Foundations of a Breakthrough: Building a Strong Therapist-Client Relationship

The Indian philosopher Jiddu Krishnamurti spoke of the “inward poverty of man,” an existential starvation that involves always looking to fill oneself with an identity, a purpose, a reason for being. 

When I entered into treatment in the mid-nineties, I was viscerally bankrupt. A shell of a person… a “nothing man.” 

My first exposure to working with a treatment team was unsuccessful, and I returned to a maximum-security psychiatric hospital for months. My doctors had warned me that if I used drugs after my first episode I would likely suffer another episode.  

I could not stop. 

Instead, I was drawn to harder narcotics. Substances that could drown the shame and anguish of returning to the world after your first hospitalization, your first diagnosis. 

The treatment failure was my own the first time. 

I was unable to fully express any of my fears to the treating physician, and I was determined to do it my own way. 

So when I entered the doctor’s office again after episode number two, I was destroyed. Lost. I didn't feel like I was a “sick” person trying to get better, as much as a fundamentally broken person with no way to live this life. Initially, my fears bled into my treatment, and I was not working toward a goal but holding on to this moment, desperately trying to not slide back into the hell of the hospital and acute psychiatric symptoms. 

But on the second go-round many things went right in my treatment, and this made all the difference. 

After the second hospital stay in 1996, the new clinician focused our initial sessions on our relationship. She made it very clear that it was a dynamic that had to be strong enough to allow me to trust her with my life and take revolutionary actions that seemed totally counterintuitive. 

In those initial meetings, I was allowed to be afraid, to voice my doubt that she could help me or that the prescriptions offered were correct. I was allowed to tell her that I didn't trust her, that she had too much power over me… that she had nothing to lose while I stared at a lifetime of hospitals and an early death. 

The foundational piece in each part of my journey today has been my relationship with my treatment team. When treating a client, it is important to remember that you may be the only close relationship they have or can trust. 

Many of us have tortured our families in the midst of addiction and active mental illness. We have cut out or lost our friends. And the choking shame of our actions and our own self-stigma can prevent us from reaching out to support systems. It is a life and death battle for many of us, and oftentimes you, the clinician, may be the only one on the planet who cares if we make it. 

To acknowledge that absolute “inward poverty of man” to another is excruciating. To drop the denial and truly see my life as it was seemed too painful. I considered ending my life rather than taking those last few steps into the unknown horrors of my reality. 

It was because of the relationship built over the years with various psychiatrists and social workers that was I able to first acknowledge the myriad of emotions I had in regard to losing my stepdaughter to my mental illness, and later, to learn how to live with it. 

When my first manic episode bloomed in my psyche in Memphis, Tennessee in 1995, I was the stepfather of a beautiful little girl who was 15-months old. I had raised her since her birth and loved being a parent. 

My symptoms present without insight, and as my fantasy world of delusion and paranoia grew, my wife and I decided to divorce. On the last day of our marriage I entered my child’s room, held her to my heart, and kissed her goodbye. 

Forever. 

Two weeks later I woke up in a psychiatric hospital in restraints and only knew one thing for sure. I had lost the only thing I had ever loved. 

Many things drive us to use and abuse narcotics and stop taking our medications. Foundational things. 

There are things we would rather die from than face. 

The loss of my stepdaughter was as somatic as it was cognitive. No single emotion. Shame. Guilt. Anguish. Pain. Crushing sorrow. To wander into that memory, I needed professionals that I knew and trusted. 

However, this wasn’t the kind of breakthrough you have quickly. It took years for me to understand the depth of the feeling and how it trapped me in a limbo where I could not move forward in relationships that had grown in my recovery. 

The relationship with my treatment team was one I had faith in. It had been tested with disagreement and resolution and, therefore, could handle the eruption of a foundational change in my psyche, body, and spirit. 

Treatment is many things, but every pharmaceutical intervention and every new concept for life change will hinge its success on the relationship between client and treatment provider. It is often the only social bond we have as we make our way through this unknown life. 

How do you create trusting and secure relationships with your clients? 

How do you tend to that relationship as the treatment progresses and the dynamic of the relationship between client and treatment provider evolves? 

Eric Arauz, MLER, is an international behavior health consumer advocate, trainer, and inspirational keynote speaker. He is a faculty member at the Rutgers-Robert Wood Johnson Medical School Department of Psychiatry, the Vice-Chairman of the current New Jersey Task Force on Opiate Addiction in citizens 18 to 25 years old, and a person with the lived experience of bipolar I disorder, PTSD, addiction, and suicidality. He is the SAMHSA 2012 "Voice Award" Fellow and the author of An American's Resurrection: My Pilgrimage from Child Abuse and Mental Illness to Salvation. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.