I know a lot of people who worry when a loved one — especially a spouse or a child — gets into therapy. They fear the therapist will drive a wedge in the relationship.
And in some cases there’s a risk of that.
Even psychotherapy that is helpful in other ways can interfere with the patient’s social support system — the advice, comfort, encouragement, and moral support of family and friends. That suggestion comes from an article in the Harvard Review of Psychiatry.
Psychiatric disorders themselves are often so damaging to human connections that it seems almost self-evident that any therapeutic effort can only improve them. In fact, there is good evidence that psychotherapy for major depression strengthens social connections — which is not surprising since isolation is a common result of depression. And couples therapy usually improves the couple’s relationship, although less is known about its effect on their relationships with other people.
But beyond that, the evidence is scarce. Swedish investigators reviewing studies of psychotherapy and psychoanalysis found that although patients usually benefited in the long run, their social relationships (as measured by a questionnaire) tended to deteriorate somewhat at the beginning of treatment, and never recovered fully.
The source of the problem could be the uniqueness of the therapeutic relationship, also known as the therapeutic alliance. Psychotherapists pay close and sympathetic attention to patients while making few demands on them — an arrangement that may make the patient’s encounters with other people seem disappointing by comparison. Patients may find that they are discussing what matters most to them mainly with the psychotherapist. And therapists may endorse patients’ critical or hostile attitudes toward others. Patients often present these relationships as a problem, and therapists sometimes find it hard to avoid reinforcing the patient’s descriptions.
If you are in therapy, you may see your relationships getting worse. Or perhaps you hesitate to talk to those closest to you about issues that come up in treatment. If you notice this, raise the matter with your therapist. No relationship is perfect, and sometimes you lose perspective on how the good and the bad fit together. Regaining perspective may be important, and your therapist can help you do that.
How has psychotherapy changed your perspective on important relationships in your life? If you became hypercritical of others or if your relationships became more painful, how did that evolve? Have you been able to talk about these kinds of questions with your therapist?
Harvard Mental Health Letter
The field of mental health is rapidly evolving, and whether your interest is professional or personal, staying informed about these mental health issues is no easy job.
Now there’s a source of mental health news you can trust…and it comes directly from the more than 8,000 doctors and researchers at Harvard Medical School. Harvard Mental Health Letter is read by professionals and a growing number of lay people alike who are fascinated by the mysteries of the human mind.
Dr. Michael Millerhas been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.
Are you Living With Depression? Connect with others with similar health concerns and issues. Click here to join the group.
recommend this
email
print
link to this page
Comments: 12
You make a number of excellent points about the therapeutic alliance and pre-existing mistrust of the therapeutic process.
It's very encouraging to hear how helpful therapy was. You really are describing therapy at its best. It sounds like you got a realistic sense of your important relationships, so that you could make better choices about which ones to invest in and which to avoid. No question, that kind of result makes life much more worth living!
And Marilyn M., you appear to have the same response to Danielle's post. I think you put it well, that seeing things for what they are is essential if you're going to have satisfying relationships.
Of course, no relationship is perfect. Psychotherapy is working well if it helps you take the good with the bad, and to make trade-offs in relationships that work for you.
You make an excellent point, too. Feeling free to speak your mind helps you make genuine connections to others. I've heard people say that they feel best in a relationship when they can be themselves. I suppose that saying what you feel is an important part of being yourself.
But Teresa points out something important, too. Speaking your mind can be hurtful to others. So sometimes you may want to keep your thoughts to yourself.
This is paradoxical, I know. But I do believe that there is a time for speaking your mind and a time for restraint. The tough part is making the judgment that will further your relationship. You don't actually have to spill all in order to be yourself. A good therapy should help you think through these kinds of choices.
I appreciate your reminding everyone of the data. It's true. For depression, a combination of psychotherapy and medication has been shown to be most effective. And also, that one size does not fit all.
You're right: A good assessment is essential. Along with getting the individual help you need to find the treatment approach that works best.
Nicole M., you make the point well, that what a given person chooses will depend on the variables you describe — the type of problem and the nature of the two individuals (patient and therapist) working together to solve it.