Therapy is about relationships. Whether the reason you seek out a therapist is to understand a turbulent romantic history, or reasons why it feels like you have a hard time making friends, or to get support in setting boundaries with your family members, therapy is about relationships. Even if the reason you’re seeking therapy is more clean cut, diagnostically speaking – say, you’re seeking cognitive behavioral therapy to help ease depression or anxiety – at one point or another, you’ll probably find yourself talking about relationships with your therapist. You may have heard the saying that people seek therapy in order to deal with all the other people in their life who won’t go to therapy; as a therapist, I can tell you there’s some truth to that.
But even if talking about relationships isn’t often part of the content of your session, therapy is still about relationships because the most important aspect of therapy is the rapport and trust that is built between you and your therapist. Without a sense of trust, positive regard, and non-judgment – or at the very least, a willingness on both sides to talk about what might be interfering with the development of these things – it’s very hard for therapy to be effective, regardless of the modality. Certainly, if you’re going to therapy to do any kind of healing work or growth around trauma, a feeling of trust and safety is of the utmost importance.
There is one modality of therapy, though, that makes this even more explicit. Unsurprisingly, it’s known as relational therapy, or relational cultural therapy. It’s unique because, as I describe sometimes to clients or prospective clients, it can be pretty meta – as part of a relational approach, the therapist and the client don’t only talk about the relationships in the client’s life outside the room, but the one that develops in the room as well.
Why Focus On What’s Happening In the Room?
One of the core tenets of relational cultural therapy is that mutually satisfying relationships are integral to our sense of emotional well-being. If you’re reading this, there’s probably a chance that you believe this too. Think about how dysregulating it can feel if you’re going through a particularly painful break up: a hollow, windy feeling in your chest; swinging wildly from anxiety to despair; or the free falling sense of alienation that rejection and loneliness can bring up for us. For those of us who experience this more than once, or who notice intense, heady relationships in our lives often following a trajectory like this one (myself included), it can feel mystifying and damning that we seem to keep repeating the same pattern over and over again.
Relational therapy confronts this pattern directly. The theory behind it is that our relationships outside of therapy clearly don’t happen in a vacuum – whatever our patterns are outside of therapy will likely be enacted in the room with the therapist in a similar way. By creating a safe, affirming environment, one in which the client can feel the unconditional positive regard of their therapist and trust that, as long as they keep showing up to therapy, the therapist will show up too, is the first step in understanding these patterns. The nature of the relationship with the therapist is professional, certainly, and yet it is also one that contains a unique kind of intimacy. Against this backdrop, clients who engage in relational therapy will often see, in real time, and within the safe container of a trained professional, what their patterns are around things like stating needs, describing and setting boundaries, bringing up feelings of hurt, harm, and frustration, and creating resolution and repair after hurt feelings (known as “rupture” in therapy). And because this work happens in the present, and can be talked about in the present, recognizing these patterns can happen on an intellectual and embodied level, rather than purely intellectual.
How Does It Work?
Relational therapy also recognizes that relationships themselves don’t happen in a vacuum. Created by Jean Baker Miller in the 1970’s and 1980’s, relational therapy concerns itself with intersections of identity and how power, privilege, and oppression influence our identities, and therefore our relationships. (This is where the ‘cultural’ part of relational cultural therapy comes from.) This was a huge departure from the emphasis on introspection that had been part of Freudian-influenced psychotherapy, which, as mentioned in previous installments of this series, tended to create more of a hierarchy between the therapist and the client, positioning the therapist as the “expert” in the room and the client as someone who needed to be “fixed” by interrogating their past.
In a relational cultural approach, clients will not only explore the power differentials in their previous relationships, and how this may have contributed to stress, disconnection, and dissatisfaction or unhappiness, but will also examine how the power differentials that exist between them and the therapist might touch on and activated old wounds, patterns, and coping mechanisms. Then, once this is illuminated, together the client and therapist can consider what the emotional experience of these patterns are, what it is like to bring greater awareness to them and talk about them with another person, and whether or not there are things that no longer serve the client that they might wish to change.
What Makes A Good Relational Therapist?
There is specific training to become a relational therapist, and the “hub of relational cultural theory” takes place at what was previously the Jean Baker Miller Training Institute, now named The International Center for Growth in Connection. The Center for Growth in Connection offers affinity groups based around education, medicine and neuroscience, and equity, power, and healing, depending on which areas practitioners are passionate about and seek to specialize in. It also offers specific training modules, and – pretty uniquely among the other modalities I’ve researched for this series – also offers a publicly accessible CARE Relational Assessment on their website, to “help you visualize your relational web in 3D.”
It’s this openness and transparency that really speaks to part of what makes a good relational therapist, in my opinion. Perhaps more than some of the other modalities that have been covered so far, relational therapy, rather than avoiding self-disclosure on the part of the therapist, instead specifically utilizes self-disclosure in an intentional way, to help the client get a sense of what it is like, for the therapist, to be with them in the room. Self-disclosure of this nature, of course, is something that was talked about quite a lot in my social work program, but that was more about how much personal detail we should share about our lives with clients (so, things like, how old are we? Do we have a romantic partner(s)? What is our sexual orientation? Do we have any siblings or children? Have we ever experienced trauma?). By contrast, self-disclosure in relational therapy is often about how the therapist is experiencing the client in the room on an emotional and embodied level. What does it tell me about the person I’m sitting with if, for example, I notice that I am feeling flustered, self-conscious, awkward, or like I’m walking on eggshells? And would communicating that to them lead us to in terms of insight?
A good relational therapist is observant, non-judgmental, warm, empathetic, and calm and discerning even if there is palpable discomfort in the room. Particularly with all the conversations about cancel culture and accountability that are flying around social media right now, I also think that a relational therapist should have a proactive practice around holding space for clients’ anger – especially when that anger is directed toward the therapist, and particularly because of the power dynamic that still exists between client and therapist, despite our efforts to practice in a non-hierarchical way. And, as with a therapist practicing from any modality, a good relational therapist will have an ongoing commitment to continuing education that is grounded in anti-racist and anti-oppressive work.
Our Relationship With Ourselves
Another relationship-centric theory that I’ll include here briefly is Internal Family Systems, which draws from Family Systems theory, which states that we cannot be understood as individuals in insolation from our family. IFS helps us understand the various “parts” of ourselves, of which there are three main players: “Managers,” whose job it is to keep us functioning in our day to day life and keep us from reacting in counterproductive ways to external stimuli; “Exiles,” or the parts of us who are often in emotional and existential pain and who are often unconscious; and “Firefighters,” whose job it is to respond when that pain becomes conscious, often by acting impulsively and sometimes incorporate sex, food, and substance use to subdue the Exile.
Internal Family Systems is mentioned in The Body Keeps the Score as an effective trauma therapy, and indeed, it is an evidenced based approach. One particularly important aspect of IFS is that – regardless of how each part shows up in the world, and what the repercussions of that might be – there is no “bad” part. Each part plays an extremely important role in helping us survive in the world; as such, it doesn’t serve us to approach any part with judgment. In relational therapy, you might be guided by your therapist instead to map out these different parts of self, how they show up in your relationships, but also how they relate to each other within you. Take, for example, a harsh inner critic (Manager) berating you to try to keep you in line, on tie, and productive. Rather than judging that inner critic, what comes up for you if you approach them non-judgmentally and with compassion and ask them, “What are you trying to protect me from?” You might be surprised at the answer, and the emotion that accompanies it.
By helping us understand our relationship with ourselves, sometimes we can better understand what happens in our relationships with other people – and vice versa. Relational therapy provides the container to do both of these things in a safe container, and at your own pace.
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