promote autonomy of the patient and that he is able to find her own answers.

Valuing language

Another aspect to take into account is the language we use. It must be appreciated that psychologists are going to deal with a large number of people from very different backgrounds and educational levels. Thus it is necessary to adapt the language so that it is understandable by the patient, doing it naturally.

Likewise, the use of technicalities may be something that reflects knowledge on the part of the professional, but we have to remember that the patient is in consultation seeking to solve a problem and not admire our level cultural.

A human soul touching another human soul

Although it is important to be clear that the relationship between psychologist and patient is a link of the professional, given in a therapeutic context and in which the psychologist must be objective, this does not imply fall into a relatively common mistake: coldness.

It is not strange that many professionals, especially if they have just started although this is not necessary, maintain a slightly distant attitude and think and manifest only in terms of treatment or focus on the trouble. But although the intention that many of them have is to make a separation that does not confuse the patient between what is professional and personal relationship, Excessive distancing makes it much more difficult for them to feel understood by the professional and even trust him.

And it is that we must not lose sight of the fact that the main basis of all good treatment, one of the The main elements of any type of therapy is the establishment of a good relationship therapy.

Feeling understood and valued by the professional is something that in itself is therapeutic, and should be favored by both parties. An open and close attitude, which reflects unconditional acceptance towards the patient and an active listening to what he comments and worries are in fact some of the aspects that are closer and more productive in order to promote a change in the patient. Let us also not forget that whoever becomes a psychologist he does it because he wants to help others to live their life without limitations and without excessive suffering that allows a normal life.

Doubts about the therapeutic relationship

As is already known, a large number of people with different problems attend a psychologist's consultation. The psychology professional will try to respond to the demands that come to him in which he is competent, trying as much as possible to be a help useful for the resolution of the problems, both expressed and not, for which they are consulted (referring to other professionals if they do not see themselves competent). However, doubts often appear in patients due to misunderstanding of some elements typical of psychological therapy.

Next we will see a series of problems and doubts that some people have had regarding the consultation with a professional of psychology.

1. Client vs Patient: what am I?

While psychologists generally tend to speak of the people who come to them as patients, it is also not unusual for them to be referred to as customers or users. Some people may interpret this name as strange, but this question is easy to explain. At the etymological level, a patient is considered to be a subject who suffers from a disease and who requires external action to solve his problem. In this procedure the subject is a passive entity that receives the solution to the problem from him.

However, in psychology the individuals who come to the consultation are going to have to make a series of efforts behavioral and cognitive if they want to solve their problems, the psychologist being a guide or help to achieve this end but always keeping the individual an active role in their recovery. That is why some professionals prefer to call the people who come to their consultation clients or users before patients.

It is only a way of referring to those who come for consultation, and whether they are called patients, clients or users in practice the processes and therapy and sessions will be the same (the main methodological variations being those due to the different currents that exist in the psychology).

2. Lack of comforting response to emotional expressions

This aspect, although it may be taken for insensitivity on the part of the therapist, does not have to be. Keep in mind that the psychologist you should try to be objective and observe the situation from a distance in order to help the patient in the most efficient 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 or she can talk to sincerity.

In addition, cutting the emotional expression of the patient can be counterproductive, since altered emotional states can allow attention to be focused on the motive underlying them and awakening the patient's own understanding of phenomena that he previously ignored.

Likewise, it must also be borne in mind that throughout the day a psychology professional sees multiple cases of people with very different problems, with which he must know how to put an emotional distance with his patients so that his personal life and his own psyche, in addition to those of later patients, are not seen affected.

However, it is true that some professionals try to take this into account so that they appear a certain coldness, which in turn It can be counterproductive as the patient does not feel that her emotions are legitimate. Remember that the psychologist deals with people.

3. The one who talks the most is me

Many psychologists often wait a relatively long time before speaking, with some awkward silences in the sessions. These periods of silence are intended to give the patient time to elaborate their speech and he dares to express ideas that with a shorter period he would not relate. Thus, he / she is intended to explore and declare the thoughts that come to mind regarding the issues raised above, however absurd he / she thinks they may sound. This may reflect content of great importance to the treatment.

They also allow the professional to reflect on the most useful methodologies to apply according to the information that the patient recounts, restructuring what he knows about the individual in question and gaining a deeper understanding of the case.

It should also be taken into account that the level of directivity of the professional varies according to the theoretical current that follows. Despite this, it is a fundamental requirement that the professional have an active listening to what the patient tells him.

4. My psychologist tells me things that are not what I consult him

This question appears in many cases as one of the issues that patients / clients / users least understand. Often the patient explains a problem to a therapist and the latter links it to something that appears to be secondary to the former.

In these cases, it is possible that the therapist has considered that the problem for which he is consulted is due to another phenomenon that is considered minor by the patient. In this way, It is intended to work on the underlying cause of the referred problem, trying to attack its possible cause more directly.

5. Therapy is unpleasant to me

This aspect can be highly conflictive. Many people come to consultation with a specific problem about which they have a specific point of view. However, the actions that the professional can advise may conflict with the expectations that the user had, being able to result in some of the adverse propositions and contrary to her wishes.

It is necessary to take into account that even though some of the recommendations of the professionals may be unpleasant for the recipient, the therapist You will always try to find the best possible method or the one that has proven most useful in most cases to help solve your trouble. Examples of this are therapies such as live exposure in cases like phobias, which, although they can arouse rejection in patients, have been revealed as the treatment of choice with a high success rate.

6. Same problem, different treatment

There is a large number of theoretical currents in psychology, varying the approach and the techniques used (although there is usually a great eclecticism). What's more each person has a different life, circumstances and even brain configurations.

In this way, what for a patient can be an effective treatment from the first moment, in other cases it can be ineffective and even harmful depending on the case. The professional will try to adapt the treatment as much as possible to the particular circumstances of its user / client / patient so that be as effective as possible, always taking into account which treatments are usually more effective and varying the strategy if they are not functional.

7. Psychological therapy is of no use to me

Many patients come to this conclusion after a few therapy sessions. The truth is that generally it takes a certain time for the therapies to have a consistent effect. Also, keep in mind that the psychologist is not going to make the problems go away. It is a professional help that guides us and facilitates overcoming problems, but not without the need for our own effort to achieve change.

However, if taking all this into account and after a relevant period of time the therapy is not effective, it is essential to notify the psychologist. In this way, the professional can clear up any doubts that the patient may have in this regard, vary the therapeutic approach (that is, It is necessary to remember that the configuration of each psyche is different and that what some find useful to overcome a problem it is not for others) or refer to another professional with a different perspective of the problem that may be more appropriate to the case.

In the same way it must also be taken into consideration that the professional must be able to know the thoughts and events that the patient experiences. The concealment of data that may be useful for the recovery of the patient or client can make it difficult to to a great extent that the professional can develop a useful strategy to treat the problems referred to in consultation.

In addition, the fulfillment or non-fulfillment of the tasks and challenges that the professional indicates and the generalization to the daily life of the professional indications (which may be difficult to carry out), will allow the patient to progress or not in their recovery, being able to to have large differences in achieving desired results.

Conclution

Throughout this article, we have tried to clear up some of the doubts and misunderstandings that some patients present with respect to psychology professionals. The consultation of a psychologist is a space for guidance, help and treatment of very diverse problems. A good professional will try to do what is best for his patient and that he improves and recovers.

However, this does not mean that in all cases the doubts of the patients are due to ignorance or misunderstandings. As in all professions, there are individuals with greater or lesser ability in the exercise of their functions, as well as cases of professional malpractice.

Bibliographic references:

• Norcross, J.C. (Ed.). (2002). Psychotherapy relationships that work. OUP.
• Rogers, D. (2015). Further Validation of the Learning Alliance Inventory: The Roles of Working Alliance, Rapport, and Immediacy in Student Learning. Teaching of Psychology. 42 (1): pp. 19 - 25.
• Spencer-Oatey, H. (2005). (Im) Politeness, Face and Perceptions of Rapport: Unpackaging their Bases and Interrelationships. Politeness Research. 1(1): 95 - 119.
• Wierzbicki, M.; Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice. 24 (2): pp. 190 - 195.