Introduction

Sometimes you accept an invitation with a mixture of enthusiasm and trepidation, as was the case when I was approached to contribute to this volume. Just as you might relish a dinner party invitation when you know and like the other guests and feel that you have some interesting stories to tell, so as an academic I relish joining with others to explore a shared interest, particularly when my expertise is recognised and acknowledged. It is much more daunting to go to a dinner party when you know only the hostess, and the other guests come from her world rather than yours. Similarly, it is challenging to address the readers of this book, an expert audience, on a topic about which they have medical knowledge and expertise I do not share. As in the dinner party analogy, I can only hope to come up with some good stories to share, and a level of common understanding that will help the evening go well.

On this occasion, my perspective is that of an ethicist with a particular interest in the experience of healthcare professionals who operate in morally complex areas (Alderson et al, 2002; Ehrich et al, 2007). My work is also informed by my earlier academic career in which I studied and taught political philosophy, and by my personal experience as a woman growing up riding the second wave of British feminism. I have not experienced the type of therapeutic relationship upon which I will reflect, and ask for understanding of my necessarily lay perspective. It is for readers to judge what happens when they fill in the gaps with their own experiences, as therapist or client.

The therapeutic relationship

Relationships between consenting adults have generally been deemed a core component of our private lives. As such, in a liberal democratic society, they remain largely outside the reach of the state and its laws. Certain relationships become formalised and legitimised through the intervention of courts and registrars, but the way in which those relationships are subsequently conducted remains profoundly private.