Although even today, going to a psychologist is a relatively uncommon action and even slightly stigmatized for part of the population, fortunately it is becoming more and more frequent that when a person suffers from some kind of psychological problem, he or she goes to professional help. Through interaction, professional and user establish a link through which to work.

This link must be worked on over time in order to offer an optimal service. What should the relationship between psychologist and patient be like? In this article we will make a brief comment on this.

The relationship between the psychologist and the patient: main requirements

We understand the therapeutic relationship to be the professional relationship forged between the therapist and the patient and which is aimed at treating one or more specific aspects or problems that hinder the quality of life of the patient or his/her environment and that the former wants to change. This relationship must always be based on mutual respect, and especially centred on the figure of the patient or user.

If the therapeutic relationship is positive, it facilitates the achievement of results regardless of the technique used, the subject does not feel confused and easily shares his thoughts and emotions with the professional and promotes willingness to change. The aim is to generate a climate and environment in which the patient can feel protected .

At the level of the therapist, it is necessary to manifest a certain level of proximity in which the subject can feel accepted and heard. The presence of empathy and cordiality in the professional also helps. Authenticity is also relevant: the capacity to be oneself and to respond sincerely to the questions that are generated in the consultation. Finally, it is worth noting the absence of judgment towards the patient, active listening, the interest in the other and the search for their well-being as basic elements of this relationship.

A professional help

One thing to keep in mind: a psychologist is a professional who is offering a service and who is charging for it. This implies that we are in the middle of a professional type of relationship, in which, although it is inevitable and desirable that a certain bond or even affection appears, we should not confuse this bond with other types of relationships. Thus, the relationship between psychologist and patient is not one of friendship or any other type that is not professional .

If this is the case, it is for a good reason: the relationship between both people seeks that the patient achieves the solution of a problem that he or she is not able to solve by himself/herself , and requires professional help in which the psychologist must be objective in order to find a way to achieve the patient’s well-being. Likewise, one of the parties has all the information about the other while the latter knows practically nothing about the other.

Transfer and Countertransference

Two of the most famous and at the same time most important concepts regarding the relationship between psychologist and patient come from psychoanalysis, being these the terms transference and countertransference.

The transference refers to the projection by the patient of the patterns of behavior, nurturing, affection or desire he or she felt towards another person in the figure of the therapist. Although the transference itself is to a certain extent positive since it allows the exteriorization of this information , the truth is that taken to the extreme it can make us think of the existence of strong feelings that cannot be reciprocated due to the type of relationship that both people have. In other words, the transference can be considered as the set of reactions generated by the therapist in the patient.

The transference is understood as a positive element that allows us to work on various topics that otherwise might not arise. However, we must appreciate that the transference can also lead to the appearance of excessively intense feelings towards the therapist, to the point of falling in love or hatred. These will have to be worked on in therapy.

On the other hand, we can find the countertransference, or the** set of emotions and feelings that the patient can awaken in the therapist**. Although a certain countertransference will obviously appear in most therapeutic processes, the practitioner should first be able to identify these emotions and then act in the most objective way possible , and if necessary should refer the patient. This countertransference is usually valued as negative, since it limits the objectivity of the psychologist and may generate an effect on the therapeutic relationship itself.

Directivity level

One of the elements to value in the relationship between psychologist and patient is the level of directivity of the former in the session. The psychologist is a professional who has been trained for years in the field of the human psyche and its alterations, possessing extensive knowledge regarding behaviour patterns , but this does not imply that he or she will simply tell us what to do. There will be occasions when a psychologist will be more directive and indicate more clearly the guidelines to be followed in the intervention, while in others the role will be more passive, acting as a guide that leads the patient to find his or her own answers.

There is no one way of acting more valid than another at a universal level, but this will depend on the patient, his or her problems and personality, as well as the level of collaboration between psychologist and patient or the objectives of the intervention. There will be patient profiles that require one way or another to act. In general, the aim at present is to favour the autonomy of the patient and for him/her to be able to find his/her own answers.

Valuing language

Another aspect to take into account is the language we use. It is necessary to value that the psychologists are going to deal with a great amount of people of very different origins and educational levels. Therefore it is necessary to adapt the language so that it is understandable by the patient, doing it in a natural way.

Likewise, the use of technical terms may reflect knowledge on the part of the professional, but we must remember that the patient is in consultation seeking to solve a problem and not to admire our cultural level.

A human soul touching another human soul

Although it is important to be clear that the relationship between psychologist and patient is a professional one, given the therapeutic context and in which the psychologist must be objective, this does not imply falling into a relatively frequent error: coldness .

It is not uncommon for many professionals, especially if they have just started but do not need to, to be slightly distant and think and express themselves only in terms of treatment or focus on the problem. But although the intention that many of them have is to make a separation that does not confuse the patient between what is professional and what is personal, an excessive distancing makes it much more difficult for the patient to feel understood by the professional and even to trust him/her.

We must not lose sight of the fact that the main basis of any good treatment, one of the main elements of any type of therapy, is the establishment of a good therapeutic relationship.

Feeling understood and valued by the professional is something that is already therapeutic in itself, and should be favored by both parties. An open and close attitude, which reflects unconditional acceptance of the patient and active listening to what he or she is saying and is concerned about, are in fact some of the aspects that are closest and at the same time most productive in promoting a change in the patient. Nor should we forget that those who become psychologists do so because they want to help others to be able to live their lives without limitations and without excessive suffering that would allow for a normal life.

Doubts about the therapeutic relationship

As we know, a lot of people with different problems come to a psychologist’s office. The psychology professional will try to respond to the demands that come to him in which he is competent, trying as far as possible to be a useful aid in solving the problems, both expressed and not, for which he is consulted (referring to other professionals if he is not competent). However, it is frequent that doubts appear in patients due to the lack of understanding of some elements typical of psychological therapy.

Below we will look at a series of problems and doubts that some people have had with regard to consulting a psychology professional.

1. Client vs. Patient: What am I?

Although psychologists generally tend to talk about the people who come to them as patients, it is also not unusual for them to be referred to as clients or users . Some people may interpret this denomination as strange, but this issue is easily explained. On an etymological level, a patient is someone who suffers from an illness and who requires external action to solve his problem. In this procedure the subject is a passive entity that receives the solution to his problem.

However, in psychology, the individuals who come for consultation are going to have to make a series of behavioural and cognitive efforts if they want to solve their problems, the psychologist being a guide or help to achieve this end but always maintaining the individual an active role in their recovery . This is why some professionals prefer to call the people who come to their practice clients or users rather than patients.

It is only a way of referring to those who come for consultation, and whether they are called patients, clients or users in practice the processes and functioning of the therapy and sessions will be the same (the main methodological variations being those due to the different currents that exist in psychology).

2. Lack of comforting response to emotional expressions

This aspect, while it may be taken as insensitive by the therapist, does not have to be. It must be taken into account that the psychologist must try to be objective and observe the situation from a certain distance in order to be able to help the patient in the most efficient way, although it is true that the professional must establish a relationship of trust with the person who arrives at the consultation so that the latter can speak with sincerity.

Furthermore, cutting off the patient’s emotional expression can be counterproductive, since altered emotional states can allow attention to be focused on the underlying reason for them and awaken the patient’s own understanding of phenomena he or she previously ignored.

Likewise, it must also be taken into account that throughout the day a professional psychologist sees multiple cases of people with very diverse problems, so he must know how to put an emotional distance from his patients so that his personal life and his own psyche, as well as those of later patients, are not affected.

However, it is true that some professionals try to take this into account so much that they appear to be cold, which in turn can be counterproductive as the patient does not feel that his or her emotions are legitimate . We must remember that the psychologist deals with people.

3. I do most of the talking

It is common for many psychologists to wait a relatively long time before speaking, with some uncomfortable silences in the sessions. These periods of silence are intended to give the patient time to elaborate his speech and to dare to express ideas that with a shorter period of time he would not relate. Thus, it is intended that the patient explores and declares the thoughts that come to his/her mind regarding the issues previously raised, no matter how absurd he/she thinks they may sound. This may reflect content of great importance to the treatment.

They also allow the professional to reflect on the most useful methodologies to be applied according to the information the patient relates, restructuring what he or she knows about the individual in question and achieving a deeper understanding of the case.

It should also be noted that the level of directivity of the professional varies according to the theoretical current he is following . Despite this, it is a fundamental requirement that the professional has an active listening with respect to what the patient is telling him/her.

4. My psychologist tells me things that are not the ones I consult

This issue appears in many cases as one of the issues that patients/clients/users understand the least. It is common for the patient to explain a problem to a therapist and the therapist links it to something that is apparently secondary to the first.

In these cases it is possible that the therapist has considered that the problem for which consultation is being made is due to another phenomenon that is considered to be of lesser importance by the patient. In this way, the aim is to work on the underlying cause of the problem referred to , trying to attack its possible cause more directly.

5. I find therapy unpleasant

This aspect can be highly contentious. Many people come for consultation with a particular problem about which they have a particular point of view. However, the actions that the professional may advise may clash with the expectations that the user may have, resulting in some of the proposals adverse and contrary to their wishes.

It is necessary to take into account that even though some of the recommendations of the professionals may not be pleasant for the person receiving them, the therapist will always try to find the best possible method or the one that has proved to be most useful in most cases to help solve your problem. Examples of this are therapies such as those of live exposure in cases such as phobias, which although they may awaken rejection in patients have revealed themselves as treatments of choice with a high percentage of success.

6. Same problem, different treatment

There are many theoretical currents in psychology, varying the approach and techniques used (although there is often a great deal of eclecticism). Furthermore each person has a different life, circumstances and even brain configurations .

Thus, what for a patient may be an effective treatment from the first moment, in other cases may be ineffective and even harmful depending on the case. The professional will try to adapt the treatment as much as possible to the particular circumstances of the user/client/patient so that it is as effective as possible, always taking into account which treatments are usually more effective and varying the strategy if it is not functional.

7. Psychological therapy does not work for me

Many patients come to this conclusion after a few therapy sessions. The fact is that generally a certain amount of time is needed for the therapies to have a consistent effect . Furthermore, one has to take into account that the psychologist will not make the problems disappear. It is a professional help that guides us and facilitates the overcoming of the problems, but not without its own effort to achieve change.

However, if taking all this into account and after a relevant period of time the therapy is not effective, it is essential to communicate this to the psychologist. In this way, the professional can clear up any doubts the patient may have about it, vary the therapeutic approach (it is necessary to remember that the configuration of each psyche is different and what is useful for some people to overcome a problem is not so for others) or refer to another professional with a different perspective of the problem that may be more appropriate to the case.

In the same way, it must also be taken into consideration that the professional must be able to know the thoughts and events that the patient is experiencing . The concealment of data that may be useful for the recovery of the patient or client may make it very difficult for the professional to draw up a useful strategy to deal with the problems referred to in the consultation.

Furthermore, the fulfilment or non-fulfilment of the tasks and challenges indicated by the professional and the generalisation to daily life of the professional indications (which may be difficult to carry out), will allow the patient to advance or not in his/her recovery, and there may be great differences in the achievement of the desired results .

Conclusion

Throughout this article, we have tried to clear up some of the doubts and misunderstandings that some patients present regarding psychology professionals. The consultation of a psychologist is a space for guidance, help and treatment of many different problems. A good professional will try to do what is best for his or her patient so that he or she gets better and recovers.

However, this does not mean that in all cases patients’ doubts are due to ignorance or misunderstanding. As in all professions, there are individuals with greater or lesser skill in the exercise of their functions, as well as cases of professional malpractice.