Trust: The High Hurdle of Therapy

All relationships are either therapeutic or non-therapeutic. Or perhaps I should say, sometimes therapeutic and sometimes not. A relationship with a counselor is not exempt from this complication. Bloggers in treatment suggest that no other topic so unsettles the soul.

The heart is easily torn. A therapist tries to get inside a patient in a way more intimate than most sexual encounters. The client is expected to strip down before the healer in a metaphorical sense. Remember, our custom of shaking hands derives from the need of two souls to prove they are unarmed — that to be near is not to risk injury. Even without weapons, however, danger is there.

Partners in friendship, love, and therapy make assumptions. Sometimes these unstated beliefs undermine the possibility of understanding and trust. Trust is like a garment made out of words and expressions; actions and expectations. In the space of less than the 50-minute hour, the fabric is woven, unwoven, and back again. By a shift in the body and a smile. By a raised eyebrow and a word well-chosen, poorly chosen, or misunderstood. By silence or its lack. By whether the counselor recognizes the tiniest of tears in the corner of an eye. By whether the patient — gaze downcast and terrified — misses the same evidence she would otherwise observe in the healer.

Too often we expect the impossible of people to whom we are close: that if we are cared for, the other will know what we are feeling and thinking automatically. “He should be able to tell,” we say to ourselves. This belief shifts the responsibility for the achievement of trust and understanding to the other; whether a parent, a spouse, or a psychologist. Sometimes it is reasonable, often not, especially when both parties are adults.

Part of what makes understanding hard (even if we do not assume the other owns a crystal ball) is a question of access. No one else can get inside our head. We have knowledge of ourselves, or what we think we are, in the bright light of the mind. We possess an internal and effortless but utterly precise grasp of our own meaning. Yet for all the clarity available on the inside, our counterpart is in the dark, far from the possibility of direct observation. He cannot see within us, only the outer disguise and armoring. He may consult the dictionary meaning of our words and interpret our expressions and movements, but not more. Relationships die when the other is obtuse and insensitive, and also when too much is expected.

No one is a mind reader. The job of comprehension leading to trust is a duet, not a solo performance. Like all good performances, it takes rehearsal. Repeated rehearsal.

Therapist and patient, when they are well-matched and both working hard, spin a spider’s web as the session begins. The fibers are fine, almost invisible. With time, the net grows. If strong enough and recreated session after session, the strands thicken and better bear the weight of personal disclosure. Yet they still can be torn and retorn.

This is not necessarily a bad thing. All of life must be tested and resilience can only grow out of disappointment. We live in a world of unreliability. Nothing is permanent and yet we seek permanence. So we weave the web — together. With familiarity, the strands are more easily rewoven when a rift develops. Confidence grows. A safety net seems possible.

Remember, this is an act of becoming, not of being. There is no “one and done” here. Repetition, persistence, and continued effort despite the fraying of hope are required.

Nothing above absolves the therapist of the need for finely tuned sensitivity, laser-like focus, and dedication. He must do his best to recognize messages often disguised; must take care not to injure. Nor does this free the patient from taking incredible risks to reveal herself, even though her history says revelation and vulnerability will result in a terrible end. Tearable of the thing we call trust, and terrible to the heart and body.

The most damaged of clients want to be known, but are afraid to be known. They are frightened to show themselves to anyone. Thus, their coded messages are misunderstood. Nonetheless, courage is essential. The unfairness of having to take one more risk carries no weight. They must do so repeatedly. Their healing is otherwise impossible.

Perhaps therapists should recite a disclaimer to the most damaged patients at the outset of treatment:

I want to understand you, but I am imperfect. I will not make a clean catch of everything you say. You might have to repeat or rephrase. You will test me, but I am helpless without your willingness to trust — to help me help you. This is asking a lot. I apologize, but there is no alternative. I will disappoint you, but I am earnest. We must keep trying to weave a beautiful fabric, like a magic carpet. One that will help carry you until you can fly without the support of a tapestry to bear you aloft.

The careful reader will be struck by how many visual metaphors I have used in this essay. I’ve tried to achieve your understanding by reference to what can be seen. In so doing, I have also been underlining how difficult it is to express oneself by abstract words alone. Put differently, how challenging is the therapeutic task of achieving understanding.

In the fairy tale, Rumplestiltskin, a miller’s daughter is said to be able to do the impossible — spin straw into gold. Such is the goal of therapist and patient, both at the wheel. They too must weave. Without even straw. They hold only the memory of pain on one side and a strained, always imperfect empathy on the other. Gold of a different kind — understanding, trust, and healing — can come of their teamwork.

Is this only a fairy tale, too?

Not if you have seen it happen.

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The top photo of a spider web on a pasture is the work of Nijeholt. The second image is a Magic Carpet created by איתמר סיאני. Both are sourced from Wikimedia Commons.