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  • about Healthy Relationships & What Makes a Good Therapeutic Alliance

    This week marks the start of February, thematically associated with love and relationships. What are the different types of relationships? What makes a healthy relationship? And what makes a healthy therapeutic relationship?

    According to Merriam-Webster, the definition of a relationship is 

    1: the state of being related or interrelated

    2: the relation connecting or binding participants in a relationship: such as

    a: KINSHIP

    b: a specific instance or type of kinship

    3a: a state of affairs existing between those having relations or dealings

    b: a romantic or passionate attachment

    Definitionally, relationships come in various forms and dynamics, each characterized by the nature of connection, level of intimacy, and purpose. Relationships get complicated because we’re people, and while I could write an entire dissertation on the complication of human nature, it would never be finished. 

    Instead, I rely on a simpler principle: a good friend and mentor of mine who taught me about Restorative Practices always corrected the adage that to err is human; her interpretation is that to harm is human. I take that a step further and believe that the fabric and strength of our relationships is tied to how all parties in a relationship take responsibility for the harm we cause (because sometimes we don’t or we don’t know how) and the ways in which we try to repair that harm.

    This is the general frame with which I discuss relationships with clients, often furthering their understanding about relationships in terms of spheres of influence – or how much power, influence, intimacy, or information someone has in your life. This exercise helps folks visualize how they prioritize specific people, relationships, and relationship types as well as their motivations for doing so.

    There are so many types of relationships, and they’re not always mutually exclusive or static. Friendships can turn into romantic relationships – and often we are friends with our lovers or romantic partners, casual relationships can grow into friendships, online relationships can develop into IRL friendships and more. These are just some examples of how folks can shift between spheres of influence in our lives.

    When working with clients, I draw spheres of influence as a bullseye or as a set of concentric circles with the folks you consider safest or emotionally closest with in middle, and working your way outward based on your level of safety and emotional connectedness. We may list specific people or do a more general exercise, thinking about which types of relationships fall where on the bullseye and why.

    If you’re thinking about doing your own spheres of influence activity at home, the list below is a pretty thorough guide to the types of relationships folks tend to have. These aren’t in any particular order or priority – it’s just a list. It may be helpful to think about specific people in your life who fall into each category, and then map out the relationship types after.

    1. Romantic or Sexual Relationships: involve emotional and physical intimacy between partners. They can range from dating to long-term committed partnerships such as marriage.

      1. If we’re parsing terms, this can be divided further into romantic relationships and sexual relationships. Think aro-spectrum and ace-spectrum.

    2. Friendships: non-romantic relationships based on mutual affection, trust, and shared interests. Friends offer emotional support, companionship, and often share activities and experiences.

    3. Family Relationships: based on blood ties, adoption, or legal bonds. They include relationships between parents and children, siblings, grandparents, aunts, uncles, extended family members, and kin.

    4. Professional Relationships: formed within work environments and are characterized by roles, responsibilities, and professional boundaries. They include relationships between colleagues, supervisors, clients, and collaborators.

    5. Casual Relationships: less emotionally invested and may involve friendships with fewer obligations or short-term romantic connections without long-term commitment.

    6. Platonic Relationships: non-romantic connections between individuals that involve deep emotional bonds and companionship without sexual intimacy.

    7. Online Relationships: formed and maintained through digital platforms such as social media, online forums, or dating apps. They can range from casual friendships to romantic connections.

    8. Parent-Child Relationships: Parent-child relationships involve the bond between a parent or guardian and their child. They are characterized by love, nurturing, guidance, and the provision of emotional and material support. Conversely, we also know that parent-child relationships can also be a primary source of childhood trauma.

    9. Transactional Relationships: based on exchanges of goods, services, or resources. They may include business partnerships, client-provider relationships, or transactions in social contexts.

    10. Intergenerational Relationships: span across different age groups and involve interactions and connections between individuals of different generations.

    11. Acquaintances: casual relationships characterized by limited interaction and familiarity. They may include people known through social circles, work, or community involvement.

    12. Caretaker Relationships: involve providing physical or emotional care and support to individuals who are ill, disabled, or elderly. These relationships often entail a sense of responsibility and compassion.

    Now that we’ve defined relationships and outline many of the different types, it’s time to consider some key components of healthy relationships. As with all things, the intensity to which these appear will vary based on the type of relationship, but all healthy relationships contain at least some of these elements:

    • Communication: non-violent, open and honest communication is crucial for understanding each other’s thoughts, feelings, and needs. Active listening, empathy, and expressing oneself respectfully contribute to effective communication.

    • Safety: safety is the foundation of a healthy relationship. It involves trust, reliability, dependability, and confidence in each other’s intentions and actions. Building and maintaining safety requires transparency, honesty, and consistency.

    • Respect: mutual respect is essential for acknowledging and honoring each other’s individuality, boundaries, and perspectives. Treating each other with curiosity, kindness and consideration fosters a positive and respectful atmosphere.

    • Equality & Equity: healthy relationships thrive on equality and equity, where both partners contribute and share similar amounts and types of responsibilities.

    • Emotional Support: providing emotional support during both challenging and positive times helps create a strong bond. This can look like checking in via text or phone, sending cute memes, providing acts of service, making food, offering emotional comfort, and validating feelings.

    • Independence and Autonomy: encouraging space for personal growth, individual pursuits, and maintaining separate identities is crucial. Healthy relationships encourage independence while fostering a strong connection. I often envision this as two people who are moving in the same direction at a similar pace, sharing their experiences with each other, but not trying to control the experiences or feelings of the other person.

    • Shared Values and Goals: having common values, interests, and long-term goals helps align the direction of the relationship. It also contributes to a sense of unity and purpose, increasing the level of emotional connectedness.

    • Conflict Resolution: addressing conflicts in a constructive manner is essential. Healthy relationships communicate openly about disagreements and work towards resolutions. Using non-violent communication, taking responsibility for harm, and employing effective problem-solving skills and compromise helps navigate differences.

    • Quality Time: Spending quality time together strengthens the emotional bond. Shared experiences and meaningful activities contribute to relationship satisfaction. Further, prioritizing each other’s company fosters a sense of connection.

    • Appreciation and Gratitude: Expressing genuine appreciation for each other’s efforts and qualities reinforces positive feelings. Regularly expressing gratitude contributes to a positive and nurturing relationship. Often, the more specific the expression of appreciation or gratitude, the more impactfully it’s felt.

    • Flexibility and Adaptability: A healthy relationship can navigate transitions and uncertainties with resilience. This requires consistent, honest, and open communication from all parties.

    • Intimacy: Intimacy involves trust, vulnerability, and a sense of closeness. Physical and emotional intimacy contribute to a deep and meaningful connection; however both are not required to feel close with someone. Further, inappropriate levels of emotional intimacy can be a red flag in other areas of the relationship.

    • Commitment: Commitment to the relationship involves dedication, loyalty, and a willingness to invest time and effort.

    Again, not all of these factors will be relevant for all types of relationships. However, most relationships will contain at least some variables on this list. As you’re considering relationship types and where they might fall in your sphere of influence, also consider that the more of these factors that apply to a relationship type, the closer it probably is to the center of the sphere of influence. If there’s incongruence between relationship type and the number of related factors, perhaps this is an opportunity for curiosity, discovery, and analysis.

    Oh my god, did I bury the lede on this one. But really, I didn’t feel like I could talk about a healthy therapeutic alliance before laying the definitional and theoretical groundwork for healthy relationships. That’s because for many folks, the therapeutic relationship might be the first healthy relationship they’ve ever had. 

    However, because of the inherent power dynamic in the therapeutic relationship, it’s also completely different from the relationships we maintain in our personal and professional lives. At a very basic level, therapeutic relationships are transactional. Therapists are, after all, compensated for our time and expertise. We are professional listeners, containers, teachers, cheerleaders, attachment figures, case managers, and system disruptors. Ethically, we cannot be friends, family, partners, or lovers. And that’s okay, because it models those boundaries that get ignored or disrespected the most.

    Research shows that the therapeutic alliance is a crucial component of successful therapy outcomes, and building a strong rapport between a therapist and a client is essential for effective psychological treatment. Yes, it is important that you actually like and feel bonded to your therapist. In fact, most of the characteristics of healthy relationships also describe a strong therapeutic alliance – and why it’s so important to connect with and trust your therapist. 

    Here are several reasons that the therapeutic alliance is integral to successful therapeutic outcomes:

    1. Trust and Safety: A strong therapeutic alliance creates a safe and trusting environment for you as the client. When you feel secure, you are more likely to open up and share your thoughts, emotions, and concerns with the therapist. You are more likely to take emotional risks, face fears, and engage in growth.

    2. Open Communication: An effective therapeutic alliance fosters open communication between you and the therapist. This open dialogue allows for a better understanding of your experiences, thoughts, and feelings, leading to more accurate assessments and targeted interventions.

    3. Collaborative Relationship: The therapeutic alliance promotes a collaborative relationship between you and the therapist. Working together as a team, you can set goals, develop strategies, and implement interventions that are tailored to your specific needs and preferences.

    4. Empathy and Understanding: Therapists who build a strong alliance with their clients demonstrate empathy and understanding. Feeling seen, heard, and understood helps you explore your emotions more deeply, gain insights, and develop a wide range of coping mechanisms, contributing to positive therapeutic outcomes.

    5. Client Engagement: A positive therapeutic alliance enhances your engagement and investment in the therapeutic process. You are more likely to actively participate in sessions, complete assignments, and adhere to treatment plans when you feel a strong connection with their therapist. Basically, it creates an added level of external accountability while you’re still learning how to be accountable to yourself.

    6. Respect and Non-Judgment: Mutual respect and a non-judgmental attitude from the therapist create an atmosphere where you feel accepted and valued. This acceptance encourages you to be honest about your thoughts, feelings, behaviors, and experiences without fear of criticism.

    7. Therapeutic Attachment: Building a secure therapeutic attachment is essential for individuals who may have experienced difficulties in forming healthy attachments in their personal lives. The therapeutic alliance can serve as a reparative and healing relationship.

    8. Motivation and Hope: A positive therapeutic alliance fosters motivation and instills hope. Feeling supported and encouraged by a therapist can encourage you to make positive changes, overcome challenges, and work towards your goals. 

    9. Adaptability: The therapeutic alliance allows for adaptability in treatment approaches. A strong connection enables therapists to tailor interventions based on your evolving needs and progress, ensuring a more effective and personalized therapeutic experience.

    10. Reduced Drop-Out Rates: You’re less likely to discontinue therapy prematurely when there is a strong therapeutic alliance. The commitment and connection established between you and the therapist contribute to increased treatment retention and more sustained therapeutic outcomes.

    I’ve thought about where the therapeutic alliance falls in the sphere of influence, and frankly, I’m not sure it belongs there. As a technically transactional relationship that has a really wonky power dynamic, often imbalanced level of emotional intimacy, and high level of influence, we could fall into literally every concentric circle. Which is why the ethical requirements for boundaries are so stringent – for the protection of both the therapist and of you as the client.

    So to wrap this whole thing up:

    Who needs therapy? Everyone – including you. It’s healing for your past self, growth for your current self, and investment in your future self.

    Why is therapy important? Because we can’t help what happened to us, but we are responsible for our reactions to triggers and for breaking harmful cycles.

    How do you choose a therapist? Consider what you want to work on and compare it with the therapist’s degree, specialties, whether you vibe with them, and whether you will respond to them challenging you to learn and grow.

    Why’s the therapeutic relationship important? Because it’s the crux of how successful you’ll be in the therapeutic process with a specific therapist.

    Now go out there, and invest in yourself. You’re worth it.