The best psychotherapy occurs when the therapist loves the patient. Love, in this context, consists of three aspects:
- The therapist is committed to the best interests of the patient.
- The therapist sees and appreciates the good in the patient.
- The therapist communicates that vision and appreciation to the patient.
The therapist’s commitment is the most important piece and must be present for psychotherapy to occur at all. As a practical matter, it is much easier to consider the needs of the other when one’s own needs have been taken care of. The therapist sets the boundaries and parameters within which psychotherapy takes place. These boundaries are there for the patient and for the therapist as well. Office policies, hours of operation, fees, standards of conduct are all ways the therapist makes sure his needs are met and provide the frame within which he can do his work. When the boundaries have been set, the therapist places his focus on the needs and well being of the patient.
Seeing the good in the patient supports the therapist’s commitment to the patient’s best interests. It motivates the therapist to do the work. Undoubtedly, some people are easier to love than others. People often, wittingly or unwittingly, hide the gold within them with maladaptive or off-putting behaviors. This is why psychotherapy is so important. People fundamentally need love and safety. During the course of life they may develop strategies that hinder their ability to get these needs met. They also develop distorted ideas about what love and safety actually are. They may even begin to believe that they are fundamentally unlovable. It is the therapist’s job to see past the maladaptive, distorted crust covering what is lovable in a person. The therapist may be the only person in the patient’s life who can do that. To be clear, it isn’t that the therapist is necessarily a paragon of love and acceptance. Rather, the therapist’s training and life experience equip the therapist to see what is below the surface and the boundaries of the therapeutic space protect the therapist from the worst of the patient’s maladaptive behaviors. To put it another way, the therapeutic frame allows the therapist to bring his best self to the therapeutic encounter.
Communicating the therapist’s sense of the patient’s goodness can be very important for the patient. When people seek out the help of a psychotherapist they are often struggling with shame, experiences of failure, or some other sense of their wrongness. It can be enormously helpful for someone in such a state to encounter another person who sees the good. It is vital that the therapist communicate, in some way, his love for the patient. Such communications help the patient understand the therapist’s commitment to the patient’s best interest. They can also help the patient tolerate those moments in which the therapist must offer potentially painful feedback. Such unconditional positive regard (to borrow a phrase from Rodgers) may also be healing in and of itself.
I write all this with a very clear sense that I have only scratched the surface with very broad generalizations. The three aspects of love I outlined above are listed in order of how difficult it is to bring them into psychotherapy in a good way. Implementation of these ideas requires that the therapist navigate a variety of potential pitfalls: cultural baggage associated with the word “love,” transference and countertransference, potential boundary crossings, cultural differences, etc. Despite these difficulties, I have found these ideas to be helpful guideposts.
