What is Therapeutic Fit and Why Does it Matter?
Published on
February 19, 2023

What is Therapeutic Fit and Why Does it Matter?

On this episode, Tyson sits down with Dr. Jessica Kim to discuss the idea of finding a good therapeutic fit, what that means, and why it matters.
Hosted by 
Tyson Conner, MA

Tyson Conner  00:00
Today, I'm talking to Dr. Jessica Kim. She is a postdoc here at Relational Psych, one of my co workers.  And she works primarily with adults and teens and focuses on trauma. And today, we are going to be answering the question, How do I know my therapist is a right fit for me?

Jessica Kim  00:26
Okay, hi, everyone.

Tyson Conner  00:27
Welcome, Dr. Kim.

Jessica Kim  00:28
Thank you. Hi, Tyson. It's good to see you here. I'm very excited to be here. And like Tyson said, my name is Dr. Jessica Kim. And we'll be talking about a very important topic today.

Tyson Conner  00:39
Yeah. So a lot of our listeners could be at all sorts of stages, people listening to this podcast, they could be, they could have never gone to therapy before at all, they might have started working with a therapist, and just not sure if it's clicking. So just like 50,000 feet view?  Like, who who will this conversation be for?  What are we going to touch on?

Jessica Kim  01:05
Yeah, no, that's a really good place to start. Like you said, there are so many starting points. But what I'm going to be focusing on is; you already had your consultation call, if that was the thing, you looked over your preferences in terms of price range, if there's any cultural identifying factors that you prefer for therapists, we looked into that.  And then we are actually about to go into the therapist's office, first session, second session. And or maybe even after the first session, you're like, how do I know this therapist, if I should continue? If this is a good fit? So that's where we're at.

Tyson Conner  01:44
So this conversation isn't so much for people to figure out how to get into the office, but more for people to figure out is this the right office for me to be in?

Jessica Kim  01:52
Yes, exactly. Yeah, you already booked your first appointment. Maybe you already saw your therapist once. So beginning stages is where we're at.

Tyson Conner  02:00
Gotcha. So I guess the first question that comes to my mind is why does this matter?

Jessica Kim  02:08
Yeah, no, I think so. First of all, I don't want to sound too, like nerdy or whatnot. But I do want to get into the research, because I think consistently over the 50-70 years, I think what we find in research is that the quality of the relationship between the therapist and the client is the most significant factor, and what contributes to treatment outcomes. So it's not modality, it's not approach, but that's how important the therapeutic relationship is. And the perception that especially the client has about the relationship actually contributes to treatment success as well. And that's why for that, alone, it is very important.

Tyson Conner  02:52
So treatment outcomes and treatment success. What are those? What are those things mean?

Jessica Kim  02:59
Yeah, so basically, that means I mean, this can go so many directions as well. But I would say treatment outcomes can be what you are coming in with, like goals, it could be symptom reduction, it can be processing trauma, working on interpersonal relationships, so it can be these goals. And I think there's a lot that you gain from therapy, besides your goals, whether it's yeah, things that you maybe weren't expecting, but you gain those things, such as insight, or maybe you're just coming in wanting to have a quick fix with your symptoms, but you grow in insight, you got to learn about yourself and your relationships. And so I think, all of that, so maybe just the positive growing experience.

Tyson Conner  03:47
Gotcha. Okay. And the research that you said has been going like research going back 70 years even?

Jessica Kim  03:55
I think so yeah.

Tyson Conner  03:56
Shows that what matters most isn't the way a therapist practices or how much experience they have or their degree.

Jessica Kim  04:06
Yeah.

Tyson Conner  04:06
But, specifically how the client feels about the relationship, the client's perception.

Jessica Kim  04:12
Yeah. Yeah.

Tyson Conner  04:14
Why? Why does that? Why is that the thing that matters?

Jessica Kim  04:18
I mean, aside from the research, um, I think this is kind of how I value what therapy is or how I approach therapy. And I think, I mean, our practice is called Relational Psych, because I think all of us and I really do believe that the relationship between the client and the therapist is at the core, and a personal belief, when it comes to therapy for myself is that growth and change happens through a relationship. You know, we're all relational beings from the minute the second that we're born, are born from a relationship and we enter into a relationship. And I think, unfortunately, there's wounds and hurts, and pain that comes from relationship, a lot of our clients come for those reasons. And just as it's what the relationship, if it caused the wound, I also believe that a relationship is what can restore and heal. Yeah, and so I think because of that, I do believe the relationship is important. And there is, there has been like a greater shift, I think even in, in psychology.

Tyson Conner  05:31
Yeah.

Jessica Kim  05:32
I feel like I'm just pop psychology, if you think about like, the client is like lying on the couch or not even looking at the therapist. And sometimes the therapist just has a very stoic face, and they're just answering questions. I think we're moving away from that. And now we are hoping to be more collaborative. Yeah. Hoping to be more engaging and to connect, because I think there is something there. Obviously, research says it, and I think, yeah.

Tyson Conner  06:04
So like modern therapeutic relationships are more, more active, more alive, more warm.

Jessica Kim  06:11
I would say so!

Tyson Conner  06:12
Maybe warms the wrong word, but.

Jessica Kim  06:14
I think warm, hopefully, not always, but yeah. For the most part, yes. And, yeah, I think ultimately, it is two people coming into, two humans coming into the room, and I think from the relationship with your therapist, you can learn about your own relationships outside of therapy. And the goal is as we are I mean, therapy isn't just going to be about your relationship with you and your therapist, obviously. But like, there's a lot that you can learn. And the goal is that as you work out different relational dynamics with your therapist, we can have these healthy relationships outside of therapy, too. And so, yeah.

Tyson Conner  06:57
So with that in mind, what are the things that somebody who's a client should keep in mind when they're asking this question? Is this the right therapist for me?

Jessica Kim  07:08
Yeah, definitely, I do want to say that a lot of the things that I will be talking about, it's a felt experience. So sometimes it's hard to put words into it, because it's something that you kind of feel, it's an internal process.  And so I would just say, just in general, when you're walking into the therapy room, I know you might be feeling anxious, uncomfortable, all of those things, but be aware of that. That you're going to be feeling things in the room. And it's important to trust your gut. For those reasons as in, I mean, I can be seeing the most famous best therapist in the world, and we might just not be a good fit. And that's okay. Like, just because a therapist was great for your friend of a friend doesn't mean that that therapist is for you. And that's okay.

Tyson Conner  08:05
Yeah, I'm hearing two things there. One is that, like, if you came to this podcast, hoping for a checklist, you're probably not gonna get it.

Jessica Kim  08:14
Right, yes.

Tyson Conner  08:15
That there isn't an objective standard of like, if your therapist is like this, or this or this, then good. And if they're like that, and that, then bad.  That it really is about trusting your gut. And that we want to give our listeners permission to trust their gut. And also to like this idea of fit, right? That like fit in psychotherapy, is the idea that different people have different personalities, and they show up in different ways.

Jessica Kim  08:44
Exactly.

Tyson Conner  08:45
And sometimes, the way that a therapist shows up isn't good for a particular client. It might be great for other people, but just the way you show up nothing, no judgment on the way a person practices, or how they practice or their skills, just how they show up could be different. And like, that's okay, if you don't click.

Jessica Kim  09:10
Exactly, yeah, kind of just going back to the checklist. Sometimes that feels so much easier, but I think there is something special about the fact that we can't box a relationship, we can't have a check, because it's a relationship, right, be more complex, and it's two people coming together. And so as much as we can have checklists for certain things, I also feel like there's so much freedom. Also, there's more choices, but I think in that case, you can really find someone that really feels like you have a good fit with.

Tyson Conner  09:44
Are there some common pitfalls that you notice people fall into that they like, some reason or other where they don't trust their gut? Maybe the fit is bad, but they're like, well, but we should because.

Jessica Kim  09:55
Of course

Tyson Conner  09:56
Yeah

Jessica Kim  09:56
Yeah, I think there is like, I think some clients feel like there's an obligation or they feel bad. Yeah, they feel bad to reach at some point, your therapist, and even thinking that this person is a professional, so maybe I should just trust the professional like, what do I know? Right? But the thing is you do know like, that is why you're coming in and therapy is for you. And as much as I think as a therapist, you're meeting your clients where they're at, and the client also you don't have to mold to your therapist, if anything, and so, and if it's not going to work for you, I have clients that maybe stayed with therapists that weren't really a good fit for various reasons, or just feeling bad or thinking, "oh, I need to stick it out."  And sooner or later, they're like, that actually wasn't helpful or effective. And so, yeah.

Tyson Conner  11:00
Yeah, yeah. So again, we're coming back to this theme of telling people trust your gut.

Jessica Kim  11:07
Yeah, it's okay.

Tyson Conner  11:08
Yeah.

Jessica Kim  11:09
And research also says that of course, give it time, of course, it takes time for a relationship to form. Don't expect the first session to be like, okay, we're, like best friends, or, you know, like, we're like, super close or whatnot. Which is, yeah, we'll get into that. But like, after one or two sessions, like you should kind of know, have a hunch at least. I don't know if I can say this, but I think as therapists, we also have a hunch of like, after the first session, we have a general feeling of like, "Oh, this is gonna be a good fit." And usually you feel it both ways. Yeah.

Tyson Conner  11:50
Yeah, I'd say that's true. And sometimes there's a misalignment in that I've had session, first sessions where I felt like, "Okay, yeah, this is gonna be a good fit." And then, you know, the client calls and cancels because, because they didn't feel that way. And, like, there's disagreement in the field about how to how to think about that. But my, one of my kind of assumptions is that my client is the expert about what's best for them.

Jessica Kim  12:18
Exactly.

Tyson Conner  12:18
Right. And especially in early days, like, if there's something where they're feeling like, "I don't think I could feel comfortable with Tyson."  "I don't think I could feel safe with Dr. Kim." Like, then like, yeah, don't like force it.

Jessica Kim  12:33
Yeah.

Tyson Conner  12:34
And there's, there's a balance to it. Right?

Jessica Kim  12:36
Yeah.

Tyson Conner  12:37
Speak to that.

Jessica Kim  12:39
The balance to it is that I mean, don't be super, super picky. As in yeah, therapists are human, we're going to make mistakes, right?  And so there is that, but I am really hoping that even if your therapist isn't perfect, or they can't be an expert on everything, or read your mind, that you get a sense that the therapist is willing to learn, is curious, wants to know more. Right? And that if they do make any mistakes, that they're humble, that they're honest, that they're able to admit to it. I think those are things that yeah, are actually very important.

Tyson Conner  13:21
Yeah, yeah. Because all relationships take work.

Jessica Kim  13:25
Yeah.

Tyson Conner  13:26
Even with a therapist.

Jessica Kim  13:27
Exactly.

Tyson Conner  13:28
But it shouldn't feel like pulling teeth.

Jessica Kim  13:30
No, no. Yeah. And I guess, like, as we're talking about work, um, I think sometimes a misconception can be that, if I find a really good therapist, that means that there's going to be a lot more progress. Yes, and no, because you actually do have to put in the work too so it doesn't mean that just because you find a really good therapist, it could be I, you guys could have the best amazing fit. But at the same time, you do have to do your work but pick someone that you want to do the work with. Yeah.

Tyson Conner  14:05
And ideally, someone who, like helps you to identify or make some sense of the work you need to do. Right?

Jessica Kim  14:13
Exactly, yeah.

Tyson Conner  14:15
You don't want your therapist to just like sit there silently, while you, you know, struggle with free associating or whatever. But you also don't necessarily want somebody who, you know, you're going to show up and, and they just, like, immediately gives you a list of tasks to to accomplish.

Jessica Kim  14:34
Yeah.

Tyson Conner  14:34
Right. There's, there's a, there's a space in between. And it sounds like maybe this is a theme that we're coming to today that like, there aren't hard and fast rules. But there is like a lot of spaces to negotiate. Room to like, check in with yourself.

Jessica Kim  14:50
Exactly.

Tyson Conner  14:51
Check in with your therapist.

Jessica Kim  14:52
Yeah.

Tyson Conner  14:53
And like try to figure out is this working? Do we think this is going to work?

Jessica Kim  14:57
Yeah. And so as you're saying that, I think like three things kind of come into mind, like the hard and fast rules. Once again, everyone is going to have their own personal preference, right? But just in general, the three that I hear the most from clients, the most, yeah, and so I think the first one is, I think we've also kind of touched upon this, like safety. As in like, do I feel safe with this therapist? Like, is the therapist listening to me? Do I feel validated? Do I feel comfortable? Or like, am I easing into that? Do I feel like I can share? Is my therapist not a robot, or like, just smile, like, you know, just looking at me as just a person that I am getting to meet too. And so, do they feel genuine. And so I think those are all maybe some indicators of like, maybe this person is a safe person.

Tyson Conner  15:52
Right? And I think with that safety idea, sometimes it's not, "do I feel safe now?" But, "do I feel like I could feel safe with this person", especially if you have a trauma history, or complex PTSD or like, or just a background of like abandonment or neglect, like, sometimes it's okay to not fully trust therapists from day one.

Jessica Kim  16:16
Yes.

Tyson Conner  16:17
And it's important to feel like you could.

Jessica Kim  16:20
Exactly, like a sense of I think I can trust this therapist, or I think it is like a sensing or the potential, you see it. Yeah. So for example, like my job as a therapist, and what I'm hoping for when I go into the first session, is that I am trying to create a safe environment for my clients. I want my clients to feel safe. Like I said, I don't want them to trust me immediately. But at least like that they feel heard, that they felt understood. So I think I, like that's my job, it's not your job to feel safe, but something about my presence, or the room or whatnot, should make you feel at least a little bit safer than you did. And also, I think it's also for that reason too, I think I do try to show up as myself, so that you can also show up as yourself.

Tyson Conner  17:18
Right?

Jessica Kim  17:18
Yeah.

Tyson Conner  17:19
It sounds like a lot of, a lot of your theory of like, what makes a good beginning involves you, as a therapist, trying to be really genuine and really honest, and like truly to show up as who you are not to be play acting the role of a therapist, you're still being a therapist. You're not going to talk about, you know, your, the movie you saw last night or whatever. But you're also trying to be yourself.

Jessica Kim  17:44
Yeah.

Tyson Conner  17:45
And it sounds like what you're encouraging our listeners to do is to check and see like, do you feel like your therapist is showing up as themself, because you feel like they're showing up as somebody else? That might be a little bit harder to build safety.

Jessica Kim  17:58
I will say so. Yeah, I think trust happens when you feel like the person is who they are, that they're genuine. They're who they say that they are, or whatnot. And so if like the therapist is not coming in as themselves, I think sometimes there could be more difficulties attaching, I feel like.

Tyson Conner  18:19
That makes a lot of sense to me.

Jessica Kim  18:20
Yeah.

Tyson Conner  18:20
We'll see if the listeners agree. Sound off in the comments. I don't think they're gonna do that. What would you recommend that somebody do if they don't feel safe with their therapist?

Jessica Kim  18:36
Yeah, I am saying this also knowing that it's not the easiest to bring things up to your therapist.

Tyson Conner  18:47
For sure.

Jessica Kim  18:47
There is power differentials, and it feels like, you know, they're the experts. So therefore, like, you know, you feel like you can't say anything. But I think at this time, I really do want to empower our listeners that like, if you don't feel safe, I mean, it's completely up to you, if you don't feel safe at all, you don't have to return. But if there is something and you feel like you want to say something, I think you can. As a therapist, like I love it when clients bring up some of these things, and we can talk about it, I'm gonna have a conversation about it.  It can actually lead to a lot of actually core things. But once again, I know upon the first, second meeting with a stranger, it might be hard to bring up these things.

Tyson Conner  19:31
Sure.

Jessica Kim  19:31
But it can be it can be rich. But once again, I know the difficulty of doing that.

Tyson Conner  19:38
Yeah, so it sounds like the advice is, if you feel safe enough to speak to your feeling of unsafety, great, go for it, good stuff might happen. And if you don't feel safe enough to talk about it, there is no, no shame or anything morally wrong with ghosting a therapist.

Jessica Kim  19:59
There isn't. I think after the first session, I mean, it'd be nice for us sure to get something like, oh, I don't think this is gonna work out or something. But.

Tyson Conner  20:08
We appreciate the feedback. It helps us get better.

Jessica Kim  20:10
Yes, yes. Yeah.

Tyson Conner  20:12
And it's not, it's not your job to take care of us.

Jessica Kim  20:15
No, it's not.

Tyson Conner  20:16
Ghost us. It's fine.

Jessica Kim  20:17
Ghost us, yes. I think that, you just said something. You don't have to take care of us. Yeah, I think if you are trying to be in the room so that you could be a good client. Or you could take care of us or, or whatnot. No, that is, that's not your job.

Tyson Conner  20:33
Yeah. And to a certain degree, I feel like that's pretty common when you get started, right? Like, people want to take care of people. Right? Even like, like, even with like little babies, like a toddler who's learning how to feed themselves, though, they'll often try to feed their parents too.

Jessica Kim  20:47
Yeah.

Tyson Conner  20:48
Right, it's human, it's what we do. And in therapy, it's okay to not need to like, to not worry about your therapist's well being.

Jessica Kim  21:00
Yeah.

Tyson Conner  21:01
Yeah, okay, so that's, that's question one. Do you feel safe? A safety?

Jessica Kim  21:05
Yeah, a safety.

Tyson Conner  21:06
What's the next?

Jessica Kim  21:07
The second one is? Do you like your therapist?

Tyson Conner  21:10
Just like as a person?

Jessica Kim  21:11
As a person.

Tyson Conner  21:12
Oh, yeah, yeah.

Jessica Kim  21:13
Yeah, like when a friend does ask you like, "how is your therapist?" I hope you can say something like, "Oh, I really liked my therapist." "My therapist is good", right. But I think you do have to like them as a human, as a person, you are trying to build a relationship with this person, you are in the room talking about very, it could be very difficult things. And so you have to like the person that you're sharing this with. Like, I think if you are sitting with someone that you really just don't like, and don't vibe with, it's going to be hard.

Tyson Conner  21:46
Yeah.

Jessica Kim  21:46
And so yeah, I hope you like your therapist.

Tyson Conner  21:49
Yeah, does that go the other way, too? Is it important to feel like your therapist likes you?

Jessica Kim  21:56
I would say so. Um, I would say so because I think as a therapist, or not therapists as a client, I think you would want to feel like your therapist likes you.

Tyson Conner  22:11
Yeah.

Jessica Kim  22:12
Yeah. I think if you thought that your therapist didn't like you and was judging you, I think it'll be harder to come to therapy. Yeah, so of course the stuff that you might talk about in therapy might not be pleasant, but I hope like, yes, it depends on the stages of therapy, but like in general, like, I hope that your relationship with your therapist is pleasant.

Tyson Conner  22:35
Yeah.

Jessica Kim  22:35
If that makes any sense. Yeah.

Tyson Conner  22:36
Yeah.

Jessica Kim  22:37
Yeah, yeah.

Tyson Conner  22:38
What's your recommendation, if someone feels like as a client, they don't really like their therapist, or they feel like their therapist doesn't really like them.

Jessica Kim  22:50
There could be so many answers to this. But if you don't like your therapist, once again, this is something that because it's so early on, I would say if there was more of a relationship, it might be a bit easier to bring some of these things up.

Tyson Conner  23:05
But it sounds like the advice is going to be the same kind of every time. Right? Which is, like, talk about it if you can, and if not, that's okay. You're allowed to walk away. Right? And like, so for example, at one point I was looking for a new therapist, and I did a consult call with someone on the phone, and they answered the phone and they had this accent, that was like a, it was like a, I don't even know.  It was very, very nasal, a lot of vocal fry. It was kind of almost like a stereotypical, like California Valley Girl almost accent.

Jessica Kim  23:40
I'm from California.

Tyson Conner  23:41
Oh, you don't have this accent though. And like, everything that she said, sounded great.

Jessica Kim  23:49
Yeah.

Tyson Conner  23:50
But I just like, the accent. Something about, I don't know if it's like some of my own neuro divergence, or what, but like, it was hard for me. And I knew that like, it's not great. Like, you should be able to listen to what a person has to say, regardless of their accent. And I knew that that would be a constant hurdle in our relationship, right? If she were my client, then like, I'd get over myself. I'd work through it, it'd be fine. But, as a client, the idea of her as a therapist, I was like, "You know what, I think, I think I'm gonna look, I'm gonna keep looking." Because as dumb as it is, like, my brain has a hard time listening to you right now. And I don't want to have to take care of you by fixing that inside of my own head.

Jessica Kim  24:39
Yeah, no, that's a really good example and plot twist, that therapist was me. Okay, we can't put that in.

Tyson Conner  24:54
No, it wasn't!

Jessica Kim  24:58
Yes.

Tyson Conner  24:59
You don't have a Valley girl accent.

Jessica Kim  25:02
I'm from California, I don't know. Maybe back in the day I did.

Tyson Conner  25:05
Maybe, maybe you did.

Jessica Kim  25:08
Good feedback Tyson.  I'm kidding.

Tyson Conner  25:10
Sure.

Jessica Kim  25:12
Yeah, so I think that was a great example. And if I can just speak to when you were talking about, like the therapist not liking you or feeling that way.

Tyson Conner  25:21
Yeah.

Jessica Kim  25:22
It could be something that's coming up for you, that I think would be, like, very once again, rich to talk about.  If it's something that is of yourself, or maybe like, it's being triggered.  We like to use the like, phrase like transference or what's happening in the room. But ,if you really, I don't know, like, this question kind of makes me a little bit sad, because I would hate to feel like my client thinks that, like, I don't like them.

Tyson Conner  25:56
Right.

Jessica Kim  25:56
Especially because we are trying to create such a safe environment. And for the most part, I think we enjoy this work so much and we enjoy our clients.  We value them. And so for them to think that, like, the therapist doesn't like them. That's actually kind of heartbreaking for me to hear. And so I don't know, I don't know if it's, if it's really the therapist, sometimes being in therapy can invoke so many of your own personal feelings. So don't know if it's that, but if it's really the therapist, I would say that therapist is a no. Yeah.

Tyson Conner  26:33
Yeah, and I want to, you brought up the word transference. And I think that's a useful one, and I think it's a good time to talk about it. That like the idea is, in therapy, with your therapist, transference is when you as a person have these experiences in your life historically, that have impacted how you experience the world. Right. So a great example of this would be if you as a little kid, got bit by a dog, right? You might be scared of dogs, the dog might be really friendly, and really nice, and the dog might be running towards you, because you look like a great person to throw a ball for and all they want is for you to throw a ball and then maybe like snuggle up against you. But if you see that dog running towards you, your previous experience tells you that that dog is coming to get me, right?  So transference is the idea that like, that same process internally happens with all of your relationships all the time. And with your therapist, it's such an intimate relationship. It's so deep, that sometimes some really deep old patterns that we took in without even realizing it, even as young as when we're like children, children can start to boil up and bubble up. And a lot of times, it comes out in how you experience your therapist.  You might experience your therapist as not liking you, because of something that's happening inside of you that you and your therapist could work with and figure out. And you might experience your therapist not liking you, because your therapist doesn't like you.

Jessica Kim  28:16
Right.

Tyson Conner  28:17
And the only way to find out, really, is to figure out how to talk about it.  And hopefully your therapist is maybe paying attention, maybe inviting you to speak about it a little bit more. Hopefully you feel safe to bring it up. But if you feel like your therapist doesn't like you, I feel like we're just going to ring this same bell, the whole,

Jessica Kim  28:38
I know.

Tyson Conner  28:39
Talk about it, talk about it, talk about it. And know that like, again, you always have the option to say, I think I'm done here. I left a therapist because he didn't like me. I worked with him for three years. I know, that was a long time.  I changed a lot in those three years, I was in grad school it was, everything was crazy. But towards the end, I realized, "You know what? I don't think this guy likes me. And I don't feel safe enough to talk about it with him." So I left.

Jessica Kim  29:07
Yeah.

Tyson Conner  29:08
And I think that was the right choice.

Jessica Kim  29:10
No, I think it was.

Tyson Conner  29:11
Yeah,

Jessica Kim  29:12
Yeah, going back to Tyson like, thank you for unpacking and describing transference so well.  As you were saying, when some of these wounds or it gets triggered, a lot of it happens within a relationship. And so it can happen with relationships with friends or even with partners. And sometimes we don't know what to do. We can have an, we can shut down, we can have an angry outburst, whatever that is. And the hope in therapy is that if that happens, that transference happens. I guess we were talking about caretaking. Maybe something about caretaking is really triggering for you. Maybe a caretaker did not take care of you well, and so when the therapist tries to take care of you, you might have a response. And maybe you have have those responses outside of therapy too. But maybe in that dynamic, you're like, "I don't know what's going on.I don't know how to talk about it or understand this." But when that comes up with your therapist, this is the place where you can talk about it, process it, and work it through with their therapist.

Tyson Conner  30:26
Right.

Jessica Kim  30:26
Yeah. And I think, I think that's something that we're really hoping for. And that's what you can do in a relationship with your therapist.

Tyson Conner  30:36
Yeah, there's this old saying, within psychoanalytic psychotherapy, which is the kind of psychotherapy we practice. There'll be another episode about that later, listeners, don't worry. But it's about transference and relevant to our conversation. It says without the positive transference, the therapy never starts. And I think that's kind of what this conversation is getting to, is that if you don't like your therapist, you feel like your therapist doesn't like you. That's another way of saying there's no positive transference.  The therapy won't get started. The second half of that saying is without the negative transference, that therapy never ends. So when we're saying like, sometimes you do need to work through conflict, sometimes you need to have those conflicts. The hope is, if you truly feel safe with your therapist, and if you have, at least in the past, felt like they liked you and you liked them. Then, when you have those feelings of dislike, or aggression, or disgust, or loneliness, or like you've been missed, or your therapist has hurt your feelings, or whatever, you can work through it, as the working through is what really, really helps.

Jessica Kim  31:46
Yes, it does. Yeah. And when you work through it with your therapist, our hope is that you can work through it outside of the therapy room, and that you can have these fulfilling relationships outside.

Tyson Conner  32:01
Because the ultimate goal is that therapy helps.

Jessica Kim  32:03
Yes, yes. The last thing is, can my therapist help me? Yes. And so, of course, I said before, we're not perfect, but we are trained in this, like there is, you need to feel like they know what they're talking about. And there is expertise, and that you're not just sitting with the friend, here. I think that therapists, as a therapist, I do want to offer something. And so whether that's what their goals, with symptom management, growing an insight.  I have clients that come in saying that, you know, like, my therapist was great, but they felt like a friend. I actually hear that pretty often. And the thing is, maybe in the beginning, like it feels nice that like a friend is friendly, comfortable or whatnot. And, but I don't think that's the goal of therapy to have a friend, I think it's to have a relationship with someone that can challenge you. That can bring something more than what you have right now. And so I think in that sense, like, I think you need to be like, oh yeah, this person knows what they're talking about. They are an expert. Yeah.

Tyson Conner  33:20
Yeah, absolutely. So, in terms of helping, we want to feel like our therapists are professionals.  That it's not just talking to some, talking to some dude, right? You're not just having a general conversation, that this person does bring some kind of specialty, experience, knowledge, something.  And that they can use it and that you can access it.

Jessica Kim  33:48
Right.

Tyson Conner  33:48
You can get in contact with it.

Jessica Kim  33:51
Exactly.

Tyson Conner  33:51
And, also maybe that you feel like your therapist can help you. Right? Like, there are some therapists who are really great for people who like are dealing with major life transitions and those like existential questions, "Why am I here?"  "What do I want to be now that I'm done with school," or I have, like my kids, or are out of the house or whatever. And those therapists might not be super great for someone who shows up saying, like, I have major OCD, and I want my symptoms to be addressed. Right? So it sounds like part of it is like, is this relationship with someone who's a professional and is it distinct from a friendship?  But also like, do you feel like this therapist has the necessary skills, experience, training, whatever, to help your specific situation?

Jessica Kim  34:42
Yeah, yeah, I agree with that. I think there are some specialties that it's actually ethical for a therapist, if they are not competent, or they can say that they're competent.  For example, like eating disorders, I think that is a specialty. And I can't say that, like, if a client comes to me, I don't specialize in eating disorders. And so I would actually refer them out. But I think there is a difference between that versus the therapist being able to be flexible.  That they're not set in their ways, or that they're rigid about how they do therapy.  That they are willing to meet you where you're at, and they're able to adapt what therapy or treatment looks like, based on what you're looking for.

Tyson Conner  35:26
Right? You don't want your therapist to treat you, to treat their office like a therapy mill.

Jessica Kim  35:31
No.

Tyson Conner  35:32
Right, you don't want to come in and get the same thing that the guy got last hour, right? You want, you want to know that what you're getting in treatment, is your treatment. That's why therapists meet with people so frequently, and so regularly. You know, like, a primary care physician oftentimes does prescribe a lot of the same treatments and interventions.  A physical therapist is doing a lot of the same exercises, with some more flexibility for specific people's bodies. And it feels like as mental health therapists, we're part of the reason we meet with people so frequently is because the treatment is specific. There's some similarities over time. And we talk about that a lot and I'll talk about that on this podcast. But at the end of the day, you want your therapist to feel like your therapist

Jessica Kim  36:17
Yes.

Tyson Conner  36:18
Not just a therapist who happens to be sitting with you.

Jessica Kim  36:20
Yeah, no, I completely agree. And Tyson, I know you can agree with this, it seems like we're just in the office and in the room doing the same thing. But every session is so different. There is no session that feels like another one. And so I think that kind of speaks to yeah, like, every client is different. You work differently with each client.

Tyson Conner  36:42
Yeah.

Jessica Kim  36:43
Yeah.

Tyson Conner  36:43
And you want to, and when picking your therapist, you want to get a sense that your therapist will, will adjust to you will adapt to you.  Instead of having you adapt to them. What do you do? If you feel like your therapist can't help you. Talk about it, obviously.

Jessica Kim  36:59
Yes.

Tyson Conner  37:00
But it seems like with the helping question, if you feel like your therapist doesn't have the experience or training or expertise or specialty, whatever, then it's appropriate to ask for referrals.

Jessica Kim  37:12
Of course.

Tyson Conner  37:12
Actually, something that I love to say to clients, especially at the beginning, is "I want to make sure you get help. I'm invested in you getting help. Not that you get it from me." Right.

Jessica Kim  37:23
Definitely.  I might steal it.

Tyson Conner  37:26
Absolutely do. Because, I think that's what our field ought to be, right?  And that's what referring out is. Referring out is saying I care about your care more than I care about you coming into my office.

Jessica Kim  37:40
As I kind of said like, before you go in, just be open to yourself and have some of these thoughts and check in with yourself afterwards. As in like, even in the session, I think there are some indicators in terms of like, do I feel like my body is tensing up less? Do I feel a bit more relaxed? Like I think humor is important, am I laughing with my client? Or my therapist here and there? Right? Like, is the time going by really, really, really slow? Or is it moderately paced? Or like, yeah, things like that, like pay attention to some of those things. And you can feel comfortable, uncomfortable, sorry, you can feel uncomfortable, because maybe you're nervous. That's very, very understandable. But maybe distinguishing is the therapist, what they're doing making me feel uncomfortable, what they're saying versus like your own discomfort, because you're in a new environment. So maybe just kind of keeping that in mind. And just reflecting on that, like after the first session, I think will help you answer that question of like, "Is this person a good fit?"

Tyson Conner  38:49
Yeah, I like what you described of like, when you go in and sit with your therapist, as you're evaluating.  Like, do I want to work with this person? What I'm hearing you say is like, pay attention to what your body's telling you. Oftentimes, we can get sort of caught up in our heads and like, feel like, "oh, but I should give them at least four sessions", or "I should like, I should work with them, because I got this referral from my best friend Greg, and Greg said that this therapist is amazing, but I'm not feeling it", right? And what I'm hearing you say is like, pay attention to your body, pay attention to how it feels. Pay attention to like, if the discomfort is coming from the therapist sitting across from you. And if that's the case, talk about it. But if you can't talk about it, ghost them, get the heck out.

Jessica Kim  39:39
Yeah, yeah and you can. Yeah. And I hope, like our listeners can, like do this for themselves, because it's important. I think this is the way that you can take care of yourself.  When you're doing therapy, is that you are invested in finding someone that you feel like is a good fit?

Tyson Conner  40:00
Yeah, absolutely. Well, that about wraps us up for today.  If people are interested in these ideas about like getting started with therapists or like the value of like the relationship, but is there any other like further learning that you recommend for people blog posts, podcasts, websites, books, anything like that?

Jessica Kim  40:25
If what we talked about kind of rang true, or this is something that you are looking for, because some clients are looking for just symptom management, right? And they're like, I just want to do five sessions or 10 sessions. And if that is your goal, that is okay. But if you're looking for this deeper, like relational work, I would say look into the literature books on psychodynamic therapy.

Tyson Conner  40:46
Sure.

Jessica Kim  40:47
And see if that's something that you're like, "oh, I feel like this is a good fit for me." Yeah.

Tyson Conner  40:52
Cool. And links to all that will be in the show notes.

Jessica Kim  40:55
Yes.

Tyson Conner  40:56
All right Dr. Kim, thank you.

Jessica Kim  40:59
Thank you, Tyson.

Tyson Conner  41:00
For coming today.

Jessica Kim  41:01
Of course. No, this was fun. Thank you for having me.

Tyson Conner  41:04
I'm sure we'll be hearing from you again.

Jessica Kim  41:07
For sure, thanks, Tyson. Have a good day, everyone.

Tyson Conner  41:14
Special thanks to Dr. Jessica Kim, for coming on to the podcast today. Dr. Kim can be found at Relational Psych. Links are in the show notes. If you're interested in learning more about things that we talked about today, a good place to start might be this article that we found, Therapeutic Alliance and the Outcome of Psychotherapy, Historical X curses, measurements and prospects for research. The links to that article are in the show notes. Or if you want something maybe a little more narrative and a little less hard sciencey and statistic heavy, a really good book about psychodynamic psychotherapy in general and fit with different providers is, A Shining Affliction:  A story of harm and healing in psychotherapy by Annie Rogers. Links to that book are also in the shownotes. The Relational Psych Podcast is a production of Relational Psych. A mental health clinic providing depth oriented psychotherapy and psychological testing in-person, in Seattle and virtually throughout Washington state. If you're interested in psychotherapy or psychological testing for yourself or a family member, links to our contact information are in the shownotes.  If you are a psychotherapist and would like to be a guest on the show or are a listener with a suggestion for someone you'd like us to interview, you can contact me at tyson@relationalpsych.group. The Relational Psych podcast is hosted and produced by me, Tyson Conner. Carly Claney is our executive producer, with technical support by Sam Claney. Our music is by Ben Lewis. We love you, buddy.

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Further learning:

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: Historical excursus, measurements, and prospects for Research. Frontiers in Psychology, 2. https://doi.org/10.3389/fpsyg.2011.00270

‚ÄćRogers, A. G. (1996). A shining affliction: A story of harm and healing in psychotherapy. Penguin. https://www.goodreads.com/en/book/show/73384.A_Shining_Affliction