The best cure for a damaged therapeutic relationship is prevention. One of the easiest and most reliable methods for avoiding misunderstandings between the therapist and patient is for the therapist to check on what the patient perceives and feels about the session.

This can be done during the course of the session (e.g.," What do you think about what I've been saying so far today?") and/or at the completion of the session (e.g., "How do you feel about today's session? Is there anything I said that rubbed you the wrong way?") If the patient states that he or she is disgruntled, or demonstrates nonverbal reactions that seem to indicate discomfort (e.g., sighing, reticence), the therapist can address this immediately, providing a heavy dose of non-defensive empathy along the way.

For example, one patient misconstrued the therapist's discussion of high-risk situations as an attempt to plant the idea into the patient's head that he was going to succumb to his urges. Once the therapist asked for feedback and ascertained that the patient thought the therapist was trying to sabotage the patient's sobriety, the therapist was able to explain his actual intentions, which were to educate and help the patient. For good measure, the therapist apologized for not being clearer.

It is important for the therapist not to assume that everything is okay in the therapeutic relationship just because the patient hasn't openly complained. Patients who have mistrust issues and/or live in dangerous neighborhoods often conceal their negative feelings extremely well. They adopt a "street smile" that hides both their vulnerability and their desire to strike back without warning.

Therefore, the therapist should make an effort to ask for feedback on a regular basis, as both a preventive and a reparative measure.