How Is Therapy Different from Talking with a Friend?

by Carol Campbell, MFT

Every once in a while I have a new patient come to therapy who seems to be expecting that our time together will be a lot like chatting over lunch with a friend. "Hi! How are you?" they greet me. "Did you have a nice weekend?" I quickly realize that there will be a learning curve here, one that I hope I can make as painless as possible. I need to find a kind way to help this person discover a different kind of relating that is devoid of the usual social conventions, and yet also profoundly intimate.

We are here to discover whatever we can about the patient's mind, so generally speaking a conversation about my own life, weekend, health, etc. would be a distraction. Many – perhaps most – patients I see have been socialized to expect that in order to expect any concern from me about their well being, they must demonstrate interest in mine. They want to be polite, considerate, friendly, and well-mannered, believing that in some way they must take care of me before I will take care of them. I need to convey to them that we have an exchange set up. In exchange for their paying me my fee for the session, I will give them my undivided attention, and provide a stage for us to become the actors from the stage of their childhood.

It is not the case that I am uninterested in what thoughts or concerns they might have about me. Such comments are often a rich part of the therapy, particularly because they tend to be laden with transferential meanings. If my own father was a weak and sickly person, I will see the slightest sniffle in my therapist as a sign she is ill. I will then treat my therapist with the same sorts of attitudes and feelings I had for my father: she can't be counted on, or she's trying to weasel her way out of showing up at work, or she's ill because I have been such a difficult patient. The past takes root in the therapy room, and flourishes in the relationship between the patient and the therapist. This is no place for the actual person of the therapist to interfere with the patient's unconscious imaginings.

My job as therapist is to deftly take on all the roles the patient casts me in. I must become the critical mother, the absent father, the privileged sibling, the intrusive grandparent, or whoever else it was whose influence on my patient caused their emotional development to become derailed so that they developed symptoms in adulthood of depression or anxiety or narcissism or whatever. When the bad feelings from long ago can be relocated in the therapist, then the hard work of therapy can begin, and those feelings can be validated, felt, and transformed. The patient can be freed from their negative influence and control, and the symptoms that brought the patient to therapy will vanish.

For this process to happen, the actual life of the therapist must remain largely out of the picture. The work of therapy is very different from the function of a friendship. Offering empathy and advice is often central to a loving friendship. Offering psychoanalytic therapy requires the discipline of restraint, so that a loving connection can be fostered that will elicit the good and bad feelings of the patient's childhood. The painful process of being shut out of the life of the therapist can lead to a profound healing that makes the sacrifice of friendship very worthwhile in the long run.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.