Between Client and Therapist

A solid patient-therapist relationship is a crucible of wellness. And the path out of depression begins with a compatible therapist.

By Ellen McGrath, published on February 01, 2002 - last reviewed on April 08, 2009

Depression can be understood in part as a disorder of connection; as a result, the fastest way out of it is through improving your skills of connection with others. One of the most helpful elements in recovery is the quality of the relationship with the therapy professional and how consistent and trustworthy the connection remains between client and therapist.

The patient-therapist relationship becomes a crucible of wellness for many reasons, but the most important may be because it is a kind of living laboratory of all relationships. In addition, the exchange of support acts as a catalyst, hastening recovery and fostering hope. How do you mobilize this most important resource for recovery?

Recognize that over and above the content of therapy, the client-therapist relationship is itself a therapeutic agent. When you feel like you are drowning in the sea of blues and someone is about to throw you a life preserver, you must be able to trust that they'll be smart and strong enough to pull you out of danger. That requires that you choose a therapist with great care. Some questions to consider in selecting a therapist:
Does he or she know what drowning in the blues is like?
Do they even have life preservers (tools for depression reduction) in the office? Or are their techniques irrelevant to depression treatment?
Do they know how to resuscitate you when you're pulled to shore and feel you can barely breathe from fear or pain?
Does the therapist aim to teach you to swim on your own?
A sense of rightness of patient-therapist fit comes from observations you make on a variety of dimensions you may not even be aware are entering your judgment. You cannot afford, however, to leave these to chance. Conduct your own Relationship Inventory of a prospective healer. Consider the following questions:
Do the interventions offered target the problems you are struggling with? What do you judge the quality to be? How would you assess the cost/benefit ratio?
Does the therapist treat you with respect? How developed does his or her own mental health seem? How free of depression?
Does this person have wisdom? The professional discipline your therapists hails from matters far less than how much he or she has learned the lessons of depression in his or her own life.
How much do you genuinely like him or her? How together does this person appear in his or her own professional setting?
Give yourself time for the project, time to identify problems, to identify patterns of reaction that are nonproductive, to learn and establish new patterns.
You may need to try several therapists to get the right match. Of course, if you keep switching without getting a good fit, then you may be using the search process as a technique to avoid facing your problems.
You should expect observable change in 12 to 14 weeks. If in that time you do not experience a significant reduction in depression symptoms, then talk to your therapist to find out why. You may need medication, or a new technique, or a second opinion from another therapist to find out why you're stuck.
Little change may be the sign of a bad match. However, bear in mind that staying put and resolving conflicts instead of moving on is often the most valuable therapeutic work you can do.

The patient-therapist relationship is generally representative of the nature of all other relationships you have, and so learning to resolve problems while maintaining connection provides skills that are widely applicable. To experience conflict with a therapist and learn to resolve it is often the path out of depression.

Learning how to connect despite difficulties is healing. Human beings wither when they are not connected with others. When you learn the skills of connecting you create the safety for exploring vulnerabilities.

A lack of significant progress by 12-14 weeks could also signal that your problem has been misdiagnosed. Or you may have another problem, perhaps an anxiety disorder, complicating the depression and its resolution. There is also the possibility that the psychotherapy will be most beneficial in tandem with a course of antidepressant medication.

There are several types of therapists who should be avoided from the outset, because their own nature itself inhibits healing connection with clients. Beware of therapists who are interested more in their own insights than in helping clients, who offer intellectual insights only, have a major life problem as yet unresolved, are drained of energy by their own unresolved depression, try to hold onto clients forever, or are themselves immature and take everything personally.

Expect a therapist to challenge your views and to make you work. Therapy is, after all, a form of re-education in a supportive partnership with someone who knows what you mean and knows how to help you solve the problems causing you the most pain.

To find a therapist in your area, enter your zipcode into Psychology Today's Therapy Directory.