Trust?

Trust. This may be an odd thing for me to say but I hadn't really considered trust in the context of my clinical work until this week. Confidentiality, yes. Privacy, yes. Clients' rights to see their clinical notes, of course. But trust – no. For me, trust is associated with a relationship I would have with a partner, family member or friend. I wouldn't use the term 'confidential' in relation to the sharing of the hopes, dreams and heartbreaks of someone close to me. Yet I would when a client does. What does it matter? It's the language of the professionals, the subtleties of language, right? Well, maybe. Or maybe it's part of what some psychodynamic therapists have identified as a way of distancing ourselves from our clients and keeping them as distinct and separate from us. A way of protecting ourselves from the pain and suffering that our clients may bring.

By aligning ourselves with this language of professionals, are we missing out on the human connection that is integral to the therapist-client relationship in a way that isn't demanded of our relationship with our solicitor or bank manager?

This week I've been approaching my sessions with clients as one based on 'trust' rather than confidentiality and this experience has subtley shifted something. I've been more attuned to the humanity in what has been brought to the session. Rather than a head full of formulation and worry about what question to ask next, I've made space for the need to 'be there' for the client and be present. Formulations and asking appropriate questions are certainly integral to our work. But I have become aware as a trainee that I have been so focussed on getting these things right that I may have been avoiding something. The human pain of their experience.

Of course, our clients want us to help them to understand how their problem has developed and ways of intervening (ie. a formulation). But my sense is that this need not be at the expense of something which may be more fundamental – a human connection based on trust.