Establishing Trust in the Therapeutic Relationship

Teen talking to therapist“When trust and confidence–at both the personal and institutional levels–are high, democracy works better, the economy develops with fewer problems, interpersonal relations are easier and more straightforward, people behave more altruistically, and standards of living increase.” 
-Aitor Riveiro: The costs of a skeptical society, June 21, 2011:  El Pais reporting on results of several pieces of sociological research.

This may not be a surprising conclusion, but I find the idea that high levels of trust are at the core of a well functioning society to be encouraging. In my work with teaching right use of power and influence one of the four essential aspects is being in right relationship. Power often seems like a monolithic thing. Ethics often seems like a cold set of rules. However, power, as the ability to have an effect or to have influence, requires being in relationship with something to effect or influence. Ethics essentially guides us in the use of our positional power to be in right relationship. The core of right relationship is being trustworthy. Trust develops over time based on experiences of trustworthy behavior. This is relationship 101.

What people often don’t realize is that successful resolution of conflict or difficulties is a high developer of trust. When the Hippocratic Oath says, “above all, do no harm,” I don’t think this is quite enough, because we unwittingly cause harm no matter how hard we try not to. The actuality or perception of harm just goes with the territory of relationship. I would add to the oath…Do no harm and above all, recognize and repair harm and promote well-being for all. There are many causes of unwitting harm: impact being different from intention, cultural differences, projection, misunderstanding, naivety…Better than pretending that you never have a harmful effect, is to track for and resolve difficulties as they emerge. Successful resolution and repair actually increases trust. Clients who have successfully repaired a relationship issue with their therapists have not less, but more trust in their therapists and more satisfaction from their completed therapy process.

Here’s an example: My client came in for her first session. The session seemed to go well and at the end I suggested some “homework” as I often do to help clients integrate or gather more information about an issue that we worked on.   Uncharacteristically, a bit of journaling seemed like it might be helpful for her. The next week she came for her appointment speaking in a loud, angry voice, almost before sitting down:

“I almost didn’t come back! You’re just like all the rest. You didn’t connect with me personally. You just have a formula that substitutes for personal attention. They all do it…assign journaling. I HATE, HATE journaling!  Do you get it?”
I took a deep breath, looked at her and said, “Well, I guess I just learned something about you….you hate journaling. I’ll certainly never suggest that again!”
She looked surprised and taken off guard. Then she began to laugh and we both laughed for a time. “You have really strong feelings about this!”
“I do.”
“Well, may I tell you something else I learned about you? (nods) It’s very important to you that I make a personal connection with you. You don’t want to be treated with a formula.”
“Yes, it is.  I thought that after I told you all that, you would reject me as a client.”
“Actually, your courage in telling me, let’s me know that we could work well together…collaborating.  It’s very important to me that you tell me your experience even or especially if you think it might not be what I want to hear.”
This was the start of the most successful therapeutic relationship she had had. Often raw, always real.  I am grateful for her courage.

As in society in general, in therapeutic relationships, “trust and confidence are factors that create a virtuous circle…they reduce negotiation costs and timetables, facilitate communication, and generally speed up transactions.” (Mariana Szmulewicz: European Mindset report, 2009).  By not becoming defensive or shutting down in response to conflict or difficulties, trust is increased, communication is improved, and the time needed for healing decreases. Unfortunately, we’re more likely to notice the relationships that are conflicted or stuck. Take time to look for and acknowledge the virtuous circles in your relationships. Trust increases trust.

© Copyright 2011 by Cedar Barstow. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Joey

    July 7th, 2011 at 11:49 PM

    It’s not for nothing that when there is ni conflict,any relationship grows better…It’s the basics…Whatare you spending your energy on? Conflicts or development of the relationship? Pretty simple isn’t t? :)

  • Elle

    July 8th, 2011 at 4:25 AM

    Trust IS the very crux of a highly functioning and successful society. No matter whether you are talking about in interpersonal relationships or corporate relationships without trust you are not going to have much of anything that really means anything.
    I can’t fathom why you would want to live with someone or do business with someone that you do not trust. That just screams of desperation, and maybe a little bit of a personality hitch in you.

  • rudy

    July 8th, 2011 at 5:57 PM

    let me just ask ya all a question-why were we not as comfortable with our now-good friends when we first met them?why was there no closeness?because you did not trust each other as much!simple way to understand how trust can help relationships and even the society at large.

  • Ginnie F

    July 9th, 2011 at 5:19 AM

    and don’t forget to trust your own instincts- sometimes a clear map of how you feel and what you see in others is the best indicator of what you can expect from that person- second guessing yourself is highly over rated

  • cassie t.

    July 9th, 2011 at 5:15 PM

    “Do no harm and above all, recognize and repair harm and promote well-being for all.” Now those are words to live by if ever I heard some. I’m going to make myself a screensaver with that on it. Thanks for the inspiration, Cedar!

  • Sally Watt

    July 9th, 2011 at 7:56 PM

    Wow, that’s fantastic that you both managed to continue the therapy and have a successful relationship. From what she said it must have been a common experience for her to be rejected by her therapist after she spoke out too. I thought the whole point of therapy was that you could speak freely without being judged because it was a safe environment. Did their dented egos override their professionalism, I wonder?

    Anyway, glad she found her way to you Cedar and thanks for sharing that story!

  • Aaron Fisher

    July 14th, 2011 at 12:41 AM

    A real friend is someone that can know absolutely everything about you, warts and all, and still be your friend.

    If there’s something that they don’t like about you and it harms your friendship, then they are not true friends at all as far as I’m concerned. Move on and find some that are.

  • DrewMathis

    July 14th, 2011 at 8:47 PM

    @Aaron: Thumbs up to the moving on part. On that note, I have broken off some longstanding friendships in a mere instant because they wanted to associate with a person that I vehemently despise. I don’t feel any guilt about it however nor loss.

    If you’re going to associate with a snake of a guy that’s below even my (embarrassingly low) standards, you really don’t deserve my friendship and loyalty. That’s why I confide nothing to no-one in my inner circle. You never know when they may turn away from you or vice versa.

  • Cedar Barstow

    September 15th, 2011 at 10:28 AM

    Thanks, Joey. Yep, developing relationships is indeed ethics 101! —- Hi Elle, Yes, of course one doesn’t want to work with someone untrustworthy! However, in the corporate and institutional world, you often don’t get to choose who you work with or are supervised by and you might find them untrustworthy. Then you need to use all the skill and sensitivity you have to try to develop more trust.—-Rudy…usually I agree, however, there have been a few times that I have trusted someone initially and then found him or her to be untrustworthy. Painful moment. —-Ginny, Right. And, in addition, I find as a therapist, my clients are often working on that very thing…learning to trust themselves! It’s not an automatic thing! —–Hey, Cassie, Thanks for the appreciation and the screensaver idea!—-Glad you appreciated the story, Sally. My thought is that therapists can be so paranoid about not ever causing harm that they become defensive or projective and thus end up causing harm! —–Hi Aaron and Drew, nice to see you having a dialogue. I wonder, however, if there is any room in your friendships for resolution, repair, forgiveness of mistakes?

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