 I suppose it is past timing in a way, but just starting to open up that communication and that relationship. Yes, because part of building up a therapeutic relationship is the easiness of communication. Yeah. Because if there's not complementary communication or complementary transactions, communication could break down, and that may not help the building of a positive therapeutic relationship. We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome to the next episode, episode 75 of The Therapy Show, behind closed doors with myself, Jackie Jones, and the formidable Mr. Bob Cook. I don't know why I said that. And in this episode, we're going to be talking about how to create the therapeutic relationship between therapist and client. What a lovely topic. It is. I like the word formidable. I went to watch Manchester City played Manchester United yesterday, and I felt very formidable there. Oh, I'm presuming you support City then and not United. And at halftime is 4-0. So I felt very formidable indeed. Oh, yes. There's a lot of my friends that aren't very happy about that result, but we'll not talk about that. It was 4-0 at halftime. It ended up 6-3. We sort of switched off in the second half because we'd won it 4-0, but it went to 6-3 in the end. Formidable is a good word, and I've just been running a therapy intensive. So I think formidable will suit me. Well, that's how you feel today, and that's good. And I'm in my conservatory today. I know, and it's looking bright still. We might notice the sun going down as we're doing this podcast. Yeah, 10 past six. Yeah. We'll try and get this podcast before we have to switch the lights on. But yeah, it's bright. Bright in, yeah. Okay, so say what the title was again, Jackie. Creating the therapeutic relationship between therapist and client. Oh, that's a big one. I mean, way back in, when was it? Gosh, 1992 was that really big pivotal research came out. But I think it was North Cross and someone else, which really was very pivotal. It was the beginning of what was called the relational turn. And basically what that means is that most research showed that the relationship is crucial to cure. So on that day, lots of other researchers come out. We're now in 2022. And I think it's automatic for people to think that the relationship is crucial to cure. Whereas, well, you know, you take psychoanalysis and way back up into about 1980, 1990, I think people didn't even, it wasn't considering so much that the relationship was important to therapy to cure. I'm not really surprising to believe. Yeah, you think about it. Think of psychoanalysis. So psychoanalysis, Freud say that he was the sort of godfather of modern psychoanalysis leading up to psycho therapy. Now, if you went to any book shops for 1950, it would be the opposite way round. It would be about how to keep out of the relationship. Because psychoanalysis, for example, was driven on keeping out of the relationship because they would argue there was a contamination there. And therefore, the therapy to cure was by what they called interpretation free association. And as I say, the theory was you keep away from relationship. And it started to change with the birth of psychotherapy 40s, 50s, 60s, then the birth of self psychology and cohorts and people like that. And then this research came out in the late 1980s, 1990s, which we should have sort of pointed the direction to the awareness of the importance of relationship for cure. I'm glad it did. Yeah. Because I know the things that we can do to work on the relationship between the client and the therapist, but there's also that bit of magic dust in there somewhere where it just clicks. And, you know, I've had clients come to me who've had therapy before, and it's not been a pleasant experience for them. And they've stuck with it rather than changing. You know, if the relationship isn't working, then I can understand why cure is not going to happen. You know, but they tend to stick with one through thick and thin, even if the relationship isn't there. So the next question for Jackie or the we're going to talk about is what is meant by the therapeutic relationship, because it's a very different relationship for, say a friendship. Yeah. A romantic relationship or a business relationship, you know, we're talking about a specific kind of relationship when we have the Korean therapeutic relationship. So when I, when we talk about therapeutic relationship. What does that mean for you, Jackie? For me, I think one of the big ones is trust. Yeah, so you can have trust in business relationships, can't you have trust in romantic relationships can have trust in collegial relationships. So what's different about therapeutic relationships. I just think it's a whole different level of trust in a therapeutic relationship. Yeah, it's about being consistent and, you know, having boundaries and, you know, showing up and doing what you say you're going to do when you're going to do it. It's, I think in a business and a relationship, you've got a bit of leeway in it, whereas in a therapeutic relationship, I think it's a bit tighter for me. I think the therapeutic relationship is a different emphasis. Yeah. So if we take the definition that therapy very much is about how the past effects are present. I'm not talking about counseling relationship here, I'm not talking about CBT. I'm talking really about what I would call relational psychotherapy with the idea of the past or psychodynamic therapy. The idea that past affects the present. When therapists will be concentrating on looking at how the past effects are present. So there's a certain focus. Yeah, focus I think is for most people, most therapists is on safety, sense of safety, a boundary to space, a sense of containment. And perhaps I'll say the most important but really important aspect anyway, confidentiality. Yeah. That's that's really important confidentiality. Which to me, all those things linking to trust, you know what I mean, that they need to know that, you know, we're 100% in that ring with them for the time that we're in there. And, you know, the only other person that we're ever going to speak to is a supervisor about anything, which, you know, for some people, having that trust is really difficult. You know, we can say that it's confidential and everything, but it's it's kind of proving that. And one of the ways I think in transactional analysis and, you know, in my training is that we won't see anybody knowingly that are in the same circle as what that person is. Especially the family. Yeah, yeah. And sometimes they don't like to hear that, you know, I've had, you know, a single person come to me that then wants me to see them as a couple, or I've seen them as a couple and one person wants to come to me. And, you know, it's blurring the lines for me. And they don't like being referred on sometimes. You know, that's right. Another aspect of a therapeutic relationship or therapeutic space or trust, confidential is that there's payment. Yeah. There's another difference. Yeah, you're paying for professional services, which means you're paying for accountability, you're paying for a trained qualified psychotherapist. And you're trained for people who will put that hour in your space. What I mean by that is there's a space for a person to come and talk about themselves, containment security, confidentiality, all those things. And I think a therapeutic relationship is very different from any other type of relationship. Yeah. Yeah, it's interesting because, you know, sometimes in the early days, and I don't suppose my friends do it now because a lot of my friends, one, they know what I do and two, half of them are in the same, you know, the job is what I am. You know, friends would say, when you go out, are you like, are you, you know, giving everybody therapy, wherever you are, and it's like, no, because I don't do it for free. You know, or they'll say, don't do the therapy on me. And it's like, you have no idea how different having a conversation outside the room is to having a conversation inside the room until you've experienced it. Yeah, save a space as confidential things we talked about. And it's, and you're on their side, and it's helping them look at how the past affects their presence in terms of connections and behavioral processes and you see one of the major prerequisites. Well, no, one of the major aspects I think of different type of relationships is often past timing. Yeah. And she's very, which is about what's happening in the present day, like the podcast with you talk about Manchester City and Manchester United and talk about various other things. That's sort of, as much as I like talking about those subjects, it's much more past timing from in TA terms, adult to adult eager state. Yeah. Whereas if we had, if it was a therapy process, we would be looking at certain aspects around change and health and improving mental health and looking at the past effects of present to the coping mechanisms. And we would be miles away from past time. Yeah. And what you say there's a definite plan to it. There's a, you know, there's a process to it. And I know sometimes it veers off, you know, maybe what we had intended to happen in the session. But it's not just killing time. It's not just like you say past timing in that hour. There's a process to it all. That's a good way. There's a process to it all. And the other thing is, of course, all of our therapists have usually been trained for four or five years on how to do therapy in that one hour, if you like. Yeah. There's a focus plan. Yeah. All training to be able to do the job. And it's a very different type of relationship from the other relationships we're talking about. Yeah. So what do you do to build the therapeutic relationship if it's not, if it's not there? Can we build? I suppose I wanted to define therapeutic relationship just to define what we're talking about and the differences between the different relationships. Now, if we just answer that question, which is a really interesting question, because it's an assumption that if somebody comes to see you, you have an idea or a criteria, Jackie, about what's not therapeutic relationship. So, for example, for you to say what happens, how do you build the therapeutic relationship if it's not therapeutic relationship? Then that means in your head somewhere, you must have some ideas of what, of what makes up a non-therapeutic relationship, which I haven't really. So for me, if somebody comes through the door and they've got that motivation. The moment I see them and I take that on and have a treatment contract, then there's a therapeutic relationship. So I suppose I like to know that from you. But while I'm talking, I think probably contracts has a really big contracting has a big part to me. Yeah. That starts the therapeutic relationship. Because if somebody comes in the room, there's a contract, not just an admin contract or a payment contract. But there's an actual, you know, there's going to be a treatment contract. And that is the sort of, if you like, the start of the inadvertence therapy relationship. Is that how you see it? Yes. Yeah, definitely. And working through that contract and, you know, I know I've said it in other ones. I ask for clients, you know, new clients to see me for at least four weeks and then reassess it after that to see, you know, how, how they're doing with it. So I'm still interested in this bit about a non-therapeutic relationship and what you meant by it. Well, I was thinking more about things that can possibly get in the way of the therapeutic relationship. Like triggers, you know, I don't know when the client comes in through the door. They're past other than what they've chosen to tell me. But whether I could potentially be a trigger for them, being a female of a certain age, you know, if it's a younger client that I might represent a parental figure to them. Those sort of things, you know, that potentially can in the early days get in the way of that therapeutic relationship. Oh, yes. So I think that's different from my head anyway, because that's about what I want to talk about building up a therapeutic relationship. I think that once somebody comes in and we have perhaps two or three sessions or whatever way we look at it, and we agree on a treatment for change or a focus, say, let's make something up. They want to be relaxed and more content in the depressed. Could be a contract. Yeah. And once they've agreed that, then we'll start the work. And so I see it from the beginning. Perhaps a good way to look at is is developmentally. There's a there's a relationship. Now is it therapeutic from the beginning? Probably because I believe in transfers from the beginning. Yeah. But I think what you're talking about is building up a positive therapeutic relationship. Yeah, quite possibly. Yeah. Which means then you've got ideas about a negative therapeutic relationship, which is another interesting thing. But I think I'll go with what I think you aim me at, which is what can you do to enhance and really clarify a strong therapeutic relationship where a person is motivated to come. They have a design passion to change. And they can utilize your services the best possible outcome. Yeah. So that's that's a good question. I think one of them, of course, is from the beginning to spell out what the contract is, but spell out the therapy is, and I suppose I see it very much like a process, not an event. So, for me, it's about say getting the admin content of the treatment contract and then actually learning about their own histories, their script, what's brought them to therapy. And in that process, they're getting to know you at one level as well as you're getting to know them. And they're building up a, I won't say trust, but they're building up a certain therapeutic rapport with you. Yeah. Now, in a way, because it's a process, not an event. As you're doing the script analysis, as you're doing the treatment planning, as you're doing the whole process about add as a therapy back to the present, you're allowing or encouraging that relationship to ferment and grow. Yeah. So, if people listen, this can move away from the idea that suddenly, or they may not have this anyway, by the way, I suppose I'm assuming something. Certainly the person walks in the room and you got therapeutic relationship. Then that doesn't work that way. I think it's a whole process where you're doing the things I've just talked about to allow trust to build to allow what I call the testing period. Yeah. In the client and the therapist where they're usually testing out the therapist in some ways, according to their script to all that to happen. They will build up a safe space. Yeah. And I think it's interesting that you mentioned the testing out because they do test out sometimes. Oh, in many ways. Smaller than others. Some clients do it for quite a while. It's odd if they wouldn't. Yeah, yes. You're a complete stranger to them. Yeah. So how does a person know if you can be trusted, if you could be trusted to be there, if you could be trusted to share their vulnerabilities, you could be trusted to share their intimate, I would say, secrets, but their intimate moments. How can they ever get to that place without being a process and not an event? Yeah. And there are certain things, you know, again, maybe this is my stuff that's coming up about, you know, remembering names and times and things like that, you know, to allow the client to be seen and heard and remembered, if that makes sense. Oh, I think you're really, really important because we're talking about building up a therapy relationship with this practice of things. Absolutely. A sense of curiosity. A sense of taking account of the person and practical terms remembering their names. Yeah. Remembering things that they've shared from one session to another session. Yeah. Remembering to be there the same time every week. Yeah. Remembering to stop the session at the time that you're supposed to stop it, which may be 50 minutes or might be an hour or 55 minutes. And all those practical things which provide continuity, stability, safety, yeah, security, all those relational needs which are very necessary, and building up the type of therapeutic relationship we're talking about. Which, you know, for me, I think that's one of the reasons why I never took on too many clients. You know, it's a lot to hold in here when, you know, if you're seeing 20 plus clients in a week, that level of intimacy in the relationship and remembering, you know, the partner's name and the kids' names and all those sorts of things. It's a lot of information that you're holding. You are. And I remember, I don't know, it was a two podcast back, I think now. And we were talking about note taking. Yeah. I think it might have been the one where we talk about effective habits. I'm not quite sure. Yeah. And you said that you kept notes and I was saying that. But we both came home to the same thing really about taking notes after the session rather than in the session. Yeah. It's an important one if it aids memory. Yeah. So if you've got lots and lots of clients, you might need, for example, to make some sort of practical notes after the session, so that you can remember not only the person's names and everything else, but also what they talk about. Yeah. Yeah. So just, you know, dropping that information in the conversation again for me is, you know, safety and security that we do remember, you know, the information that they're giving us. It's not like each session is a separate thing that, you know, there's a line running through everything. One of the things I do in the early days is to do a timeline as well. Can you explain that? Just to get an overarching view of the whole picture, quite early on, you know, anything that sticks out for them and, you know, have they got a birth story? Do you remember your first day at school and what that was like? Just pinpointing certain things, you know, in their life. Again, I suppose it is past timing in a way, but just starting to open up that communication and that relationship. That's because part of building up a therapeutic relationship is the easiness of communication. Yeah. Because if it's not complementary communication or complementary transactions, communication could break down and that's may not help the building of a positive therapeutic relationship. And particularly for me in the early days, you know, when I'm seeing a new client that they feel comfortable that, you know, they're talking about their life, their memories, you know, all those sort of things, rather than going in, tattling the topic straight on the first session, if that makes sense. So it's just getting a background feel. They get to know me a bit more and I get to know them. And on our on the back of this might have come up with the light on a minute in this room, but on the back of this is is an important one when we talk about therapeutic relationships. It's the whole idea of transference. In other words, you know, a transferential relationship, or the repeated relationship or the needed relationship. So if you think about relationships and transferential or psychedelic terms, then we might be seeing a positive therapeutic relationship in helping them and knocked out a different experience. Yeah. Or might encourage idealized transference where the relationship is what they didn't have as a child. Yeah. So, you know, it's an interesting question. When we say what, you know, building up a positive therapeutic relationship. Psychodynamic therapist think about transfers and for them, a positive psychotherapy relationship is going to be one, I think, which provides a relationship they didn't have, you know, in a healing sense all those years ago. Yeah. I think that's why, but for me, it is important to be seen and heard and things like that. It's not necessarily reparenting, but it's, you know, kind of demonstrating a different way that it can be done. And then allowing them to move on with that, if that makes sense. I think that can be quite parental, actually, in the therapy room. As I'm saying that I do think I am. I am quite parental. Well, again, we're, we're really narrowing the whole realm of a transferential relationship. So for example, I think most therapeutic issues people come with is often placed back to the source of difficulties and challenges with their important significant figures themselves. And usually, again, in psychodynamic therapy and transactionalised therapy, if you're talking about transferential positive therapeutic relationship, it's the to allow them to have an environment or space to project onto the therapist, you or me or whichever you like to a parental object which is different. Yeah. In experience from their histories which are so toxic. Yeah. It's a wonderful job that we do, Paul. Yeah, but that's what I think you see that's why I started off what do we call the therapeutic relationship, because I think a psychodynamic relationship and the way that I'm talking about, we'll talk about a positive therapeutic relationship where the transference has actually been realised. Right, whereas a CBT therapist, for example, if you call CBT therapist therapist, if you know what I mean. Yeah. Then transference isn't in isn't in their heads. The past is not really in their heads. It's all about thought change and thinking distortions and therefore their idea of a positive relationship will be utterly different from the idea of a psychodynamic therapist who believes in what I'm just talking about in terms of transference. Yeah. Yeah, because transference in the room can be quite useful. It can be used in the room. It's very useful. Do you know what I mean? Yeah. And I find it interesting when we compare and talk about CBT because in my eyes, transference will be going on in that room. Yes, but yeah, you and I think the same. And if the therapist is, say, CBT trained and doesn't really know about transference or use transference, then or even if they do know about transference, they won't use it. Yeah. They're going to keep to, I'm going to use TA language. I know they're going to keep to adult to adult conversations and transactions rather than think in the way of transference or parental projections or child deficits. They won't go that direction. Yeah, which is understandable because they're not trained in it. You know, it sees a completely different modality, but yeah, it's interesting. I've never had CBT, so I don't know what it's like in a room with a CBT. You write, transference will always be there, parental projections will always be there, transference will always be there for my framework. And as the therapist hasn't been trained in any of that, they may inadvertently enact our transference possibilities. However, the focus will be adult, well, it'll be a solution focused. Yeah. Be around behavioural change and thinking distortions. It won't be around anything to do with the history or child deficits. Yeah. Which is for psychodynamic therapist or transactionalist or gestalt psych therapist. That focus will tend to be there more. Yeah. Because that's the past effect in the present. Yeah, yeah. Yeah. So you've got a transference relationship, which is the formulation that they think about. And that's what I think they would define a positive therapeutic relationship. When that's being actioned. Yeah. So it's an interesting discussion on what constitutes a positive therapeutic relationship. Now, if you come from a transferential place and you think that way by an action of the past onto the present and all things I'm talking about, then you will do things maybe to encourage the transference. In other words, act out like the parent or not act out like the parent. You may do things which encourage that transference relationship, which then they might argue is a positive therapeutic relationship. Yeah. Like you, I think transference happens anyway. It's whether the therapist is trained, not only to understand transference, but to use it for me. Personally, I think you can have a therapeutic relationship without using the transference and you can even call it positive and you may do things like we've just talked about accounting for the safe place and all these sorts of other things. And that would build up trust and containment and continuity and stability and all those things we're talking about. However, for me again, if I want to really use the positive therapeutic relationship, I would be thinking about transference and how to action it. Yeah. Which builds a stronger relationship on a deeper level. It's like you say, you know, somebody who doesn't, that's not to say that change won't occur. No, no, not at all. That's right. It's from a different place. Yeah. Now, how interestingly, I'm going to, well, I agree about many things you say, Jack, if I'm going to go into another one. Those CBT therapists might not think this way. And that's fine by the way around transference. I think transference will already occur. And another debate and maybe this way from the podcast is will CBT therapy be more effective if there's a positive transference, even if they don't think that way. That's an interesting one, isn't it? Yeah. I sometimes wish or think that it would be good to experience from a, you know, a client's point of view, different therapies to see what they're like, because you know an awful lot about lots of different therapies. I don't really know that much about how it differs from transactional analysis, because that's all I've been training. Apart from person centred, I did a bit of person centred counselling that for me personally was a bit wishy-washy. Well, it's a completely different focus. Yeah. So, so I think it is important, I think to talk, when you're talking about building a therapeutic relationship, to think about what we mean by the therapeutic relationship. Plus, I think that we framed from our training and how we see the use of the relationship in the first place. Yeah. Yeah. Because, you know, being that safe, confined space, it allows the client to test that out to be a different way in a relationship, in a safe environment. A word we haven't used, by the way, in all this is non-judgmental. Yeah. See, I think that's really important. Yeah. Building up the template or the ground for good psychotherapy. Yeah. I think if you talk to most people, what they really want in the therapeutic relationship, let's say confidentiality. They say non-judgmental attitude. Yeah. They say continuity. They think about stability. They think about safety. They think about the environment being in a place where it's not going to be invaded. And they'd probably talk about, you know, things like a warm place, you know, a heated place. They talk about those early relational needs as a template for the nurturing of the relationship with regards to the therapist and the client. Yeah. The next question will be, how do we think about what is a positive therapeutic relationship? You know, is it going to be a needed relationship from the past? Is it going to, you know, we could go on. And that is framed by how you're trained. Yeah. Yeah. It's an interesting topic. Hmm. You know, I suppose it's something that we don't always necessarily break down what it means. And, you know, Well, another thing we haven't mentioned the more I go on, I think what we haven't mentioned is potency. Yeah. And again, what builds up a positive therapy to release you in the sense what we're talking about is that the client experiences, not only that the person takes account of them as curious and all the things we just talked about, but they're potent. Yeah. That they are involved with the therapeutic process. They have a sense of really being on the side of the client. The client feels really held and contained. They're the sort of prerequisites, I think, for the template of a positive therapeutic relationship. Yeah. What to do with it is another question. And how you see it is another question. Well, that, that, that's a question and a half because, you know, one of the things that I became aware of in the early days, you know, is that I am in that room as well and my, my baggage is in that room. Sometimes I explain it to the clients that there's probably half a dozen people in this room with us because you've got your parents in here and I've got my parents in here and you're in here and I'm in here. So there's a lot of people in this room. Very interesting Bob. Yeah, enjoy talking about it. Thank you for wanting me to talk about this and break it down. Yeah. You say, unless you're talking about it as a topic, it's very rarely that we do look at what actually constitutes a positive, you know, therapeutic relationship. Yeah. No, absolutely. And I think it's vitally important because then you will know what isn't a therapy positive therapeutic relationship. Yeah, they go together. Yeah. Yeah. Thank you for that Bob. I've really enjoyed that. Great. What's the next one going to be on then? The next one is the understanding of unconscious defences, which I think kind of follows on quite well from building the therapeutic relationship because you're battling through the defences a lot of the time. 100% correct. So I look forward to talking about that. Okie dokie. See you on the next one. Yeah. Bye bye. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.