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Psychotherapy: Therapeutic Relationship

Psychotherapy: Therapeutic Relationship

Author: Erick Taggart

Identify key aspects of psychotherapy as a profession.

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Hello, class. So in our previous unit on careers in psychology we talked a bit about how therapy is generally considered to be the most recognized of the psychological professions. And it's important to note because over half of the psychologists are engaged in some form of psychotherapy. So this is definitely an area that's important.

So in this unit, we're going to be talking about what constitutes psychotherapy. And in this lesson in particular, we'll be talking about what psychotherapy is, as well as what constitutes a therapeutic relationship. So what is psychotherapy?

Psychotherapy is what we refer to as any psychological technique that's used to facilitate positive changes in a person's personality, their behavior, or adjustment. In other words, it's the treatment of some kind of psychological problem. The goal of psychotherapy is to improve the mental health of its patients.

So you've probably seen that there are different professions in psychotherapy. Namely, there are psychologists and there are psychiatrists. So what's the difference between those two?

Well, mainly the difference is that a psychiatrist is a medical professional whereas a psychologist is engaged specifically in psychology. So a psychiatrist can prescribe drugs, although that's a difference that's beginning to disappear in that some psychologists in different states are able to do that as well. But the main difference that you want to focus on is that psychiatrists are medical professionals. They have to go to medical school whereas psychologists are engaged in counseling more specifically.

So there are different levels of therapy within psychotherapy as well. We might look at clinical psychology again as the treatment of severe mental disorders whereas more everyday problems where people are having trouble with depression or anxiety on a smaller level we might refer to as simply counseling. It's important to note though that they all fall under the umbrella category of psychotherapy.

So how does psychotherapy work? Well, generally a psychologist or a psychiatrist will start by taking a patient and having them engage in either one or a series more often than not of tests. And what we mean is that tests can involve either written sorts of inventories, like a personality inventory where they go through and check either a yes or no, or how much or to what degree they feel a certain way. But it can also involve an oral test, like giving a history of their family illnesses or their family history.

It can also involve pictorial tests, which is to say a thematic aptitude test or a Rorschach test, which you might be acquainted with. It's called an inkblot test where a person talks about what they see within a somewhat ambiguous picture. Now once these tests are done, the person engages in the psychotherapy. And there are different schools of thought that will be covered in some detail later.

These can include psychoanalytical psychotherapy, humanist or cognitive behavioral therapy. But the important thing to remember is that with all of these different forms of psychotherapy, the main way that people are treated is through conversation, which is to say the person is speaking with their therapist in a back and forth question and answer format. Because conversation is at the heart of psychotherapy, it's important to establish a strong relationship between a therapist and their patient.

In other words, the patient really has to trust their therapist in order to be able to discuss things with them. This is what we call a therapeutic alliance. A therapeutic alliance is the relationship between a therapist and clients where they can both work together to affect some kind of positive change in the clients. Either in their mental processes or their behaviors.

So there are certain aspects of this therapeutic alliance that make it unique from other types of relationships that a person has. For example, this relationship is professional, which is to say this is the job of the therapist to help the patients. Also, the therapist expects nothing other than payment in return from the patient. So the patient can feel a bit more comfortable in opening up to that person.

And the therapist suspends any kind of expectations or judgments that they have about that person. So the person feels like they're more open and apt to discuss things that might be a bit more sensitive to them.

Psychotherapy also relies on what we refer to as the placebo effect to be effective. Now this is something that you might have heard before. And it's definitely something we'll go on in more detail when we talk about the experimental psychology. But the important thing to know is that the placebo effect is a change in a condition or a behavior that's due to the patient's expectation that the treatment will have an effect even though the treatment might not actually have any kind of effect.

As you hear in experimental context, the placebo effect is when you give somebody a sugar pill and you say that it's actually medicine that will make them better. And they still get better because they expect to be taking the medicine even though they really didn't. In other words, it's all in your head. The effect is essentially psychological in its basis.

Now a therapist, they use certain techniques in psychotherapy. But what's most important is this expectation that the patient will get better. So when we say it's all in your head, in fact in psychology, it is all in your head. And that's the point. So to establish this expectation that the patient is going to get better, that again falls back on that therapeutic alliance, that feeling that the psychotherapist is competent and also somebody that cares for and wants to cure the patient.

So this is something that's really at the heart of psychotherapy and it's an important term to know. And it's also why it's important to establish that professional relationship as well. Now another aspect of the therapeutic relationship is that the therapist often doesn't reveal any opinions about themselves and they don't show very much information about themselves. The focus is supposed to be on the clients.

So they generally ask questions and they interpret responses either verbal or nonverbal because a lot of times therapists are trained to look at both of those. But they generally don't add any additional information except when giving interpretations. Now this can be different depending on the theoretical perspective that you're employing, but generally we can assume that that's the case.

Terms to Know
Therapeutic Alliance

A caring and collaborative union of the therapist and the client to resolve the client's problem.

Therapeutic Relationship

Helping relationship aimed at resolving problems and improving the client's life.


Intervention designed to improve client's state of mind through changing beliefs, understanding the etiology of their difficulties, finding new ways to act and react.

Therapy Placebo Effect

Using the expectations, motivation and perceptions of the client (and therapist) to aid in changing the client's life.