Dr. Matt Hersh, founder of The Thriving Therapist

Dr. Hersh is a psychotherapist, Certified Energy Psychologist, mindfulness teacher, & founder of The Thriving Therapist, a site devoted to helping the helpers. Learn more about us and check out our free resources, online courses, and workshops on self-care, work-life balance, burnout prevention, your thriving practice, & much more.

The therapeutic relationship can be considered the most important vehicle to helping your clients toward mental health improvements, healing, and growth. I propose in this post that the therapeutic relationship begins before you think.

It likely begins well before we have even confirmed our intake call or initial session.


Let’s explore the nuanced (and often hidden) process involved in how prospective clients come to be our actual clients. There’s much more going on than meets the eye.

If you are in private practice and personally manage your own caseload, you intimately know the importance of initial communication.

If you are employed in a clinic or hospital setting, you probably don’t have the opportunity to field that initial correspondence. However, someone does. You unknowingly have entrusted this vital point of initial contact to another human being. This intake coordinator has begun the institutional side of the therapeutic relationship for you.

A Common Scenario of Initial Client Contact

Imagine a new client leaves you a voicemail seeking your services. The quality of the message isn’t the best, and you have trouble hearing this man’s voice. You can barely make out the phone number he quietly leaves at the end of the message.

What you can understand from the message is that the man has been struggling for years with depression and anxiety and that no therapist has been able to help him thus far. He says that a local family member learned about your practice and strongly recommended that he reach out to you. He reluctantly agreed.

Pause for a moment…

Tune into your emotional reactions to the voicemail. What comes up for you right now? What feelings, sentiments, and thoughts are already forming? Are you drawn in or repelled? Are you feeling overly cautious or cautiously optimistic? Do you feel a sense of over-striving to be the one therapist who will help? Or do you feel hopeless already?

The therapeutic relationship, and thus the therapy, has already partly begun.

But you haven’t even met him let alone spoken to him to do your phone screen or intake. Therapy has indeed begun because you are already forming opinions and impressions of this man. Counter-transference (whether or not you use this specific term) is already developing.

Why The Therapeutic Begins Before You Think

What is responsible for this effect and its practical implications?

Implicit attitudes in large part undergird the process of such quick impressions being formed of our clients before we even meet them.

Implicit attitudes, largely the research domain of social psychology but wildly applicable to clinical endeavors, are memories that serve as connecting links between an object (writ large) and feelings or thoughts toward that object.

Sometimes our implicit and explicit attitudes are aligned well. But other times, we have “hidden” or latent sentiments about a group of people (e.g., “depressed”), the way someone speaks (e.g., timidly and softly), or even feeling states within ourselves (e.g., powerlessness) that trigger previous associations we have made from experiences we have had.

The fascinating aspect of this process is that we are likely unaware of the origins of our reactions or attitudes, and they can run the show if we are not mindfully aware of them – if we have not made the implicit explicit.

Thus, it behooves us to cultivate a curious, gentle awareness of the impressions we are already forming before we even call our prospective clients back.

3 Uncommon Ingredients to Help Forge an Optimal Relationship

So, if therapy actually begins before we think, what are some ways we can harness the knowledge and power of implicit attitudes to benefit our clients and ourselves?

  1. Increase your awareness (outside of the therapy room) of the clinical populations toward which you gravitate. Reflect on what draws you to these groups? What in your personal past might hold any relevance for the clinical populations to which you are energetically drawn?
  2. Increase your awareness of the clinical populations toward which you react “negatively”, in any way. Reflect on what feels awkward or problematic about this group? What in your personal past might hold any relevance for the clinical population to which you are energetically reactive?
  3. Reflect with honesty and self-kindness on these pushes and pulls toward certain types of people and presenting issues. See if you can hold yourself with a compassionate understanding of how your beliefs, reactions, and sentiments about certain people and conditions have come to life over the years.

You may uncover some hidden opportunities for self-growth as a therapist specifically and as a person in general.

You may also find that, at least for right now, you just need to stay away from clinical contact with some populations. This skillful avoidance might ultimately be therapeutic for all involved.

The other main (more obvious) reason we may want to stay away from or be drawn to particular populations is based on our training. But even our desires to be trained in particular domains may derive from experiences from our personal histories.

Please drop a comment below  – I’d love to hear your thoughts on how implicit attitudes might influence your therapeutic work before you even start therapy.  (As alway, please respect client confidentiality and privacy 🙂 )

Be well,


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