It is the Relationship that Heals: Freedom, Encounter, and the Heart of Psychotherapy

Image via Aliaksei Lepik

I encountered two popular therapeutic maxims when reading Irvin Yalom’s Existential Psychotherapy. 

The first maxim states that “the goal of psychotherapy is to bring the patient to the point where he can make a free choice.” The second maxim is a simple reminder that “it is the relationship that heals.” 

Work as a psychotherapist long enough and you will see these maxims get restated in multiple ways, all of which contain the same essential truth, but I still find it helpful to return to this version of them. The practice of psychotherapy is complex, which is why Yalom also says a separate and distinct psychotherapy is needed for each patient. There’s truth in that as well, but I find it comforting and helpful to have a mooring post.

I suspect the general public is mostly unaware of the fact that multiple research studies show that the quality of the therapeutic relationship is the strongest indicator of therapeutic success, by a wide margin. There are some therapists working hard to make you think otherwise, that there is a single technique that can accelerate growth and healing, but data doesn’t actually support this. 

The real question, which these maxims are alluding to, is why does the therapeutic relationship matter so much? Even more so than therapeutic techniques.

The Complexity of Free Choice 

Before getting to that, let’s start with the first maxim and the notion of making a free choice. Most people assume they need no help with this. They make choices daily that testify to the fact that they are free and in a literal sense this is true, but a closer look reveals the relationship between freedom and choice is more tenuous, more complicated. 

Freedom implies more than being able to act without opposition. Freedom implies awareness of the psychological forces and inner motives that underlie one’s decisions., as well as an awareness of the consequences. To be free is to claim agency over one’s choices so that they become self-determined, which is more difficult than it seems. Study yourself and you’ll realize that many of the choices you take for granted are at least partially influenced if not wholly generated by a confluence of external factors. People look to friends, family, media, and everywhere else for guidance. There’s nothing wrong with that, but most go a step further and allow their choices to be solely based on the thoughts and opinions of others. 

Clinical Implications 

Psychotherapy is unique amongst the helping professions precisely because it does not seek to satisfy the patient’s desire for easy answers. Instead, psychotherapy provides a space for people to grapple with their own thoughts and feelings and arrive at their own answers. Therapy is a space where choice becomes possible rather than prescriptive. 

There is a dizzying effect when people start to peel back the layers of their own existence and discover parts of themselves sitting at the center of their existence, covered in conditions, but still capable of giving them the awareness they need to make their own free decisions. Passing through this stage of psychological vertigo is necessary in order to experience the freedom that exists on the other side. 

It is the Relationship that Heals

After nearly ten years in this profession, saying “it is the relationship that heals” feels self-evident. Of the many patients I have worked with in various capacities, none of them has ever praised me for my interventions or clinical acumen. Which is not to say that neither is relevant, but time and time again, patients make it known to us that what is most important to them is the way we relate to them.

The support we provide and the trust we instill through therapy is more important than any interpretation, technique, or orientation. Or any one kind of diploma for that matter. In truth, these things are only useful if they allow us to establish a real connection with our patient, without which any and all therapeutic interventions will be rendered ineffective. 

Emotional Demands of Therapeutic Practice 

The psychotherapy relationship is a new kind of relational encounter, and it succeeds by providing the patient with a corrective emotional experience. One that is defined by presence, authenticity, and mutual recognition. The relationship is the mechanism of change, and its effectiveness hinges on the therapist's ability to be with their own humanity and use it as an instrument of healing. 

Reflecting on all of this reaffirms my belief that the demands of being a therapist are misunderstood, including by therapists themselves. These demands are intense and constant—therapists are required to be self-aware, emotionally available, and tolerant of uncertainty well beyond what is required of the average person. By necessity patients are unaware of this burden, but therapists are never far from it. 

People come to therapy or get sent to therapy with the hopes of being fixed. If they stay long enough past the disappointment of realizing that’s not what therapy is about, they can gain something of greater value. An opportunity to meet themselves. An opportunity to be seen and heard and understood in the context of a relationship that restores their dignity and full humanity. A relationship where healing comes from connection and not solely from correction. 

Both maxims speak to the view of psychotherapy as a practice whose foundation is based on the willingness to meet another person where they are at. It is a view worth preserving.