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How Much Should A Therapist Care Or Reach Out?


I appreciate your time and consideration of my question.

A few months ago I started seeing my therapist again who I’d seen the previous for 5-6 years. I returned because my life-long battle with depression worsened considerably and over the years I’ve drawn strength from believing and feeling he was my ally and cared about me.

Although it’s too hard for me to cry in therapy, I do my best to verbalize the pain I’m in and have been so disappointed by what seems to be his lack of concern. Because I’ve only responded to medications in the past, which are currently being adjusted, I didn’t think typical therapy would help my depression. However, I’ve been so isolated and in need of a human being caring about me I hoped therapy would help provide a lifeline to me. It hasn’t been that way.

I understand therapists need to remain detached, but how much? Is it crossing a boundary if he told me he was concerned about me? Can I use therapy as a means of human support, or, does it always have to involve analysis? I’ve been trying to hold on and am not suicidal now, but feel worse each time I reach out because his responses seem detached and lack empathy. Thank you again, Krista

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Hi Krista,

I am answering your questions for Dr. Dombeck.

In my opinion, as a psychotherapist, now retired, the therapist should not remain detached and, in fact, cannot be detached because they have thoughts and feelings about the patient during the session. This is why I want to direct your attention to the books written by Irwin Yalom, Psychiatrist, Psychoanalyst and author. Most of his books are written for the general public, are both readable and enjoyable. The point is that he practices therapy based on existentialist thinking. That simply means that he regards the real relationship between therapist and patient to be vitally important. He does not hide behind a mask of neutrality, answers questions asked by the patient and is very genuine in his approach. That is the way I practiced psychotherapy and that is the way I experienced psychotherapy.

Yet, I cannot help but wonder if you are being honest with your therapist in expressing your disappointment, just the same way you are doing here? I have no way of knowing what his response would be but, if he remains neutral and detached I would advise you to find another therapist, one who can combine being professional while expressing concern, empathy, support and warmth. A good starting place might be to discuss the problem with your psychiatrist and ask him for a new referral.

So, to make my point very clear, the anwers are yes, a therapsis should not be detached and should express concern about you. Most definitely, therapy and the therapeutic relationship should provide support. A therapist should express caring and should reach out.

Good Luck

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