June 14th, 2011
10:08 AM ET

Can I ask my therapist personal questions?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Asked by J. Johnston, U.S.
I am curious about the working relationship of therapist and patient. I have always been aware that there is a boundary. But I also think it is human nature to make assumptions. So, of course, I make assumptions based on the way my therapist responds to some of my comments. The bad thing is that I don't feel I can ever ask if my assumptions are correct since some of them would be somewhat personal. On the other hand, I sometimes think this information would be helpful to know because I think I would trust the therapist a little more (since education and life experience are two different things). I know with my previous therapist I made several assumptions that I now know are wrong. Because of those assumptions, I feel like it slowed my progress down. So, what is that line? Can I ask questions, knowing that although I can't have, nor do I need to know, all the details of my therapist's personal life, can I ask basic information to try go get a better understanding of my therapist?

Expert answer

You are asking one of those all important questions that is seldom discussed, and you are thinking about the issue with remarkable clarity.

I wish I could give you an answer of equal clarity, but alas, one of the reasons this issue is not often discussed is because it is so complex and potentially problematic.

To some degree all psychotherapies are built upon a knowledge differential between patient and therapist.

The therapist is in the relationship to focus on the patient and to provide knowledge and/or guidance of one sort or other, depending on the type of therapy. The patient is in the relationship to focus on him or herself and to attempt to use the interaction with the therapist to "get well" or at least better.

Freud - the inventor of psychoanalysis - recognized early on that this imbalance made the therapeutic relationship much different than any other type of adult relationship.

When was the last time you willingly spent extended periods of time with someone who only talked about themselves? In the case of psychotherapy the balancing element is the fact that the patient pays the therapist, so that quid pro quo is established.

A powerful result of this arrangement is that the therapist typically retains a fair amount of anonymity.

In some types of psychotherapy - for example traditional psychoanalysis - this anonymity is considered to be essential to the treatment because it allows the patient to project his or her fantasies on the therapist without the realities of the therapist's personality intruding.

When successful, the therapist becomes a stand-in for early parental figures. Because this process is viewed as essential, most psychoanalysts won't answer direct questions about themselves but will rather use the questions as a chance to explore further the patient's fantasies about the therapist.

In other types of therapy, such as cognitive behavioral therapy, the anonymity of the therapist is far less essential to the way the process is believed to work.

As a result, cognitive behavioral therapists are typically far more willing to answer questions about themselves, especially if providing an answer is perceived as being of potential benefit to the patient.

In your particular case, I do have some advice, which is that you ask your therapist exactly what you asked me and be prepared for any type of response, recognizing that what you get back from the therapist will be dictated as much by the type of therapy you are in as by your relationship with the therapist.

But one word of warning. The psychotherapeutic relationship can be profoundly powerful, but it is always to some degree built on an illusion, because the therapist is also a human being and therefore has problems of his or her own.

Sometimes seeing these vulnerabilities can empower a patient, other times it can weaken what was previously a powerful tool for therapeutic change.

By the way, this is not a new problem. Tibetan Buddhists counsel against getting too familiar with a guru for fear of seeing their human failings.

More than 200 years ago, the great English author Samuel Johnson wrote that anyone who is deeply moved by a work of literature and then goes to meet the author in person has only himself to blame when he is sorely disappointed by what he finds. Johnson reminds his readers that if the author wasn't struggling with the same issues as the reader he never would have set them down in print.

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