There are two essential elements to effective psychotherapy. The first is trust. For my clients, the therapeutic relationship is the only one in which they can let their guard down and be themselves. Most depressed clients feel guilt and shame for not living up to their own high standards. They feel like failures. When I listen to their guilty secrets and show compassion and understanding, then the healing begins. Accepting the client as a worthwhile individual, even though they are not perfect is crucial in building the trust needed for successful therapy. Secondly, emotional engagement and support are essential in effective therapy. The client usually doesn’t communicate the depth of their pain to those closest to them, out of shame or fear of rejection. I connect with my clients and show them that their feelings are not to be feared and that there is good reason for hope that their depression will end. I’m a good referral for your sister who doesn’t open up to you. She is so busy at work, that she is only free at night for a therapy appointment. Tell her she doesn’t need to leave her house and she can wear sweat pants. I won’t judge.