Therapy is often about relationships; not least the relationship between the client and the clinician, which is widely held to be as important, if not more important, to successful outcomes than the treatment model.

I care about my clients and try to offer them a safe space to explore their inner worlds, in order to gain insight and perhaps effect change. The relationship, I hope, is supportive. We work together.

In the room, we also think about relationships, both past and present, with family, partners, friends and colleagues. Sometimes, those relationships offer succour and warmth. But they can also be a source of discomfort, even distress. I am sure I am not the only therapist who has sat with a client while they recall and relive their experience of an intrusive mother, an absent father or a rivalrous sibling.

But when does a difficult relationship become an abusive relationship? How do we know? And what do we do, especially if a client is not willing or able to see or acknowledge the abuse? In the October issue of HCPJ, Cathy Press offers guidance on working therapeutically with people who are in abusive relationships. Cathy explains the cycle of abuse and how we might support a client to recognise a toxic relationship and understand its traumatic impact.

Do we still have relationships with people who have died? They surely don’t end, but do they change? John Wilson calls on his experience and research as a bereavement counsellor to write movingly about how clients can develop a new relationship with a lost loved one. It’s perhaps the therapist’s task to support the bereaved client to adapt to the new world, while at the same time creating a continuing bond with the deceased.

Our relationships with others most likely inform our relationship with the world around us. Do we think of our world as a safe place, where we can flourish and thrive? Or do we think of it as dangerous, threatening to our survival? If we experience the world as unsafe, we might be anxious – and anxiety is often difficult to treat. But Terence Watts thinks he has found an effective treatment model. He calls it brainworking recursive therapy, which works by exploiting the gap between the brain’s reaction to a situation and conscious awareness of the reaction.

So, maybe therapy is not just about relationships but about changing relationships with others and the world – and ultimately ourselves.