I mentioned to someone recently how much I cared about a patient I worked with. This person then said that knowing the therapist cared would have made a big difference in therapy for her.
Some of this goes back to what I have said before -- that we ultimately behave with the therapist the way we do with most important people in our lives, with the same kinds of assumptions about the therapist and about ourselves. And we do so unquestioningly.
It is also true that it is difficult for the therapist to respond to feelings and issues that the patient does not talk about. All rumors to the contrary, we are not mind readers! This underlies the basic therapeutic dictum that the patient should say whatever comes to mind.
Now of course, this is difficult for most of us, conditioned as we are by social norms, by rules we have learned from our parents. Remember Thumper in Bambi."If you can't say something nice, don't say anything at all"? Most of us operate on some version of that in our relationships and avoid saying things to another person that we think might make them uncomfortable or angry with us. But therapy is a place where Thumper's Rule needs to be suspended. So, if you don't tell the therapist you don't feel cared about, there isn't much the therapist can do to help you with that. Similarly if you are angry with the therapist, have sexual feelings toward him or her, or any of the myriad of other feelings and thoughts about the therapist you might have. It all belongs in therapy. Putting those feelings into words is a key part of what therapy is about, after all, because that opens the doorway to understanding where they come from and how to deal with them in ways that are helpful rather than destructive in life.
Therapy is a relationship above anything else. Often patients see the therapist as someone who can and should *do* something to make things better when all we have to work with is what we are told or can observe. There is no magic in therapy. We meet. The patient talks. I listen and reflect what I see. Rinse and repeat.