This Life: Good therapist guide

A therapeutic relationship is one of the closest we are likely to have in our lives, and is a lifeline for those who have mental health problems. I’ve had two close – and very contrasting – therapeutic encounters.

My first therapeutic relationship lasted four years. We met once a week but it came to an abrupt stop. I had started seeing my current therapist six months before this happened and we have continued meeting on a monthly cycle. This is now our sixth year of working together and we are making good progress.

Therapeutic relationships are necessarily long. It takes time for people to develop the confidence to reveal long and deep hidden or ignored feelings, and time for the therapist to understand them. I saw my first therapist privately and my second is funded through the NHS, but both relationships are essentially contractual. My current therapist sees the NHS as “a calling” whereas I suspect my first therapist was financially motivated. The nature of the relationship and how both parties perceive it reflects the nature of the contract – whether the service is being purchased or provided.

Trust is the key to a successful therapeutic relationship. The difference between my two therapists is most striking in this respect. My current therapist does not patronise me, treats me as an equal and aims in our sessions to present a view of us working together and having mutual trust. While much management guidance recommends such an approach, the more rigid, detached attitude is still favoured in many therapeutic circles.

This was the approach taken by my first therapist, who would rarely engage at a personal level or show any emotion. I know how difficult this can be to manage and how it feels. The eminent psychoanalyst, Valerie Sinason, believes that limited interaction and response in a therapeutic context is tantamount to abuse. Why then did I continue with the therapy? The answer is in the nature of such a relationship: the dependence they induce. I told myself it had to be helpful and I needed the weekly fix.

Eventually I explored other strategies and was referred for NHS treatment, although I still wanted my first relationship to continue. But when it became clear that I was seeing someone else, the first relationship came to an abrupt end. It was like a divorce I felt abandoned and betrayed. Someone to whom I had entrusted my innermost thoughts and anxieties no longer wanted to see me.

My second therapeutic relationship is much healthier. As equals, we have mutual trust to the extent that I have developed my sense of humour and I can take criticism. My therapist gives me honest answers and I feel my trust will not be betrayed. One phrase I remember my first therapist using was “I’m interested in your pathology”. Surely people in therapy have the right to expect that their therapist is interested in them as a person, not just their pathology?

Anna C Young uses a wheelchair and has mental health problems