Hello, this is Liz Long Rottman.
Today we’re going to talk about how to center the therapeutic relationship and why that matters more than collecting tools as a therapist.
I always knew the therapeutic relationship was the most important factor in therapy.
That’s not controversial.
We’re taught that very early on in school.
But knowing that intellectually is very different from actually understanding where the rubber hits the road and how easily we can miss that.
And I missed it for a long time.
My first experience in therapy was in a psychodynamic framework.
It had a very classical foundation, tried and true.
Later, I had the opportunity to audit an object relations theory course at the University of Texas, which deepened that relational lens and gave language to what I had already been experiencing personally in my own therapy.
So from the beginning, my exposure to therapy was grounded in relationship and attachment, not as an abstract idea, but as the foundations of the work.
It’s something I really had in my body, and I also understood intellectually, but I wasn’t quite bridging the two yet.
And this was before I had even become a bodyworker or a psychotherapist.
This was just through my own therapy and study.
So at that time, despite this foundation and this intellectual understanding that I had, something in my early therapeutic experience felt off.
I couldn’t name it at the time.
I assumed the problem was me.
It took someone else pointing it out, actually, for me to even see what was going on.
And at the time, my conclusion was simple.
The therapist probably didn’t have the right tools, right?
So I went looking for better tools.
I went to philosophy school to gain conceptual clarity.
I became a bodyworker, and I started to see preverbal trauma patterns and started to understand how to treat those—preverbal meaning trauma patterns that happened before we have a lot of language, so under the age of three.
I also learned somatic modalities and nervous system work, and I became a trauma specialist.
I studied mindset and influence as well. In DBT, we call that interpersonal effectiveness.
That field is very helpful—the influence field.
Every one of these gave me something real and useful, but I kept coming back to the same things:
Relationship, boundaries, and attachment.
So then I had a huge realization.
At this point, I had a huge tool bag.
And I still do.
And I intend to explore those tools on this channel.
But no single tool—and no number of tools on their own—create a strong, clear, clean therapeutic relationship.
And without that, the tools don’t land.
I’m not perfect at this.
I’m continuously improving.
And the rest of my story will elucidate that.
But everything that I’ve learned, this has been the most important and the most challenging aspect of therapy.
So over time, a pattern became clear.
Clients who did best had a strong therapeutic relationship first.
Clients who struggled often had relational mismatches or unclear boundaries, regardless of my technical skill.
The moment I really saw this was when I became a supervisor.
A supervisee had excellent training, but their clients kept leaving.
It wasn’t the modalities they were using.
It was their relational capacity.
That’s when I started turning the lens on myself more seriously.
Because I could see what was happening with them, it made me wonder: am I doing any of these things?
I didn’t have so much of the client loss issue, but I wanted to make sure that I was continuing to develop my relational skills.
So I asked myself: where do I get activated?
Where do I avoid directness?
When am I performing presence instead of actually being present, and why is that happening?
And so this has been the most humbling work I’ve done.
Because I already had over a decade of experience when I started to really realize this this time around.
So the research really backs up what I’m about to say.
Studies consistently show that the therapeutic relationship is the most important factor in successful outcomes.
Therapists who develop relational capacity outperform therapists who primarily collect techniques.
We’re also under pressure from client capacity—how the client is perceiving therapy—and also any marginalization or oppression that they may be experiencing.
But the greatest leverage that a therapist has in the therapy room is their ability to create rapport and be relational with the client.
Relational capacity doesn’t add to tools.
It makes the tools effective.
It’s foundational.
It’s the foundation upon which the tools must be delivered.
So here are ten concrete actions that you can use to improve your relational capacity as a counselor.
Number one.
Understand your biases.
This includes multicultural perspectives, but also your therapeutic approach, philosophy, temperament, and personal history.
You don’t need to fix your temperament.
You just need to know what you’re working with.
Number two.
Develop healthy detachment.
Healthy detachment is not not caring.
It’s not distance.
It’s a boundaried stance.
It’s not taking on all of your client’s emotions while still allowing some of yourself to be moved by your client’s experience.
It allows you to remain oriented and objective.
It prevents you from getting pulled into the client’s defense mechanisms, emotional induction, or enactments.
These things are still going to happen.
Just developing healthy detachment isn’t going to 100% prevent that, but it will decrease that to some degree.
And to be fair, when we get into enactments or we get emotionally induced, that’s just more compost for the garden when it comes to therapy.
Healthy detachment helps you stay more objective, so you’re more likely to catch when you’re getting into an enactment with a client, when you have countertransference, so that you don’t get defensive and instead can work through it and create a solid repair.
Number three.
Cultivate analytic curiosity.
What does that mean?
Does your client just get hostile?
Get curious, not offended.
Are you feeling bored with a client?
That’s just information for you.
Client only talks about cars?
Ask what they might be communicating through cars.
And if they can’t answer that directly, you can just ask yourself that.
So adopt this mindset:
Everything is interesting.
I have a friend who likes to go out and play this game, and it’s called Everything Is Interesting.
So no matter who you’re talking to, you can find a way to be interested in what they’re talking about, even if it appears to be mundane.
Practice this out in the wild.
Use it in the therapy room.
Number four.
Let yourself care.
Don’t be intrusive.
Don’t make it about your care.
But let your attachment system do its thing.
Your attachment system wants to love your clients.
Therapists attach to clients while remaining ready to let them grow, change, or leave.
Clients feel the difference between genuine care versus professional distance—or professional anything.
Like, you need to stay professional, of course, but let a little bit of yourself come through that.
Side note: if you’re burned out, this might not work.
Or if you have early attachment trauma yourself, you might need to get support first before you’re going to be able to let yourself care about your clients to a healthy degree.
Number five.
Don’t underestimate your client’s attachment to you.
This video was a post a few weeks ago, and somebody told me that number five really jumped out at them.
It’s not always obvious that your clients are super attached to you, because clients can get prickly or distant, or they don’t express their attachment.
They kind of hold it close to the chest.
Even when it’s not obvious, underestimating this is a serious error.
You will disappoint clients.
You will have to say no.
You will have to refer people out at some point.
These moments require gravity and respect for the client’s vulnerability.
So if you can keep in mind that your client is really attached to you, even if they’re not showing it, when you have to do those things, you’ll do it in a way that has the appropriate care and softness.
Number six.
Maintain excellent session boundaries with calculated exceptions.
Start on time.
End on time.
Respond reliably.
Stay client-centered.
Use standing appointments.
This is the basic psychodynamic container.
This isn’t just administrative fluff.
This is there to contain unconscious material.
When we start on time and end on time, and we do that every single time, our clients know that their therapist isn’t going to make them late, that they’re going to get their full session time.
When we respond reliably within 24 to 48 hours, the client knows that they can reach out and the therapist will respond, and they’re not going to have to wait long periods of time before they hear back.
This isn’t about responding to client crises.
This is about responding, period—having a rhythm they can expect.
Crises obviously need to be escalated to higher levels of care.
Clearly, I’m talking to people in private practice right here.
Staying client-centered—especially in long-term work—it can be tempting to get a little more casual with clients.
It’s okay to do that a little bit, but that needs strong guardrails.
After maybe a short exchange that’s more personal, we need to jump right back into the therapy.
No more than maybe five to ten minutes of any session should have a casual or rapport-building feel, unless you and the client have agreed to a lighter session and the clinical rationale for that is known.
And lastly, using standard standing appointments.
This is behavioral—it’s like operant conditioning.
When the client’s nervous system expects to come at 2 p.m. on Tuesdays, there’s a process that happens every week where the brain’s predictive systems help them process what happened in the last session and prepare for the next.
That’s why standing appointments are important—outside of the fact that constant scheduling labor is exhausting.
I’ve noticed that some therapists resist this structure at first and want to be creative with it, but eventually most notice that the structure deepens and contains the work.
At least that’s what I’ve seen with my supervisees.
Some clients do need more flexibility.
But when we offer flexibility—start times, session length, irregular scheduling—it still needs to be regular, expected, and agreed upon.
Number seven.
Be impeccably clear in logistical communication.
Your administrative communication should be so tight that the client barely notices it.
Unless they have executive functioning issues and hate paperwork.
Prompt, clear emails.
Immediate scheduling changes.
Explicit policies.
Fees that you maintain.
No ambiguity in the administrative realm.
This stabilizes the relational field more than most therapists realize.
Number eight.
Work toward relational directness.
Notice where you feel confused, afraid, or avoidant about naming relational dynamics.
Assess the client’s tolerance for directness and attune to it.
Help expand that tolerance over time.
Don’t mistake your anxiety about directness for theirs.
This one is hard.
You’ll have to face your fears and stop avoiding what you want to avoid.
Number nine.
Ask for direct feedback regularly.
Especially early in therapy, and whenever you sense misalignment.
Ask how clients experience you and the work.
Ask what they want from the session.
Update treatment plans regularly.
If clients say “I don’t know,” slow down and help them sense internally rather than pushing forward.
You need to do number eight in order to tolerate number nine.
Number ten.
Cultivate your ability to stay present through deliberate contemplative practice.
Presence isn’t a personality trait.
It’s a practice.
Some therapists need to lean in.
Others need to lean back.
Pause.
Breathe.
Notice when you’re planning instead of listening.
Stay connected to your own body.
Check your spine.
Shift your seat.
Take a sip of water.
Check your body state before sessions.
If you’re going to be 60 seconds late because you need to go to the bathroom, go to the bathroom.
Don’t give yourself a UTI.
Bring the same quality of attention to emails and calls as you do to sessions.
Presence is an ongoing calibration of center in the here and now.
So back to my story.
I’m still finding my edges.
Just last month, I felt a rupture with a client, and it took me three sessions to name it directly.
When I finally said, “I’m noticing some distance from you—am I making that up?” they said, “Oh, thank God you said that. I thought it was just me.”
That confirmed I was picking something up accurately, and we were able to repair intentionally.
All of this is to say: tools matter.
I’ll keep learning them.
I’ll keep talking about them.
But the therapeutic relationship is the container that makes tools work.
You can have every certification and know every protocol, but if the relational foundation isn’t there, the work won’t land.
This isn’t about being perfect.
It’s about being willing to work on this continuously.
Most therapists collect tools when they should be developing relational capacity, because this work requires examining yourself, not just learning content.
The relationship creates the conditions for change.
Everything else is downstream from this.
For therapists: if clients aren’t progressing, check the relationship before adding another modality.
For clients: you’re not therapy-resistant.
You may just need a different relational fit.
Look for a therapist who can talk directly about the relationship and work through it—alongside having the expertise you need.
This is the work.
It’s the most important part, and it’s the most challenging.
Thanks for joining me today.
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Bye for now.
