Unspoken Rules in Psychotherapy

Medical Reviewer

Our daily lives are underpinned by countless unspoken rules that allow us, and others, to feel comfortable and unthreatened. You know the sort of thing:

  • Stand patiently in line
  • Don’t talk over or interrupt people
  • Don’t keep people waiting
  • Wait your turn
  • Don’t stand too close
  • Cover your mouth when coughing

Our familiarity with these conventions keeps things ticking over and we generally only become nervous when we enter unfamiliar situations. Visiting different countries is a prime example. In Japan, for example, it’s deemed rude to blow your nose in public whereas noisy slurping of noodles or soup is sign of appreciation.

So what, if any, are the unspoken rules that follow us into psychotherapy? To begin with there are different types of psychotherapy that may be undertaken in quite different settings. These range from highly professional offices with walls covered in impressive degrees and professional diplomas through to a comfortable room set aside in an ordinary house. Some therapists wear business suits and sit behind desks while others prefer less formal settings and dress codes.

But for now, let's think of our therapist simply as a talk-therapist. You’ve signed the consent form, you’ve arrived on time and you’re in the room with your therapist. Here are a few questions from an imaginary client:

  • Can I smoke?
  • Is it alright to swear?
  • Should I always tell the truth?
  • What will the therapist think of me?
  • What might they find offensive?
  • Should I tip or give gifts?

Even though you may be paying the bills there is often a view that the therapist knows best. It’s not a relationship of equals because you, the client, feel vulnerable and are seeking direction and advice. It’s not uncommon for clients to simply drop out because they don’t feel they are making progress or they feel unable to confront issues with the therapist for fear of causing upset. A colleague of mine mentioned a client who did just that because he felt the therapist had more issues than him. The client described the therapist as “in need of a good meal, nervous as hell, and smoked liked a train.”

More typically the therapeutic relationship is based on authenticity rather than weirdness or superiority. For therapy to work there have to be limits and boundaries but the therapist tends to take his or her lead from the client. It’s highly unlikely that a therapist will take offense over a few swear words. They may not swear themselves or they may use your form of words in order to ask questions or move things forward. For example, you might say, “My boss is a complete ____” to which the therapist might reply, “You said a moment ago that your boss is a complete ____. Why is that?”

Your therapy is all about you. In that respect it’s probably a tricky concept to get your head around because so much of your life may be about others. You will find your therapist talks less than you, but it’s not judgmental. Nor are they bored. More likely they are adopting a neutral stance, which allows you to shape the direction of the discussion. It reduces the risk of the therapist closing off avenues that you might want to address.

Really, the best way of approaching assumed, unspoken rules with a therapist is to bring them out into the open. Ask if you can smoke. Tell the therapist of the concerns that make you anxious or uneasy. We all wear masks in our everyday lives and therapy should be one place where you are able to let the mask slip without fear of judgment. As a person who uses therapy you should know that it works best when we’re allowed to be ourselves. If you spend your time editing words and expressions for fear of causing offence or sounding stupid it doesn’t help you or the therapist. If there is one rule you really should try to remember it’s this: when in doubt, spit it out.

See more helpful articles:

How to Select a Therapist

How to Know When You Have a Bad Therapist

When and Why to Call ‘Time’ on Therapy