By:Nando Pelusi Ph.D.
Q: I’ve been seeing a therapist for the last five months. We’ve been working through my issues but I don’t feel the sessions and insight are productive. When and how can I tell that I have a bad therapist-patient relationship?
A: Your gut can tell you, better than anyone, whether someone is helping you. What stops you from trusting your gut? Perhaps you believe you must be totally sure about the situation—a need for certainty that just sets you up for constant questioning. Or perhaps you’re telling yourself you need your therapist’s love, and thus disconnecting from your own intuition. Clients know a lot about themselves, and it is up to the professional to respect this fact. You do not need to seek the approval of your therapist to terminate therapy.
Five months is more than enough time to figure out whether your therapist is a good fit. Good therapeutic results are often seen after about a dozen sessions, and greater results still after two dozen.
That said there are a few criteria for you to consider. Your goals probably include feeling better—but that is accomplished by truly getting better and thinking better—seeing more options and feeling understood by your therapist.
A sense that your therapist understands you is a prerequisite for improvement. You want a therapist who intuits your feelings and thoughts, one who demonstrates his or hers by using specific examples, such as proposing what you might be telling yourself to get upset. Such a therapist functions as a collaborator in your life, a person with whom you can assess your ideas, feelings, and goals. More important, a good therapist helps you learn to make these assessments on your own. You can become a better therapist to yourself—if you have a method, a theory of self, and you feel confident in your ability, you are growing and getting better.
Clients who like their therapists, and in turn, are liked by their therapists, tend to improve more quickly than those who do not have a so-called “therapeutic alliance.” If you identify with someone, feel understood, and have help processing your experiences, you will take the behavioral steps that can improve your life.
Does your therapist help you to get better, or merely to feel relieved for the hour? It’s easy to feel good by getting distracted. On the other hand, getting better means that you are increasing your general confidence, your openness to new experiences and people, and that you have overcome your disturbances, such as anxiety and depression, to a noticeable degree.
If you are upset about your relationship with your boyfriend, you can feel better temporarily by cataloguing his deficiencies and having your therapist sympathetically agree that yes, that man is in the wrong. However, you get better by accepting that your boyfriend is imperfect, refusing to despair about being with him, and creating productive platforms such as giving the relationship a timeline for growth.
Research into various types of therapy (psychoanalysis, psychodynamic, cognitive-behavioral therapy, etc.) has found that it may not be the approach itself but the relationship you have with the therapist that most accounts for improvement. The cognitive behavioral approach, for example, has much to recommend it, but it can be executed poorly, too rigidly, or not rigorously enough.
Sometimes the fit is just not there. Like any relationship, you know when it clicks, and if you look deep down, you also know when it does not.
warm_snow: hi, 何学卿.谢谢你这么细心，把原文都对照过一遍。我翻译得...
leejr: 说得很好，但也不要绝对吧！
假如你在做深层分析时，遇到了不...
warm snow: hi, 何学卿.谢谢你这么细心，把原文都对照过一遍。我翻译得...
何学卿: 不过有些地方似乎和作者原意不符，一起讨论下？
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黄金闪光:2007-08-19 14:10 PM
让来访者体验
“登天的感觉”
Guest:2007-08-19 14:14 PM
这个….更象在描述一个”心理老师”啊.
monochrome:2007-08-19 17:46 PM
啊…..的确,是要让咨询者变成自己的心理医生…
说得很好，但也不要绝对吧！
假如你在做深层分析时，遇到了不可避免的对抗，那时的来访者对咨询师的感觉应该很坏，要是他接受不了，推门而走，是他错还是咨询师不好呢？
我个人对心理学的看法是一个多维度的，任何一维的角度都是片面的，这是复杂的人性决定的。
warm snow:2007-08-20 0:47 AM
所以说判断的标准是十个session以后，20个session以后效果如何啊。
不过好的心理医生永远都要考虑到咨询者的承受能力和认识能力。找到适合咨询者的方式，是心理医生的责任。搞到走人的程度上，只能说明这个心理医生的水平有限。
何学卿:2007-08-20 11:05 AM
谢谢warm snow翻译过来和大家分享
何学卿:2007-08-20 11:40 AM
不过有些地方似乎和作者原意不符，一起讨论下？
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1、Your goals probably include feeling better—but that is accomplished by truly getting better （and） thinking better—seeing more options and feeling understood by your therapist.
【Warm Snow】你看心理医生的目的，应该包括让自己心里好受一些。要记住，这个好受，一定得是确实感觉到更好受了，（而不是）更想得开了。应该是你确实觉得生活的选择多起来了，觉得你的心理医生真的能理解你。
【comment】“觉得好受”和“想开了”是一起的。试译：你看心理医生或许包括想好受点，但这是随着真的好起来和想开了才有的。因为你发现生活中更多的选择，……
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2、a prerequisite for improvement
【Warm Snow】一切改观的基础
【comment】prerequisite是前提（必要条件），和基础（充分条件）不同。
【Longman DCE】prerequisite——something that is necessary before something else can happen or be done。
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3、You want a therapist who intuits your feelings and thoughts, one who demonstrates his or hers by using specific examples, such as proposing what you might be telling yourself to get upset.
【Warm Snow】你需要一个能感觉到你的感受和想法，能以事实证明他可以帮助你的心理医生。比如，他具体分析你的内心活动，要能分析的准确无误才行。
【comment】总感觉意思不太对。试译：你需要的治疗师不仅要能洞察你的感受和想法，而且要表现出来，比如找出你心里面可能让自己特别难受的那些想法。
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4、therapeutic alliance
【Warm Snow】医患关系
【comment】现成的专业术语有“治疗同盟”，强调治疗师和咨客的共同合作、努力。医患关系是中性名词，没有这个意思。
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5、you will take the behavioral steps that can improve your life.
【Warm Snow】你会发现有了行动起来改善生活的可能
【comment】作者的意思貌似比“可能”还更进一步，“你就会行动起来改善自己的生活”。
不过有些地方似乎和作者原意不符，一起讨论下？
=======
1、Your goals probably include feeling better—but that is accomplished by truly getting better （and） thinking better—seeing more options and feeling understood by your therapist.
【Warm Snow】你看心理医生的目的，应该包括让自己心里好受一些。要记住，这个好受，一定得是确实感觉到更好受了，（而不是）更想得开了。应该是你确实觉得生活的选择多起来了，觉得你的心理医生真的能理解你。
【comment】“觉得好受”和“想开了”是一起的。试译：你看心理医生或许包括想好受点，但这是随着真的好起来和想开了才有的。因为你发现生活中更多的选择，……
何学卿:2007-08-20 13:03 PM
=======
2、a prerequisite for improvement
【Warm Snow】一切改观的基础
【comment】prerequisite是前提（必要条件），和基础（充分条件）不同。
【Longman DCE】prerequisite——something that is necessary before something else can happen or be done。
=======
..:2007-08-21 12:31 PM
都是一群外语高手
hi, 何学卿.谢谢你这么细心，把原文都对照过一遍。我翻译得太粗疏了。反馈如下：
1.更正：“你看心理医生的目的，应该包括让自己心里好受一些。要记住，这个好受，一定得是不光感觉上更好受了，而且看问题也更客观更积极了”。
（你提示得非常对，我看文章的把内容套进我正在想的别的东西离去了。 think better没法直译，参照认知—行为疗法对think better的看法，翻译成客观积极地看问题。）
2.基础不等于充分条件， 参看：http://www.zdic.net/cd/ci/11/ZdicE5Zdic9FZdicBA295101.htm 或http://dictionary.reference.com/search?db=dictionary&q=basis
但前提是直译，确实比基础更准确。
3.拆成两句翻译，为的是强调demonstrate。因为用英语说demonstrate…by…such as proposing…听的和说的都知道这是一个整句，分词和例子的应用不会产生割裂证据的效果。但按照这个结构翻译成汉语的话，demonstrate和proposing之间的逻辑关系在语感当中就减弱了。而demonstrate才使这句话的重心。因此牺牲掉句法结构上的对应，以意译来强调demonstrate。另外“表现”或“表现出来”不足以表达demonstrate当中“证明且能取信于对方”的意思。
4. “治疗同盟”确实是现成的词。I wouldn’t say it’s a bad translation, 但therapeutic alliance可以让非专业人士一读就明白是什么意思，“治疗同盟”则不行。既然是“科普”文章不是专业期刊，所以用加了引号的“医患关系”，而不用这个现成的词汇。另外therapeutic alliance在这里翻译成“良好的‘医患关系’”，而不是“医患关系”。
5.这个提醒得也很好。更正为：你会真的着手去改善自己的生活。这里要加上一个“真的”是因为否则不能表达“take behavioural step to”在语气上的加重。
谢谢你啦。
也麻烦 Psytopic帮忙更正以下三处：
1.你看心理医生的目的，应该包括让自己心里好受一些。要记住，这个好受，一定得是不光感觉上更好受了，而且看问题也更客观更积极了.
2.你的心理医生能理解你，这是一切改观的前提。
3.当你觉得找对了人，能被理解，能在其帮助下更好的理解自己的经历，你会真的着手去改善自己的生活。
另外还有就是：
4.还是只能让你在咨询的拿一个小时里面感觉好一点？
应该是“那一个小时”，不是“拿”。非常抱歉。。。。当时没好好检查。
hi, 何学卿.谢谢你这么细心，把原文都对照过一遍。我翻译得太粗疏了。反馈如下：
1.更正：“你看心理医生的目的，应该包括让自己心里好受一些。要记住，这个好受，一定得是不光感觉上更好受了，而且看问题也更客观更积极了”。
（你提示得非常对，我看文章的把内容套进我正在想的别的东西离去了。 think better没法直译，参照认知—行为疗法对think better的看法，翻译成客观积极地看问题。）
warm snow:2007-08-21 18:52 PM
贴不上评论，好郁闷啊。刚才发了好几遍了，也不知道会不会明天突然都跳出来，不知道的还以为我刷屏呢。
其他几点我只好先贴自己博客了，你去那边看好吗？实在是不知道什么时候能把其他的都贴在这里。时间有限，我只好先放弃了。
warmsnow:2007-08-21 23:40 PM
psytopic对不起，折腾你们了。
整个文章的更新在这里：http://warmsnow.blog.edu.cn/user4/warm_snow/archives/2007/counselor.shtml
leejr:2007-08-22 23:01 PM
说得很对，辛苦warmsnow，希望你不要介意我上面说过的话！
warmsnow:2007-08-28 4:36 AM
怎么会介意。
xcmqpsazg xcryn:2007-08-31 6:29 AM
byli xwpzqv zkdh kpzo wmtzounsi lwdaymb skzmj
Guest:2007-09-03 11:29 AM
1323
1321633:2007-09-03 15:09 PM
151851181
despresion:2007-09-16 15:30 PM
我是外行 希望找个心理好朋友 QQ517663866
dodo:2008-01-22 16:05 PM
呵呵，遇到过性骚扰的心理医生
大叔:2008-03-13 14:38 PM
找你们的说法真的是日子没法过了。。。
只要我自己觉得开心就好，没什么不可以！
我来说两句