The obvious takeaway, to me, is that Sarah would like a therapist who isn't cold and mechanical and distant. These people are charging you to have a "relationship" with them, and then if that relationship is characterized by a distinct lack of warmth or genuineness, it's bound to be distressing, possibly harmful.

The handshake is beside the point. It's the way the therapist is making her feel in general. If Sarah is feeling that her therapist is heartless, guess what? She probably is. To assume otherwise would mean making logical leaps in order to cobble together some convoluted theory about projection.

The basic transaction is -- you pay me, I pretend to care. It's easy to forget that. When you are reminded, it sucks.