• Some of us may struggle to accept empathy within the therapeutic relationship

  • Therapist Joshua Miles explores the nature of personal change that occurs in therapy

  • If you are looking for a therapist, you can find one here

The therapeutic relationship exists on different levels of reality, both that of ordinary life and the experiences occurring within it, as well as within the therapeutic frame and boundaries of therapy. Due to therapy occurring on different levels of reality, it is inherent that this brings about paradoxical experiences for both therapist and client. Within this article, I aim to explore the different paradoxes that exist within therapy and offer an insight into how these can be further understood.


We live in a world that demands change from us at many levels, both consciously and unconsciously. Advertising asks that we become something different to what we are: be thinner, be fitter, be more intelligent. In our working lives, we encounter managers, bosses or departments that ask we prove we are making progress in our respective fields, that we are moving forward or getting results.

This drive to prove to ourselves and others that we are making progress, is in direct conflict with the process of psychotherapy, where change does not operate on a graph, and cannot be mapped. Change within the therapeutic relationship is of a highly personal nature and depends on many factors such as, the length of therapy, relationship with your therapist or your motivation for therapy.

The paradox of change in therapy is that in order for it to occur, the person must be allowed to truly be who they are. So, even though a therapist will work to encourage, foster and enable change, it must be noted that a client may first need to endure a period of time and struggle before this change occurs. So, even though one of the key words associated with therapy is change, this is not always as simple as it may seem. 


Empathy in psychotherapy is usually understood as a benevolent act whereby the therapist deeply understands their client, and in turn the client is grateful, and feels moved by the fact they have been heard, valued and had their difficulties recognised. This level of empathic connection has long been common knowledge within psychotherapy, and it is one aspect of the therapeutic relationship that can be attributed to fostering change and development within a client.

The paradox within empathy is that it is possible a client may not be desiring, wanting or welcoming of such a deep level of understanding, and may instead view it as intrusive. Instead of wishing to be fully seen by their therapist, a client may feel that the deep levels of their self have been entered, the barriers and defenses they built up over time breached, and their feelings exposed, leaving them overwhelmed by anxiety, fear or shame. 

The idea that empathy could be viewed as hurtful would seem counterintuitive to many of us. The paradox of empathy becomes more complicated as the therapist assists someone to re-engage with difficult feelings, thoughts or memories that may have been blocked, cut off or disowned. Those cut off memories or experiences are often hidden for good reason, so an ever increasing contact with difficult memories and experiences via the therapist’s empathic efforts can also evoke anxiety and a sense of vulnerability within us.

Additionally, there can be a sense in therapy that by expressing these hidden or prohibited thoughts and feelings they may by proxy injure the therapist. This can often be manifested in statements such as, ‘Oh, you don’t want to hear my difficulties, you must get bored of hearing people’s problems all day’, or ‘So, how are you, I bet you’ve had a long day’. 

When clients are caught between a longing for validation and the fear of rejection or interpersonal injury, they may choose to take evasive action before a new set of trauma can arise and cause them difficulties. It is not uncommon for the sensitive and empathic responses of a therapist to be met with conflict, disengagement or as a criticism of the process or the therapist themselves. This can do the job of assigning the therapist feelings and thoughts that confirm the client’s expectations of rejection, or prevent the therapist from becoming an important attachment within their lives.

Anyone who has experienced the therapeutic relationship either as a client or as a therapist will know it is unlike any other relationship in ordinary life, and that it does not fit within a category. Even though there is clearly a meaningful bond formed over time between therapist and client, this relationship is hard to define, and to those who are not within it, difficult to understand.

However, the paradox of the therapeutic relationship is that it is a relationship that one could argue has one side, or that it is a relationship where one person is the beneficiary. Of course, therapists gain much from their clients emotionally, take joy in their work and learn from their clients. However, for the most part, the client, their stories, experiences and difficulties take centre stage within the relationship. When the therapeutic relationship between client and therapist is discussed, or worked on, it is for the benefit of the client, so they can can gain further or more informed understanding of their difficulties. The therapeutic relationship can be used as a mirror so clients can see a reflection of their relationships in their personal lives as reflected in their interactions with the therapist. 

Finally, once a resolution or sufficient understanding of issues has been reached, the therapy will end, and there is in most cases no further contact, unless by way of re-entering therapy for a new difficulty should it arise.  

Further reading

The three different types of empathy

This is why the therapeutic relationship is so different

Is empathy the last truly human quality?

How does relationship counselling work?