Health: Is your therapist a friend?

One of the comments that most annoys psychotherapists and counsellors is that therapy is "just like talking to a friend". It's annoying because it's saying that, really, there is nothing special to what we as therapists do - anyone can do it - and there's the implication, too, that really it's all a bit self-indulgent. I have taken issue with such remarks more times than I care to remember.

And yet, I have come to think that there may be more to such remarks than insult or ignorance. Therapy is, I believe, much more akin to a form of friendship than it is to anything else. What is being expressed when people compare therapy and friendship is a belief in what friends should be able to do, what friendship might consist of - and a complaint of what it too often does not. Think of the elements of a good friend. He is someone who has our interests at heart, who has a sense of our history and who respects us. She does not suspend criticism, but is nevertheless tactful. He is someone who can stand back from what we are describing, who can talk honestly and openly to us, who has time for us, who is attentive and thoughtful and appreciative and can keep his own feelings out of, say, any predicament that we might be describing. These are, to be sure, ideal qualities. Anyone who has them is lucky indeed; their friends are luckier still. But they are, I suspect, what we long for, in ourselves as in others. Are they not also the qualities, or some of them, of a good therapist? I believe they are.

"A friend is a person with whom I may be sincere. Before him I may think aloud," said the philosopher and writer Ralph Waldo Emerson. And this, precisely, is what therapy is about, an opportunity to voice your thoughts, however abhorrent, unacceptable, unformed, confused or painful you might think them, without fear of judgement or retribution. You voice them in the hope that you will be understood, and so come to a deeper self-understanding.

To say that therapy is a form of friendship is not to suggest that therapists invite their patients or clients to the cinema, to come for a meal, to ring up and discuss a television programme, to give us presents on our birthdays, and so on. The word to be emphasised here is "form". Not all friendships are the same. There is the friendship of lovers, of family, of colleagues, and of many different degrees, of the people we call friends. Each has its own boundaries and conventions, its own sense of what is appropriate.

The negotiation of these regulations and conventions in a friendship is, of course, a struggle and a challenge for both parties, and it is to do with whether a person wants, or can even tolerate, the degree of closeness and intimacy desired and offered. So, too, must you deal with the disappointments and differences inevitable when two people try to meet each other.

There is, of course, a major difference between most forms of friendship and therapy. A social friendship that does not involve a degree of reciprocity, at least over time, is unsustainable. A lack of reciprocity is, I suspect, why so many friendships founder on a reef of resentment of one kind or another. Therapy, on the other hand, is not reciprocal. As a therapist, I am there for the other person and responsible to them; they are not there for me. But this does not make the relationship any less a friendship, and it does not preclude a reciprocity if this seems appropriate, in the sense of a sharing of your experience or thought.

The fact that one often pays for therapy is a sign that the relationship has its limits, a statement that it is ultimately a professional reltionship. And yet, all the qualities of a good friendship - a welcome, an acceptance, an attunement, an attentiveness, a suspension of self-interest, a questioning, a criticism, a distance that does not yet pretend to objectivity, a faith in the other, a commitment to truthfulness, and above all perhaps a responsibility to the other - these surely are the qualities also of an ethical therapy.

In the end, however, these can no more be a guide than there could be a guide to friendship. The content and the form of a particular therapeutic relationship - just as the content and form that cannot be prescribed in advance but must, it they are to be meaningful, be negotiated by the people involved. In the end, whatever the style or orientation of the particular therapist, therapy is a relationship, or at least the offer of one.

Paul Gordon is a psychotherapist and author of `Face to Face - Therapy as Ethics', published by Constable, price pounds 15.99