LIFE GOES ON: Patient-Therapist Relationship


Psychotherapy creates a very unique relationship based on confidentiality, trust, openness, and safety. As a psychologist, I am legally and ethically bound to secrecy of everything you tell me. (Exceptions are if you are a threat to yourself or others, where I am a mandated reporter.) I am also not allowed to have a “dual relationship” with you. That means I cannot meet you for coffee or have any personal relationship with you outside of my office. This allows you to tell me your truth without having to worry about seeing me in a public place. It creates a feeling of safety. Our time together is all about you, your needs, your fears and anxieties, worries, and troubles. It is not about me, although I occassionally share personal information about myself if I think it would help in your therapy.

When there is a good “match” between patient and therapist, a very special bond develops because of this safe environment. One big component of therapy is our relationship. We talk about the very private parts of your life; past and present and future.  The feelings you develop towards me is called “Transference.” I may represent your mother, wife, sister, girlfriend, daughter, or all women in general. There is a tendency to idealize who you think I am as a person.

Sometimes it’s necessary to end the therapeutic relationship before the therapy is completed. Moving, illness, or change in life circumstances can disrupt the work, and  there can be a sense of loss, perhaps feelings of abandonment and depression. It’s very important to discuss this with your therapist if it happens to you. You need to know that it is normal to become attached during your work, as you are sharing your innermost feelings, dreams, fears, and ideas with this person. It takes time to build trust, and so it can be very painful if the relationship ends too soon.

On the otherhand, “Countertransference” are the feelings I have about you. When I get to know you, I care deeply about your life, your feelings, and your progress. When it is time to end therapy, I will miss you, think about you, and wonder how you are doing. I really enjoy receiving cards or emails from people I have worked with in the past.

Our relationship is as important to me as it is to you.


Kathleen Cairns, Psy.D. is a licensed clinical psychologist in private practice in West Hartford, Connecticut. She works with adults, adolescents, and couples. You may call her at 860-236-5555 to make an appointment. She is the author of “The Psychotherapy Workbook.”  You may email her at and she will try to answer as many of your questions as possible.

Life goes on… and every day matters…

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5 Comments on "LIFE GOES ON: Patient-Therapist Relationship"

  1. When I turned 65 and medicare became my primary insurance (even though I still had my old insurance as supplement), my psychiatrist told me he didn’t take medicare so I had to stop going. He recommeneded another place, which as it turns out, also did other types of work but not the therapy I needed. I felt lost, depressed and a bit ill treated – although I had not ever been displeased throughout the ten plus years I had been going. It took a while for me to accept the loss as such but I still feel a bit of anomosity that all I was was just another hours worth of money.

    • George Gombossy | June 30, 2012 at 11:05 am |

      Thanks for writing to us. I have to tell you that if you have been going to the same therapist for more than 10 years, he/she was using you as an annuity, instead of helping you to be independent. So often I have heard friends going to therapists and how they love talking to them. They should not love. Therapy should be hard work, with assignments given each session that need to be completed prior to the next session. Too many therapists are more interested in making money than making you well.

  2. I’m so sorry that you lost your therapist due to insurance. I do believe this is not the normal behavior of most clinicians. There are sliding scales, paying out-of-pocket. Please don’t let this hurt the work that you accomplished together.

  3. There are times when long-term therapy is important, needed, and justified. If there is a serious mental illness, like Bipolar Disorder, Major Depressive Disorder, Major Anxiety Disorder, or Obsessive Compulsive Disorder, therapy offers the support needed to maintain a balanced life. Yes, there is homework, readings, and activities assigned, and this can be the ground that enables someone to live a normal life. These disorders usually require medications, as they may likely be caused by a chemical imbalance. Therapy with medication may be the best treatment for long-term stability.

  4. Thank you for explaining this. I feel so much better that my thoughts and experiences with my therapist(s) were and are normal. I had also considered sending a note in the future to my former therapist and appreciate your thoughts on this too. (And yes, it was me who wrote an email to you last week asking about transference, etc.) Look forward to your columns and the CT Watchdog emails each week. Keep up the good work!

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