Dear Therapist:

I was advised to see a therapist for our son for a certain issue. When getting the referral we were told that a specific therapist is a mumcheh in this area. The issue is that he lives in our neighborhood and davens in our shul. We don’t really have anything to do with him personally but my son is very uncomfortable with the idea that he would bump into him. Our question is if you think this is a concern? I am sure in the frum world this comes up. How do therapists deal with such a type of situation? Is there anything you could advise we tell our son to reassure him?



You didn’t mention the specific issue with which your son is dealing. I also don’t know other details, like his age, maturity level, and level of awareness with regard to the issue. These details could make a difference in terms of my response.

Generally speaking, the most significant factor leading to successful treatment is the therapeutic relationship. This has been shown in multiple studies and meta-studies, and is true for a variety of reasons. Buy-in and motivation, as well as placebo effects are likely primary reasons that the therapeutic relationship is so important, and why it—in and of itself—is so effective a treatment component.

Psychotherapy is different from other forms of therapy (physical, occupational, speech, etc.), and from the field of medicine. The doctor-patient relationship is often a factor in successful treatment (one could argue that it always is). Within psychotherapy, this factor is usually greatly magnified. It bears repeating that the therapeutic relationship has been shown to be the most significant indicator of successful treatment (more so than specific treatment style, for instance).

The efficacy of the therapeutic relationship has been established across the board, regardless of the particular therapeutic modality. This should guide us to choose therapists with whom we mesh, and with whom we feel comfortable. When we have a sense that the therapist is warm, understanding, empathic, genuine, and supportive, this can go a long way toward development of a strong therapeutic relationship. This is largely dependent on us, however. Although therapists can do their part to exhibit these qualities, the relationship is ultimately a function of the client’s perception.

Naturally, a prerequisite to a positive therapeutic relationship is the sense of being comfortable with the therapist. If your son goes into the first session with a preconceived level of discomfort, he is more likely to be resistant (consciously or otherwise) to developing a strong alliance. This can greatly reduce the effectiveness of the therapy.

The degree to which the therapeutic relationship affects treatment outcome may vary to some degree depending on the specific issue being addressed. Also, the availability of therapists who treat relatively obscure conditions may be limited. Of course there are considerations other than the therapeutic relationship. However, without a strong relationship, the likelihood of successful treatment is probably greatly diminished.


-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer / 516-218-4200


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