Behind the Couch has an interesting post today on trust of therapist for patient. She asserts the following as the necessary components of trust in this direction:
What does this trust look like? * trust that the client is telling the truth (to the best of their knowledge/according to their own reality) * trust that the client is working as hard as they can * trust that the client is allowing themselves to be part of the alliance * trust that the client will adhere to imposed boundaries (payment, attendance, contact between sessions) . As I posted earlier this week about Mia of In Treatment, trust is a two way street in therapy -- the patient needs to be able to trust the therapist and likewise the therapist needs to feel some measure of trust that the patient will not willfully attempt to injure him or her. Being a therapist can be a very dangerous business. More than one therapist has been murdered by a patient, though this happens more to psychiatrists treating psychotic patients than to most of us, nevertheless it is a risk. Because we most often practice alone and not uncommonly see patients in the evening, the risk is there. Any therapist working with perpetrators or victims of domestic violence must be mindful of a degree of risk. * To say nothing of the fears of being sued and the difficulty defending such a suit because therapy by its very nature is a subjective enterprise and because jurors are far more likely to feel connection to and sympathy for the plaintiff than for the defending therapist. So at baseline we must be able to feel some measure of safety from harm by the patient. And we must allow that even so there is always risk. This element of danger in our work is rarely discussed. I am not so concerned about patients telling the truth. Whether what they say is factually accurate or not, what they say is still about who they are and how they experience life and we work together with what they offer. As the patient becomes more comfortable and more willing to trust the therapist, what was concealed may be revealed. Nor am I concerned with measuring how hard the patient is working. Psyche works in its own time and my task is to be patient with the process and not try to set it on my timetable. The therapeutic alliance similarly will develop as we work together. It helps for the patient to be willing to enter into such an alliance, but I think we need only to start with faith that some small element of such willingness is present just in being willing to come to sessions. The boundaries of time, place, payment are elements of the therapeutic frame and it falls to the therapist to maintain those boundaries and confront and interpret violations of them. It is the task of the therapist to clearly set the frame and ascertain that the patient understands it and accepts it. Yes, trust is important here but more important is consciousness on the part of the therapist about what these boundaries are and that they are clearly stated. Interesting topic and one I want to think about some more. Edited to add following links on violence directed at therapists: * Alarming Number of Patients Think About Killing Their Doctors
Patient vs. DoctorA gruesome murder in New York raises questions about the security of mental health professionals at work.