The Therapeutic Relationship

Women, Abuse and Trauma Therapy: An Information Guide

On this page:

• Developing a collaborative alliance
• Reactions you might have to your therapist
• Learning to set boundaries

The goals for your relationship with your therapist are to:

• Develop a “collaborative alliance” (or connection)
• Learn to set boundaries
• Understand yourself with empathy and respect.

Developing a collaborative alliance

A collaborative alliance is the positive connection you make with your therapist. It is important to develop an alliance with your therapist, because a lot of the distress women experience is related to the way they were hurt in a close relationship. Many abuse survivors find that the relationship with a therapist makes them anxious. People often feel betrayed, powerless and taken advantage of when someone they trust abuses them. When this happens, many women begin to believe that others can't be trusted or relied on for support. So relationships with others, especially relationships with people who are in a position of power, or with people you rely on, may seem dangerous and threatening.

Many abuse survivors start therapy expecting that their relationship with the therapist will have dangers similar to those in the relationship with the person who abused them. This is not surprising. In the abuse survivor/therapist relationship, the therapist is in a position of power, and the survivor feels less powerful. Because of this power, survivors may find it hard to talk about their feelings and reactions to trauma, about which they may feel shame, anger, fear or anxiety.

People need to heal within a relationship in order to see relationships as positive and safe. Learning to trust and feel safe with a therapist helps people form relationship skills. This helps them build more meaningful and respectful connections with others.

Reactions you may have to your therapist

Abuse survivors have learned different ways to avoid and negotiate relationships to stay safe from more abuse or to protect themselves from being abandoned or neglected. You may find yourself using some off these methods in your relationship with you therapist.

• You may try to keep your relationship with your therapist safe by going along with what your therapist wants or says. At the same time, you may ignore your own thoughts, feelings and needs.
• You may test your therapist's ability to deal with your thoughts and feelings by only telling the therapist a tiny amount of what you really think or feel.
• You may try to tell your therapist interesting stories so you don't have to talk about your painful feelings.
• You may try to please your therapist by bringing in gifts or asking questions about the therapist, because you don't feel your needs are important to others.

Your therapist should be trained to understand the ways you protect yourself. She or he shouldn't punish you, reject you or withdraw from you. Instead, you should expect guidance, suggestions and directions from your therapist. Your therapist should encourage you to discuss only the things that you feel able to talk about.

It is normal to have different reactions to the therapist at different times during your therapy – you may:

• Feel a positive connection
• Feel nervous because you need someone's help
• Feel that you are valued and cared for
• Feel too vulnerable to reveal yourself.

Your relationship with your therapist is, in some important ways, like any other relationship. You may have misunderstandings; you may feel disappointed, let down or even angry.

Many people don't realize before they start therapy that the relationship with their therapist is very important. For some people, it is the first time they have truly felt safe and listened to. It is not unusual for therapy clients (not just abuse survivors) to feel that they are loved by their therapist. This is difficult for some people, because the positive experiences with their therapist may bring up many strong feelings. These feelings can range from fear of being dependent on the therapist to wanting the therapist to meet your unfulfilled needs.

There is nothing wrong with having these feelings – they are normal. It is the therapist's responsibility to give you a safe and predictable relationship in which to explore these feelings, while always staying inside the boundaries of the relationship.

With a respectful and trustworthy therapist, abuse survivors can work through the stressful feelings that may arise during therapy. This is because the issues that come up between client and therapist often are similar to problems in the survivor's other relationships. Like all relationships, the therapeutic relationship will have difficulties and disagreements. This does not mean that the relationship is a failure. Instead, looking at the problems in the safety of the therapeutic relationship will give you feedback as you practise relating to others. This will help you to have more satisfying relationships outside of therapy.

If you feel uncomfortable with you therapist, it's important to discuss your concerns with him or her. While you have the right to end your therapy at any time, it is useful to talk about the conflict and check out your concerns, in case there has been any misunderstanding or misinterpretation that can be worked through. Many therapists will ask you to let them know if you feel misunderstood. At other times your therapist may realize that he or she made a mistake and will talk about it with you. For example, a therapist might not understand the importance of something you said, or might respond with impatience instead of understanding.

For many survivors, an important part of therapy is changing from seeing people as either good or bad (a way of protecting yourself, or what is called a “self-protective stance”). Instead, you learn that everyone has limitations and can make mistakes. Most therapists believe it is important to talk about any concerns you have in your life, as well as concerns you have about your therapy.

Learning to set boundaries

Women who have had their physical and emotional boundaries violated over and over will need to learn how to set boundaries. Setting boundaries is a difficult psychological task, but is important in developing healthy relationships.

What are boundaries?

Boundaries define your personal space and limits, and let others know how to relate to you.

Physical boundaries are the limits you place around bodily contact, especially in sexual situations. These kinds of boundaries allow you to protect your personal space. For example, many women find it helpful to set limits on the kind of sexual touch they are comfortable with, such as asking their romantic partners not to touch them for behind, especially when they are not expecting it.

Emotional boundaries protect your feelings and thoughts and your right to experience and express what you think or feel. For example, if someone asks you a personal question that you are not comfortable answering, you set a boundary by saying, “I am not really comfortable with that question,” or “What you have asked me is my private business.”

Finding the right distance between two people emotionally and physically is the key to setting safe boundaries. Many survivors become too involved with friends or intimate partners, making themselves and others uncomfortable. Other abuse survivors, in an effort to protect themselves, may remain too distant and are unable to make strong friendships or intimacies.

With the help of a skilled therapist, you can observe how you set boundaries and learn how to protect yourself more effectively, both physically and emotionally.

Types of boundaries

Boundaries are important in therapy for the benefit and protection of both you and the therapist. Most boundaries are worked out between you and your therapist. Some of the boundaries are laws that the therapist has to follow, for example, a therapist cannot have a sexual relationship with a client.

The more predictable and consistent the boundaries are, the safer you will feel. You and your therapist will probably talk about some of the following boundaries.

Physical closeness

Therapists should talk with you about boundaries for touching. Some therapists have firm rules that they never touch their clients, while other therapists may use touch in therapy to help ground or comfort their clients. Your therapist should always ask before touching you.

Therapist revealing personal information

Therapists should always let clients know what information they will discuss about themselves.

Client disclosing information

Part of the safety of therapy is that you know that your therapist respects the pace you want to set for discussing painful or personal issues in your life. If you are not ready to deal with certain issues, you don't have to. Learning to express your personal limits in therapy, with the help of your therapist, is how you learn to set emotional boundaries.

Your therapist should also work with you to back over situations where you have felt uncomfortable or frightened with others, so that you can learn from these situations. An important part of self-care is being able to anticipate your future needs in setting boundaries.

Therapist accessibility

Your therapist should talk with you about whether she or he is available to speak to you the phone between sessions, and what to do in case of an emergency.

A therapist should not start a dual relationship. As your therapist, he or she can't also be your friend or someone you socialize with, or someone who provides any other service to you. For example, if you receive trauma therapy from your medical doctor, that doctor should refer you to another doctor for your physical examinations. This should be done before the therapy begins.

Behavioural limits

Your therapist will need you to agree to control aggressive or violent behaviour in the treatment setting. You will also need to agree not to drink or use recreational drugs before therapy sessions.

Rules for therapy

The therapist should talk with you about the rules for therapy. For example, the therapist must maintain confidentiality, but must report information to the authorities if you inform him or her of any current abuse of children in your life. Other rules usually include that you keep appointments and cancel or reschedule your appointments with enough notice. Most therapists will talk with you about how much you need to pay for therapy and when and how to make your payments.

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