Don’t Trust Your Therapist- Even in Therapy, Trust Needs to Be Built

I like to think of myself as a pretty trustworthy person. In both personal and professional relationships, I operate with good intentions and try my best to be thoughtful and act with others in mind. I’m honest and try to deliver even hard messages with kindness. However, I know that in all of my relationships, especially those with my patients, trust is not readymade and always has to be built.

Safe Enough Is Good Enough…to Start

The world is not broken up into two binary groups of people, trustworthy and untrustworthy. Most people are varying degrees of safe enough; they mean well and want to co-create a constructive and positive relationship. Presumably, a therapist is especially safe enough and well-intentioned, as an inherent part of the job description includes offering true care and support. 

The organization of the therapeutic relationship helps with the “safe enough”. There is a transparency in the set up of the therapeutic relationship that is mutually agreed upon and openly talked about. Hopefully the patient chose the therapist and did some shopping around in the process to find someone who felt right for them. Also hopefully, the therapist’s caring is palpable and the patient feels as if they are invested in them and their growth. This sets the stage for a secure and trusting relationship but there is so much that needs to happen after that for true security to exist. 

Curiosity Is Necessary To Build Safety

Part of building trust and safety with another person is allowing yourself to be truly known. You can never make any assumptions about someone’s values, their experiences, and what their road has looked like up until this point. This is often the focal point of my treatment with couples, as knowing your partner deeply allows for an empathy and understanding that increases closeness and the capacity for constructive conflict. So many unconstructive conflicts are rooted in assumptions and leaps about where the other person is coming from.

This can be said for any type of relationship. When you feel more known by someone, you trust them more and trust their intentions are good. When you understand another person deeply, you understand more of where they are coming from and will be more likely to be generous when there is a conflict or misunderstanding. 

In therapy, knowing my patient deeply is essential for our closeness and trust. I want to know all of the things, not just about what ails them. However, as I write about here, when it comes to symptomology, thinking that I know my patient better than I actually do can shut down curiosity on my part and can lead me to miss things. Even if I have worked with many patients who have depressive symptoms, for example, I cannot make any assumptions about a new patient with similar traits because inevitably there will be differences.

Making Use of Feelings of Unsafety

As lovely as the idea of “being known” is, for some, allowing someone close is scary. In the therapeutic relationship, there may be feelings that arise and dynamics that play out that make the therapist feel unsafe. It will impede trust and safety if we don’t make good use of these moments and move towards these feelings. It is a foundational tenant of both relational and psychodynamic therapy theory that dynamics that play out for the patient in outside relationships will also play out in the therapy room.

For example, if a patient grew up with a lot of criticism, they may anticipate criticism from others, especially authority figures, even when that criticism is not present or is intended to be constructive and kind. Even if I am not being critical, if my patient is feeling criticism, the relationship will feel unsafe and will feel like something that needs to be guarded against.

Building True Safety

A moment like this can be painful and complex but it is ripe for healing and opportunity. The thing that heals relational trauma is relationships. When a patient gets to a sore and familiar point in a relationship and something different than what they are anticipating plays out, it can be very profound and impactful.

As a therapist, it is my job to pay attention to the feelings and dynamics playing out between my patients and I and to reflect back and/or invite curiosity around what is happening. In the aforementioned example, I may notice a defensiveness or tenseness from my patient and check in with them about it, which gives us the opportunity to look at what they are feeling and compare that with what is happening in the room. In other words, we get to build safety in this moment and teach the patient how to build something similar in other relationships in a way that can be gamechanging.