I asked Dr. Jean Mercer at CHILDMYTHS about this and she kindly agreed to share her thoughts here with me so that I could share them with you.
How can you, or why should you, trust a psychotherapist? I know many people wonder about this, and although I can’t completely answer the questions, I want to make a few comments. Before I do that, though, I need to say that I don’t speak as a therapist. I’m not trained or licensed as a therapist. I do have a doctorate in psychology, so I’ve studied a lot of material connected to psychotherapy; I’ve been in therapy myself; I was trained and worked dealing with telephone calls at a suicide prevention center; and I led therapy groups under the supervision of a licensed therapists. So, I speak as somebody with some experience of the field, but as it’s not a main part of my professional life, I don’t speak of therapy as a person would who is deeply identified with that kind of work.
I understand the real confusion between the therapist as a professional helping person and the therapist as a possible friend. When we tell therapists our deep feelings, we can’t help being reminded of the way we’ve done this, or wanted to do it, with friends, and it can feel very strange when the process doesn’t go the way it would with a friend.
When we tell a friend our secrets or feelings, he or she normally responds in some predictable ways. If we cry, the friend might cry too, or at least look sad. If we tell what someone else has done to us, the friend will usually speak up and say that we were in the right, our attacker in the wrong. And often a friend will respond to our problem by disclosing something similar, or at least equally secret and disturbing, in his or her own life. All those things are comforting and make us feel as if we have been heard and can trust this friend-- trust him or her to empathize, to take our side, and to share secrets with us.
Friends also sometimes do things that are predictable but not necessarily what we want. A friend may be embarrassed or annoyed by our emotion and try to change the subject. A friend may accuse us of making up part of the story, or state that until he or she hears both sides of a conflict, there will be no deciding who’s right. A friend may say “that’s nothing, listen to what happened to me!”. Those things are not comforting, and we may decide that while we can trust that person to do just what they feel like doing, we can’t trust them sometimes to give our needs first priority.
Talking to a therapist can feel very confusing because the therapist’s responses are pretty predictable, but they don’t follow either of those friend patterns. Well-trained therapists have learned that they need to empathize enough to know what you feel like, but that they should not become so “enmeshed” that your feelings seem like their own. If the therapist was that engaged, he or she could not think rationally or objectively about what’s going on with you and what approach should help you most. In the same way, if you’re talking about a conflict with another person, the therapist may want you to get better at understanding the other person’s perspective, so he or she is not going to tell you that you’re right and that’s all there is to it.
And the therapist is not going to try to win your trust by disclosing inappropriate matters from his or her own life. Therapists have been carefully trained to avoid telling personal secrets, and know very well that the whole point of therapy is to concentrate on what is happening with you, not to talk about their own lives, unless their stories can make a point that will really be helpful to you.
In all those ways, therapists are not supposed to act like friends, even friends who are being comforting. And of course they are not supposed to tell you off for what you say, or to insist on telling their own story to you, so they are also not to act like the kind of friend who does a poor job of listening.
There are also a number of things therapists are not supposed to do and can get into a lot of trouble for doing, even though there’s nothing to stop a friend from these actions. For example, if a therapist thinks you’re pretty attractive, he or she is not supposed to ask you out. If you live in the same neighborhood, the therapist is not supposed to ask you for a ride home if their car breaks down, or to take care of their cat while they travel. Above all, the therapist is supposed to keep everything you say, and the therapist’s opinions about you, perfectly confidential-- not to tell anyone or leave your file lying around where others can see it.
When you pay for therapy, part of what you’re paying for is a guarantee that your therapist will not take advantage of your emotional distress to behave in ways that exploit you. Another thing you’re paying for is that complete confidentiality which is so important. If the matters you disclose to the therapist were spread around, you could possibly lose your job, your spouse, or your children. When you disclose your concerns and history to your friend, you assume they won’t tell-- but people who have not been trained in confidentiality can let things slip quite unintentionally and cause catastrophes that they regret deeply but can’t repair.
Finally, when you pay for therapy, you’re paying for the fact that your therapist has a better understanding of how people usually feel and behave than your friends usually will. You go to the dentist rather than your friend, because the dentist has studied what teeth are like and how they should be treated. Similarly, good therapists have studied both common and unusual ways people feel and act, and how to tell the difference between sadness over a problem and serious depression, or between poor social skills and schizophrenia. In addition, where your friend might say “this is awful, but I don’t know how to begin helping you”, the therapist has studied ways to talk to you and to encourage you to talk, and can consult with medical colleagues if medication may help you. Therapists also have been trained to understand how uncomfortable it may be for you to do the work of therapy and how much you may want to quit at times.
Naturally, I don’t mean to say that all therapists do good jobs, or that every therapist works equally well with every patient, or that no therapist ever makes mistakes or even surprising ethical errors. But I do mean to say therapists play different roles in our lives than friends do, and their training allows them to do jobs for us which our friends can’t do-- jobs they deserve to be paid for, and which they could not afford to do without being paid.
When people say they don’t trust their therapists, it’s possible that they should go to different therapists. But it’s also possible that they should ask themselves, “trust the therapist … to do what?” To keep our secrets in confidence? To know how our problems can best be helped? To persuade us to keep working when we feel like giving up? If any of those points are of concern, certainly a client should make sure before going on with that therapist, and in fact should talk to the therapist about the concerns. But if the question is, “can I trust the therapist to do what a friend does?”, the answer should be “no”. Therapists should not do what friends do, and if they did, this would be clear evidence that we should not trust them.