THERE IS A TROLL-LIKE CERAMIC creature for sale in many gift shops whose tunic bears the inscription, “Can we talk? I can’t afford a psychiatrist.” Like many jokes, behind it lurks a -whole set of cultural attitudes and assumptions, in this case about the parallels between friendship and psychotherapy. While most therapists acknowledge that the relationship between therapist and client encompasses certain comradely qualities, some have taken this similarity a provocative step further, arguing that when the formalities of the clinical hour are stripped away, there may not be a whole lot of difference between good friendship and good therapy.
In his classic 1964 work, Psychotherapy: The Purchase of Friendship, William Schofield threw down the gauntlet. He charged that the modern “cult of the psychotherapy expert” had actually led to an unintended constriction of friendship, because it subtly encouraged people to believe that only trained professionals could supply the particular environment of support, trust and validation that permitted emotional healing. On the contrary, he argued, if the fundamental transformative power of therapy lay in the relationship between clinician and client one marked by acceptance, positive regard and a willingness to listen and help then it stood to reason that close friendships might wield much of the healing power that psychotherapy had claimed for itself. An important responsibility of therapists, therefore, was to encourage each client “to seek and to find the satisfaction of his emotional needs in the natural supplies of his social world,” to afford him or her a lifelong, no-cost source of therapeutic sustenance.
Schofield’s main argument that a sympathetic and committed pal can provide much of what therapy has to offer has been mostly shrugged off by clinicians until very recently, when several disconcerting analyses of outcome research were published showing that on average, psychotherapy outcome is improved neither by amount of clinical experience nor degree of professional training. Studies have found that all manner of nontherapists who have volunteered to counsel troubled individuals have consistently produced therapeutic improvement on a par with therapists with up to ’23 years of experience.
What does account for a goodly chunk of the positive change that clients experience from therapy, the outcome research shows, is the time-honored therapeutic alliance that emerges from the client’s perception of the therapist as warm, trustworthy, nonjudgmental and empathetic precisely the qualities that, as Schofield observed, many of us recognize and treasure in our close friends. “What the data show is that therapy is just not all that magical,” says Scott Miller, who directs the Brief Therapy Training Consortium in Chicago and recently reviewed 50 years of outcome research. “When you get beyond the therapist-client contract, there is really no significant difference in what is curative, helpful and healing in therapy and what is curative, helpful and healing in friendship.” One can almost see the managed-care folks furrowing their collective brow on this one: What, we’re paying for the equivalent of a long conversation with a good buddy?
It is clear enough, certainly, that close friendship has therapeutic properties. Most of us can remember a time in our lives when a pa! pulled us out of a dark hole with no assistance from psychotherapy, by simply listening at length to our confusion, gently pushing us to take the risk we needed to take but were convinced would do us in, or simply pointing out a choice we didn’t know we had. Meanwhile, the research literature bulges with data linking friendship to lower risks of mental illness, alcoholism and suicide; higher levels of stress resistance; and a greater capacity to cope with transitions and reversals in life such as unemployment, divorce, pregnancy and the death of a loved one. In a recent Gallup Poll, respondents were five times more likely to report that they were helped to make an important life change by a friend than by a psychotherapist. With 37 million Americans uninsured and millions more simply unwilling to seek succor from a stranger, the vast majority of individuals have never stepped inside a therapist’s office, and never will. Many more people can point to a friend who has made a difference in the emotional quality of their lives, and in that sense, friendship is far more therapeutically influential than psychotherapy.
But to acknowledge that friends are critical healing influences in one another’s lives is a far cry from suggesting that they can or should routinely perform the kind of work that goes on in a clinician’s consulting room. Most individuals who attempt this, in fact, seem to fail rather spectacularly. This is not because ordinary people don’t have the capacity to heal each other, for they clearly do. Rather, it is because the essence of friendship lies in its very elective quality, the unspoken understanding that you and I are creating this particular connection purely for its own sake. While we may also tacitly agree to provide each other with a good deal of emotional aid, the primary motivation for friendship is nearly always the prospect of mutual delight, not mutual obligation. The reality is that few friendships can survive the kind of continuous, intense, nakedly honest, frequently draining and persistently other-directed work that is the very guts of therapy, clinicians, in fact, are often treated to tales of friendships gone sour because one friend leaned on another too much or too long, or leaked a secret, or unveiled a dark comer of self that a friend may have tried valiantly to embrace, but could not.
Therapy works as well as it does in part because it is so vigilantly unlike real friendship; because the contract between client and clinician protects both from the frailties and vicissitudes of human connection; because, as Scott Miller points out, “there are no relationship costs to therapy.” This doesn’t mean that therapists and clients don’t often feel profound affection for each other or even fantasize about being pals there is plenty of wishful thinking on both sides of the coffee table. What it does mean, however, is that the boundaries of therapy create a kind of emotional-free zone for the client, allowing the exposure of one’s fullest, deepest, least-spruced-up self without risk of censure or abandonment. It means, too, that when individuals are feeling too hopeless or frightened or simply too overwhelmed to negotiate the usual give-and-take required of reciprocal ties, there is a relationship that exists explicitly and solely to support them through their distress and to help them discover the sources of their own strength. In our most wistful daydreams, we may wish for a friend to expend this kind of concentrated, tenacious, all-out energy and intelligence on behalf of our emotional well-being. But this, after all, is not friendship. This is the foundation and the matchless strength of therapy.
Marian Sandmaier is the author of two nonfiction books, Original Kin: The Search for Connection Among Adult Sisters and Brothers (Dutton-Penguin) and The Invisible Alcoholics: Women and Alcohol Abuse in America (McGraw-Hill). She is Features Editor at Psychotherapy Networker and has written for the New York Times Book Review, the Washington Post, and other publications. Sandmaier has discussed her work on the Oprah Winfrey Show, the Today Show, and NPR’s “All Things Considered” and “Fresh Air.” On several occasions, she has received recognition from the American Society of Journalists and Authors for magazine articles on psychology and behavior. Most recently, she won the 2021 ASJA first-person essay award for her article “Hanging Out with Dick Van Dyke” on her inconvenient attack of shyness while interviewing. You can learn more about her work at www.mariansandmaier.net.