Why Your Psychotherapist Can't Be Your Friend

Many clients who are new to psychotherapy don't understand why they can't have a personal relationship with their psychotherapist.  To clarify this issue, my goal in this article is to address why psychotherapists can't be friends with their clients.

See my articles: 

Psychotherapy and the Erotic Transference: Falling "In Love" With Your Therapist

Boundary Violations and Sexual Exploitation in Psychotherapy

Psychotherapy and the Positive Transference). 

Your Therapist Can't Be Your Friend

Psychotherapists have a code of ethics that they must follow.  One of the items in the code of ethics is that therapists and clients can't become friends outside of the therapy sessions.  The purpose of this stipulation is to protect the client from boundary violations and to protect the therapeutic work that the therapist and client are engaged in.

While it's understandable that clients might have a desire to become friends with their therapist, it's up to the therapist to explore this desire, try to understand how it's connected to the client's problems and history, help the client work through this issue, and maintain a professional boundary.

There are times when psychotherapists get caught up in enactments with their clients.  Enactments are usually unconscious on the part of the client and the therapist and often related to prior personal history that gets played out in the therapy.

Mutual enactments are common and exploration and resolution of these enactments can deepen and enhance the work.

The following fictional vignette is about a case where these issues come up in therapy:

Fictional Vignette: Why Your Psychotherapist Can't Be Your Friend and Understanding Mutual Enactments in Therapy

Jane
Jane moved to New York City to start a new job after she completed graduate school.  Although she loved her new job and New York, she felt very lonely on weekends because she didn't know anyone other than her coworkers and they were all married and led busy lives.

She tried various social groups and participated in local events, but she had no luck in forming friendships among the people that she met.  This reinforced a longstanding feeling that she had about herself that she wasn't lovable or good enough for people to want to care about her.

After several months of feeling increasingly lonely, Jane began therapy at a psychotherapy center where they offered sliding scale fees.

After her intake, Jane was assigned to a new woman therapist who was part of the center's training institute, and Jane began attending therapy twice a week.

Jane liked her therapist, Susan, from their first session, which was unusual for Jane.  Usually, she felt shy and awkward when she met someone new, but Susan had a way of helping Jane to be at ease.

Jane looked forward to her therapy sessions on Mondays and Wednesdays.  She liked talking to Susan and felt better afterwards.  But between sessions, Jane still felt lonely.

A few months later, a friend from graduate school, Dee, moved to New York and reconnected with Jane.

Jane and Dee were friends in graduate school and they usually enjoyed each other's company, but now whenever they got together, Jane found her mind wandering back to Susan.  She noticed that she was comparing Dee to Susan and Dee would always fall short.

As time went on and Jane continued to compare Dee unfavorably to Susan in her mind, she spoke to Susan about it in one of their therapy sessions.

Susan was already aware from the way Jane complimented her and how much Jane said she enjoyed their sessions that Jane was idealizing her.  So, she wasn't surprised when Jane told her that she was comparing Dee unfavorably to Susan.

Jane told Susan that she would really like it if they could be friends outside the therapy sessions.  She told Susan that, after all, they were close in age and she suspected that they probably had a lot in common.

Susan listened attentively and then normalized Jane's wish.  She told her that many clients feel this way about their therapists and this was part of an idealizing transference.  She also explained why it was important that they maintain their therapeutic relationship, as opposed to a personal relationship, in order not to cross boundaries and sacrifice their work together. On some level, Jane knew that she and Susan couldn't be friends, but she felt hurt and rejected when she heard Susan tell her this.  She told Susan that she didn't think their therapeutic work would be compromised in any way and, in fact, she thought the work might be enhanced if they became friends.

As Jane and Susan continued to explore these issues, Susan talked to her training supervisor about this issue.  Susan was clear that she wasn't going to violate an ethical boundary, but she felt herself defensively pulling away emotionally from Jane, and she was afraid that this would ruin their work together.

Susan and her training supervisor talked about how Susan could remain balanced in her approach with Jane--neither too friendly nor too distant--to maintain a therapeutic rapport with Jane.

During this time, Jane missed a therapy session.  She was aware that the psychotherapy center's policy was to give at least 48 hours notice (unless there was an emergency) and that she would be responsible for the fee if she gave less than 48 hours notice.  But she left a message for Susan an hour before their appointed session time saying that she wasn't feeling up to going to their session that day.

When Jane returned to her next session, Susan asked Jane about the missed session, and Jane responded that she just didn't feel like coming to therapy that day.  She offered no other explanation.

When Susan reminded her about the center's policy about broken appointments, Jane told her that she didn't feel she should be charged for the appointment because she had come to all her other appointments and this was the first appointment that she missed.

Susan sensed that something had gone awry between Jane and her and that it was probably related to their talk about why she and Jane couldn't be friends.

But when she tried to explore this with Jane, Jane said that her missed session had nothing to do with their discussion and she would rather that they "move on" and talk about more important things than continue to talk about her missed session.

Susan knew that Jane's idealizing transference wouldn't last forever and that an idealizing transference often changes to a negative transference since no therapist could live up to the idealization and remain on a pedestal indefinitely.  But she was surprised that this change happened so quickly.

Susan was also concerned that if there was a negative transference that it would interfere with the work, which she wanted to avoid.

As a new therapist and without the benefit of being able to speak with her supervisor beforehand, Susan told Jane that she would overlook the broken appointment fee this time, but if Jane had another broken appointment, she would have to pay the fee.

When Jane left another message the following week indicating that she wasn't coming to their appointment on the same day as the appointment, Susan spoke with her supervisor about it.

During their supervisory session, Susan and her supervisor talked about "enactments" between clients and therapists.  She explained to Susan that, like many therapists, Susan got caught up in an enactment with Jane when she agreed not to charge her for the missed appointment despite the fact that Jane was well aware of the center's policy and had signed an agreement about broken appointments.

Susan's supervisor told Susan that it appeared that Jane wanted to feel "special" in Susan's eyes and if she couldn't be friends with Susan, she might have unconsciously created this situation where she could feel that she was a special client to Susan where Susan would break the rules for her.

The supervisor encouraged Susan to address and explore this issue with Jane and to explain Susan's role in getting caught up in this enactment.  She also told Susan that, based on the center's policy, Susan would have to collect the fees from Jane.

Jane felt embarrassed about her role in the enactment, but she also understood that she was a new therapist, she was still learning, and that even experienced psychotherapists unconsciously get caught up in mutual enactments with therapy clients.

When Jane returned for her next session, she didn't offer a reason for the last cancellation, so Susan brought up the issue and suggested they talk about it.

Initially, Jane was defensive and told Susan that she didn't want to waste her time talking about this when she had other more important things to talk about it, "And, anyway, isn't it my session to talk about anything that I want to talk about?"

Susan explained why they needed to talk about the cancellations and the unpaid fees.  She started by acknowledging that, as a new therapist who wanted their work to go smoothly, she made a mistake allowing Jane to break the rules.

When Jane heard Susan admit to making a mistake, she softened somewhat.  She still liked Susan and she was concerned that she might have gotten Susan "in trouble" with the center (see my article: Ruptures and Repairs in Psychotherapy).

Susan explained that she wasn't in trouble with the center, but she needed to address the mutual enactment that occurred between them so they could understand the meaning of it.

Reluctantly, Jane admitted that she felt hurt and angry when Susan told her that they couldn't be friends, even though Jane was already aware of the rules.  She also admitted that she could have come in for her therapy sessions, but she was annoyed and decided to skip those sessions.

This discussion led to Jane talking about how she always wanted to feel special with her mother, but she was aware that her younger sister was her mother's favorite, which left Jane feeling that she wasn't good enough or lovable enough to be her mother's favorite.

This lead to their talking about why Jane wanted to feel special to Susan.

Although, as a new therapist, Susan initially feared that what started as a negative transference would lead to the demise of the therapy, she now saw that discussing it was key to getting Jane to open up and get to more core issues.

Jane agreed to pay for the missed sessions, and they continued to work on the core issues of her feelings of being unlovable and not good enough (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Conclusion
The therapeutic relationship is a unique relationship unlike any other because it's focused on you.

It's common for clients to wish to have a personal relationship with their therapist--either a romantic/sexual relationship or a friendship.

It's the therapist's job to recognize these transferential issues, address them in therapy, and maintain a professional boundary.

It's not unusual for clients' transferential experience to change from an idealized transference to a negative transference, especially since no therapist remains on a pedestal indefinitely.

Addressing transference issues and mutual enactments, if handled well by the therapist, can enhance the therapy by helping the client to address the core underlying issues.

Getting Help in Therapy
If you're feeling stuck in your life, you could benefit from working with a skilled psychotherapist who can help you to overcome your problems (see my article: The Benefits of Psychotherapy).

There are also times when you and your therapist can get stuck in mutual enactments, including boundary violations, when you could benefit from a consultation with another therapist.

Rather than struggling on your own, you could work through your problems with an experienced therapist who has the skills and knowledge to help you overcome your obstacles (see my article: Choosing a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist with over 20 years of experience who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why Do Clients Leave Psychotherapy Prematurely?

This article will focus on the topic of when clients leave psychotherapy treatment prematurely. Of course, there are times when the time is right to leave psychotherapy. One reason could be because you've met your treatment goals, discussed ending treatment with your therapist, and you both agree that it's time for you to end treatment. 

Another reason could be that you know that the psychotherapist that you're seeing is not the right therapist for you. It's not a good match, and you're sure that this is the reason and you're not leaving treatment for one of the reasons that I've outlined below. But ending psychotherapy treatment is a topic for another article.

When Clients Leave Psychotherapy Prematurely

Why Do Clients Leave Psychotherapy Treatment Prematurely?

Clients Leave Psychotherapy Treatment Prematurely Because They Feel Annoyed About Something Their Therapist Said:
It's not unusual for there to be ruptures in psychotherapy treatment. After all, a therapeutic relationship is like many other types of relationships between two people. There are bound to be misunderstandings at times. A client might misunderstand something that the therapist has said. A therapist, being human, might not always be perfectly attuned to a client and might say something the represents an empathic failure. But rather than leaving treatment prematurely without saying something about it to the therapist, unless what has been said is egregious, it's much more valuable for a client to talk to the therapist about it at the next session.

Why is it worthwhile to tell your therapist if she has said something that hurt or annoyed you? Well, for many people, growing up in families of origin where they didn't have a chance to express themselves, it's an opportunity to be heard in a way that they've never been heard before. So, it can be a very empowering experience to assert yourself in this way. Also, often, after a rupture has been worked out in psychotherapy treatment, the treatment advances further than it might have without it.

Clients Leave Psychotherapy Treatment Prematurely Because They Feel "Stuck" in the Treatment Process:
When you begin psychotherapy, you're in the initial phase of treatment. During this phase, you and your therapist are getting to know each other. If you're new to therapy, you're also learning what it means to be a psychotherapy client and how the process works.

As I've mentioned in prior articles, some clients come to therapy expecting a "quick fix." Even when they come to treatment with complicated, multi-layered problems, they expect that their problems will be resolved in a few sessions. While there are certain problems that lend themselves to brief treatment, many problems do not. So, if you're feeling "stuck" early on in treatment, it might be that you're feeling impatient with the beginning phase of treatment.

It might also be that your treatment has reached an impasse because of some obstacle in the treatment either with you or with the therapist or between the two of you. But, before you leave treatment prematurely, it's best to talk to your therapist about how you're feeling. 

Then, not only are you able to express your feelings, but you can also find out how your therapist assesses the treatment at that point. Maybe the two of you need to change how you're working. Maybe there needs to be adjunctive treatment for a while with a second therapist. 

This is often the case with trauma, where regular talk therapy isn't enough and you might need to work briefly with a second therapist who does EMDR (Eye Movement Desensitization Reprocessing) or clinical hypnosis. Whatever the reason, it's a good idea for you and your therapist to have a check-in talk with each other every once in a while to evaluate the treatment.

Clients Leave Psychotherapy Treatment Prematurely Due to Financial Reasons:
It's not surprising that many clients have to think carefully about whether they can afford to attend psychotherapy, especially because it's getting harder and harder to find psychotherapists on managed care panels, and many people are now paying for their therapy out of pocket. But rather than leaving prematurely, if you're having financial problems, it's best to let your therapist know.

Many therapists work on a sliding scale basis and your therapist might be able to reduce your fee. Your therapist can also help you to look at your money issues. Money can be a complicated subject. Often, clients will say they can't afford to be in treatment when there are really other underlying issues. At times, it's easier to look at a concrete issue like money than to look at your fear of being in treatment. Other times, it might be a matter of looking at your priorities. 

Are you spending $10-20 a day on cigarettes? If you stopped smoking, not only would you have money for therapy, but you would also preserve your health. Are you spending money on other frivolous purchases as a way to momentarily boost your mood? If so, maybe that's something that you need to look at with your therapist.

Clients Leave Psychotherapy Treatment Prematurely Because They Become Fearful When Therapy Starts to Delve into Core Issues:
Compared to the other issues that I've discussed so far in this article, this is the most complicated issue. Why is it so complicated? Well, first, when clients become fearful of talking about core issues, they often don't realize that this is what's going on. 

It might be completely unconscious for them. They might think that they want to leave for other reasons that are really unrelated to what's really going on with them. 

This is often the time when clients might say that they can't afford to come to treatment any more or they don't have time any more. While these might be issues, it's always worthwhile for you and your therapist to explore if what's really operating is that you've gotten to a point in therapy where you're dealing with deeper, core issues and this is frightening you.

You might wonder how this could happen. After all, you might say, "Don't people come into psychotherapy treatment to work on these issues?" While it's true that clients start psychotherapy because they want to work on a problem and they're often motivated at the beginning of treatment, it's also true that many clients get frightened when the therapy actually starts to delve into the very issues that they came to work on. This is very common in psychotherapy.

Sometimes, clients take a "flight into health," meaning that they tell themselves and their therapists that they're feeling better now (when they're really not) and that they don't need therapy any more. This is a common reaction. When this happens, the challenge is to stick it out in therapy and to be willing to explore this with your therapist.

It might not be obvious to you that this is what's happening. But, often, if you step back and you're able to detach yourself from your fear of addressing your core issues, you and your therapist can work through this treatment impasse. Are you really feeling better or are you in denial and telling yourself this because you're too frightened to deal with core issues?

Maybe it means that the two of you need to address your fear of delving into the problem before you actually delve directly into your core issues. Maybe the two of you need to take a different tact in treatment or change treatment strategies. Whatever is needed in this situation, it's better to talk to your therapist rather than leaving treatment prematurely.

Since this is one of the most complicated issues as to why clients leave treatment prematurely, it's worthwhile to look at a composite vignette. As always this vignette does not refer to a particular client, but represents many clients who have this problem in common.

Alan:
Alan began psychotherapy because he had problems making a commitment in his relationship. He knew that this was a life long problem for him. Whenever he got close to a woman that he was seeing, he got frightened and left the relationship, even if he cared about his girlfriend very much.

A year prior to Alan starting psychotherapy, Alan began dating Paula. According to Alan, the first few months were great. But as the relationship started to get more serious and Paula wanted more of a commitment from Alan, Alan began to feel that old familiar fear again. He began giving himself all kinds of reasons why the relationship with Paula wouldn't work out in the long run. He never talked to Paula about what he was feeling, but he felt a mounting panic whenever she talked about the possibility of their moving in together.

Alan really loved Paula, and he didn't want to ruin their relationship because of his fears, so he came to therapy. During the first few months of therapy, Alan learned ways to cope with his panic so that he didn't act on it and end his relationship with Paula due to his fear. At that point, Alan actually enjoyed therapy. But when his therapist began exploring Alan's childhood issues in a highly dysfunctional family, Alan began thinking about leaving treatment.

Even though Alan knew that his life long relationship issues were related to his feeling abandoned as a child, when it came time to deal with this issue in treatment, he became frightened. At that point, he began cancelling therapy sessions or coming to his therapy sessions late so that there wasn't enough time to delve into these issues. He didn't realize that this is what he was doing. He always thought that his cancellations and latenesses were legitimate and unrelated to his feelings about what he and his therapists were talking about.

When his therapist spoke to him about his cancellations and latenesses as it related to what they were working on, Alan couldn't see the connection at first. He couldn't see that he was sabotaging his own treatment. So that, with so many cancellations and short sessions, the therapeutic work began to stall, and Alan and his therapist reached an impasse in treatment.

In order to have good treatment, clients need to come to their sessions on a regular basis. When a client misses too many sessions or comes to sessions late, the client can bring about the treatment impasse. A skilled therapist can point this out to a client, but if a client is unable or unwilling to see this, the client can end up sabotaging the treatment--often in the same way that he or she sabotages personal relationships.

While this was happening, Alan thought about leaving his therapist a voicemail message or sending an email that he thought treatment wasn't working and he was leaving. But Paula convinced him that this wasn't the way to end a therapeutic relationship and it would be better to talk to his therapist in person.

So, reluctantly, Alan came into his next session and told his therapist that he wanted to leave treatment. His therapist was able to reflect back to Alan just how anxious he had become once they began talking about his childhood. She also told him that this was not unusual.

When Alan heard this, he was able to relax a little and think back as to when he began cancelling sessions and coming in late. He realized that it coincided with talking about when his mother disappeared from the family household. His mother left when Alan was four, and Alan never saw her again. No one knew of her whereabouts. His father tried to manage as best as he could but, with five children, his father was often overwhelmed, he began drinking excessively, and Alan often felt alone.

When Alan got older, he thought of himself as being "independent" and "not needing anyone." But it was clear to his therapist that this was a pseudo independence. It was a defense against opening up his heart and getting hurt again. Alan had never recognized this before. When his therapist discussed this with him, it resonated with him, and he felt it to be true. He also knew that this was a breakthrough for him in his therapy. So, he decided to stick it out in treatment and not to run because of his fear. Whenever he felt the urge to flee from treatment, he talked about it with his therapist and each time he gained new insights into himself.

He also realized that when he felt fearful in therapy and he was tempted to leave, he was going through a parallel process in his therapy that was similar to how he felt in his relationship with Paula. In addition, he realized that his issues were complicated and treatment would not be brief.

Over time, as Alan continued to explore his childhood issues, he continued to gain new insights into why getting close to Paula was frightening for him. Rather than fleeing from his relationship with Paula or fleeing from his therapist, he learned to stay in these relationships and to manage his anxiety while he worked through his problems.

If You're Thinking About Leaving Treatment, Talk to Your Psychotherapist in Person:
Many clients feel too uncomfortable about talking to their therapists in person about leaving treatment. They will often leave a voicemail message or send an email. But when clients leave treatment in this way, they are short changing themselves and the treatment process (see my article: How to Talk to Your Therapist If Something is Bothering You About Your Therapy).

It's worthwhile to remember that the therapeutic relationship between a client and a therapist is still a relationship, albeit a professional relationship. You owe it to yourself and the treatment to talk to your therapist in person if you want to leave treatment or you're thinking about it.

Clients who leave voicemail messages or send emails to end treatment often regret it afterwards. Even if there are legitimate reasons to leave treatment, they've had no closure to the relationship. And it's not surprising that these same clients do similar things in their personal relationships by avoiding direct communication with people in their lives when there are unpleasant or uncomfortable things to talk about.

I hope this article has been helpful to you or someone that you know who might be thinking about leaving psychotherapy treatment prematurely. There are many other reasons why clients leave treatment prematurely, but the issues that I've discussed above tend to be the most common reasons.

About Me

I am a licensed NYC psychotherapist, hypnotherapist EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during regular business hours or email me.

Also, see article:  Returning to Therapy