Why pay to see a therapist when my friends are more than willing to listen when I have a problem and I feel supported by them?

This is an important question I sometimes get asked and the answer is that there are many significant differences. Most people report their experience of a therapy relationship feeling vastly different to a friendly chat, as it should.

Generally speaking, most people don’t come to see a therapist with the sorts of issues they feel comfortable sharing with friends. Mostly they come when repeated patterns seem to be causing more harm than good, or a traumatic event occurs which triggers certain things. For others, it is a more elusive but pervasive sense that something is wrong and they feel ready to address it. These things are often beyond the remit of friendships and kindness from those that care for us. Professional support is different in that it is a structured approach to how the situation is explored.

Another key difference is that friends rightly hold their personal view of the world including values, beliefs, prejudices and opinions. We know what is acceptable to one may not be acceptable to another so we make choices about who we speak to about certain issues which fragments the picture for us and our friends. There are also differences in levels of trust and reliability with friends and because they don’t want to hurt us, friends may also avoid painful truths.

Therapists are trained to cut through these sorts of issues having spent many years in therapy themselves learning to separate their own experiences and to ‘leave them out’ of the therapy encounter. Also, therapists are trained to work with painful material as it comes through in the therapy at a safe and supportive pace. Of course, the client is always in the driver’s seat, another factor that seems simple but is actually complex and important.

I have outlined six key factors that separate a therapy relationship from a friendship but there are many more.

1. Therapists hold a theoretical ‘frame’ 

Many people come to therapy when life strategies no longer seem to work and sometimes they may have even become self-destructive. What sets a therapist apart from a friend is the fact that a trained therapist has a coherent theoretical ‘frame’ to looking at these patterns, something a friend cannot offer.

This ‘frame’ offers a professionally trained therapist the skills to safely explore the feelings, thoughts and even fantasies underlying these patterns and the structure to work towards a goal of change.

Another key difference separating therapists from friends is that while a therapist holds a therapeutic ‘frame’ in which he or she considers the client’s situation, the therapist does not approach the client with a preconception about how and why things are happening. The therapist makes a concerted effort to fully attune to the clients unique story and experience and does not make assumptions. This is a complex skill.

2. Boundaries are the cornerstone of therapy

In therapy, a non-sexual and non-friendship kind of intimacy develops between the client and therapist and evidence shows this connection or alliance is the biggest factor in the success of therapy. To create an environment of safety, trust and mutual respect very clear boundaries need to be set up so the relationship is close but within strict limits.

These limits ensure a consistent, reliable and predictable setting for the work to take place. Boundaries also recognise the inherent power inequity in the patient-therapist relationship and are therefore essential to any effective and ethical work. Such boundaries are not factored into relationships with friends in the same structured ways. 

3. Patient safety and legal considerations are uppermost in a therapist’s mind

Unlike a friendship, a therapy relationship entails responsibilities on the part of the therapist including ensuring the patient is safe. This extends to issues around undertaking a structured assessment of a client’s suicide risk, whether there is domestic violence and children at risk in a relationship and many other matters. These issues and how they will be dealt with, should they arise, need to be clarified from the outset of a therapy relationship. Again, unlike a friendship, it is a structured relationship with clear responsibilities and rights.

4. Confidentiality is an ethical issue

All professional therapists adhere to codes of professional conduct for their respective professional groups and this includes ethical responsibilities including, within legal limits, a client’s absolute confidentiality. For an example of a code of professional conduct many therapists adhere to click here. This sets the scene for consistent behaviour and values among therapists, something that can’t be expected of friends or acquaintances.

5. A clear contract is central

Unlike friendly support and advice, therapy relationships should involve a mutually agreed contract about what the work will involve, the client’s expected outcomes and the goal of the work. Contracts are dynamic and they can change as the work develops but it is vital that a mutually agreed plan is put in place so the work has an agreed direction toward what the client is seeking to achieve.

6. The dialogue is focused in one direction 

Friendship discussions work both ways and often involve sharing experiences or personal stories as a way of being supportive and helpful. This is generally not appropriate in a therapeutic relationship. The focus of a therapeutic relationship is the client and not the therapist and thus it is incumbent on the therapist to ensure the work does not stray into a mutual exchange of dialogue where the therapist’s own life enters into the work.

It is important to realise that a therapy relationship should feel quite different from discussing a problem with a friend. If it doesn’t, it is important to raise it with your therapist and discuss your experience. If you don’t feel satisfied with the outcome of such a discussion it may be time to consider your options.