Which One Is It?

Q:

I’m confused about the process of psychotherapy. First of all, there are so many emotional healing modalities out there — CBT, DBT, IFS, EMDR, art therapy — to name just a few. And how does therapy work — is it the modality that is curative or is it the therapeutic relationship? If the therapist-client relationship is central to the healing process, wouldn’t it be traumatizing to clients to have to eventually end therapy? And, adding insult to injury, wouldn’t clients then realize that the relationship wasn’t real, it was only based on paying money as long as the therapy was continuing? I’m thinking of going to therapy because I really want someone to understand and support me. But I don’t want a fake and temporary experience that will just add to my history of painful relationships. Am I right to be worried about this?

A: 

These are good questions and concerns. Let’s address them in the order you wrote them.

First, you want to know what is the therapeutic aspect to therapy — the techniques the therapist uses or the therapist-client relationship. How much the therapist-client relationship matters to the treatment depends entirely on what treatment is being used. Some therapeutic approaches rely heavily on the therapeutic relationship, while others don’t. CBT, for example, works very well even when carried out by computer or workbook exercises. Behavioral therapies are definitely less therapist oriented as well. Some experiential psychotherapies focus much more on the internal experience of the client than they do on the therapeutic relationship.

On the other hand, therapies like Rogerian (client-centered) therapy, psychodynamic therapy, relational psychotherapy, humanistic and relationship-based therapy, all rely heavily on the therapist-client relationship.

You ask whether it is hard to give up a cherished bond with a therapist and suggest that it might even be traumatic to do so. Ideally, the therapist is a well-trained professional who is able to maintain a good therapeutic relationship with the client without encouraging emotional dependence. This means that the therapist — in a warm, friendly, and caring manner — uses techniques from different modalities to help a client unburden herself from unfinished childhood business, and divest herself of internal conflicts, unhealthy mental habits, and old defenses.