People often don’t know what to expect from therapy, or what is expected of them.
While it is true that counselors have no real expectations of their clients beyond hoping they show up and behave like decent human beings, there are things that you as a client can do to improve your therapeutic experience.
Some of them are obvious—try to be truthful and vulnerable, participate in the conversation, and attend regularly—but some are less so, to the point that they may seem counterintuitive. If you want to maximize treatment and perhaps shorten its course by doing so, consider any or all of the following unusual bits of advice.
Acknowledge and examine your feelings toward your therapist.
Irvin Yalum, MD, the world renowned psychiatrist, is grounded in classic Freudian tradition in many ways, one of the most significant being his emphasis on the relationship between client and clinician.
The ideas of transference, countertransference, attachment styles, and more are the means by which he conceptualizes cases. In other words, he cares more about what is happening in the therapy room between the two people sitting there than what happens outside of it, because he believes that the therapy room becomes a microcosm of a client’s emotional life that can be dissected and hopefully corrected.
This idea can be confusing. After all, aren’t we in therapy to talk about the problems we have with ourselves and the people we know? Why would we talk about our relationship with our therapist?
Simply put, our therapists can come to represent many of the characters in our lives; they might take on the role of parent, protector, enemy, love interest, child, and any other iteration of the human dynamic.
When we acknowledge and articulate our feelings toward our therapist, we provide valuable insight into our interior lives. This is not, in my opinion, the only way to interpret therapeutic data, but it is an important one. If a patient finds themselves “falling in love” with their counselor, wanting to avoid them, wishing to bring them gifts, obsessing about what they think, or having any other heightened emotion, this should be brought into session.
It is important material that a (good, ethical) therapist will draw a lot from, and is likely to enhance your treatment outcomes.
Get comfortable with not knowing.
We go to therapy because we want answers. “Why am I so anxious all the time?” “Can I save my marriage?” “What should I do about my drug addicted kid?” “How can I find a sense of purpose?”
While these are valid questions and entering treatment is a great way to get some clarity around them, the process is a lot less straightforward—and longer—than people imagine.
Generally, the “presenting issue,” or the problem clients believe they are there to solve, isn’t the real problem at all, but is something much deeper, hidden way down inside the muck of our lizard brain. Because that is true, we need to be patient explorers of our own subconscious. If it seems like sessions are meandering, or sometimes don’t have much to do with what you think you should be talking about, it’s best to go with the flow.
The truth is often something we can only see out of the corner of our eye—if we look directly at it, it promptly disappears. Get comfortable with not knowing, let your rational mind have a seat in the back row, and trust the process. By “trust the process,” I mean, trust that everything you need to restore yourself is right inside you—it just needs a safe place and an empathetic guide so it can peek out its tender head.
Don’t jump up and leave the first moment you feel better.
The first epiphany or wave of relief in therapy can feel like the first time we fall in love. “Everything is better! It all makes sense! And it only took me six weeks! Wow, my therapist is amazing!”
Your therapist may very well be amazing, and you certainly are feeling better, but this is not the time to bail. Sometimes just the comfort of speaking to someone and being deeply heard gives us the impression that things are fine now. This, however, could be when the real work begins.
The fact that you’ve had such a positive experience thus far speaks volumes about your compatibility with your clinician, which should never be taken for granted. By disappearing, you are depriving yourself of the real healing you are now in a position to receive.
If you think you’re suddenly doing so great that counseling is a big waste of time—you might be right—but run it past your counselor just in case. (They are amazing, after all!)
At the very least, the two of you will review your progress (which is fun if you’re feeling dandy) and establish what to do should the tide turn once again.
Make time to reflect.
People often mistakenly think therapy ends when their session does. Nothing could be further from the truth.
Our mental wheels are turning long after we’re done whether we are aware of it or not. We also may feel worn out by the process and want to put the brakes on the minute we walk out the door. While this can be tempting—therapy is hard work!—most of the time, it’s better to create some time and space to soak it all in.
I’m not suggesting that we all go and meditate for an hour after counseling sessions (though I’d actually love to suggest that because even though it isn’t realistic, it would pay massive dividends), but that we allow ourselves to sit briefly with whatever thoughts and emotions have been unearthed in the hour prior.
The car ride home is a great place for this. We can just breathe in and out, no radio, no phone, and notice what is happening inside of us. If we can do this, the work takes root more deeply, becomes more dynamic, and again, is possibly shorter in duration because we are putting more into it.
Five or ten minutes of conscious self-reflective awareness post-session is a consistently powerful way to upgrade our own treatment.
Find a therapist like you.
In this age when inclusivity and social justice are blessedly gaining traction, it might be surprising to hear me say that clients do best with clinicians from similar cultural backgrounds.
While cultural humility is now taught to aspiring clinicians as part of the standard curriculum in an effort to broaden the reach of mental health services to more kinds of people, as well as to diminish stereotyping and “us versus them” thinking, there are no amount of class hours that can make up for all gaps in understanding and differing cultural norms, both of which can inhibit treatment outcomes.
For example, Jenny Jim and Nancy Pistrang in their article “Culture and the Therapeutic Relationship” state that “differences in values and belief systems of Eastern and Western cultures are frequently cited as one reason that Chinese clients may terminate therapy prematurely. Chinese cultural values include an emphasis on collectivism, the centrality of the family, filial piety, hierarchical relationships, academic achievement, humility, and emotional self-control (Kim, Atkinson, & Yang, 1999; D.W. Sue & Sue, 2003). Such values are likely to play a role in Chinese clients’ experience of self and identity, how they make sense of their problems, and what they expect from therapy.”
While it is certainly possible to bridge cultural divides, therapy may not be the best place to do so.
If we find someone we feel understands us: who we are, what our priorities are, where we come from, and even the all-important nuances of the language we share—we are much more likely to feel safe enough to do the work at hand.
If you’re chronically late or unwilling to pay, ask yourself why.
There is a phenomenon in therapy called “resistance,” when a client consciously or unconsciously pushes back against treatment, most likely because it is opening the door to change—a generally terrifying prospect.
Two classic forms of passive-aggressive resistance come neatly hidden within the currencies of money and time. Both are things clients can control, and sometimes use to express their feelings of fear, anger, resentment, lack of commitment to the process, and so on, in a silent, but unmistakable way.
If you find yourself playing any sort of game with, or being disrespectful about, time or money in therapy, take a minute to think about it. What emotions come up when you consider paying your therapist? Do you feel you’re worth the money you pay to talk to her? Do you feel she’s worth it? What are you really saying when you’re always 5, 10, or 15 minutes late? Are you angry because your counselor will never go past the allotted hour? Are you getting tired of treatment and feel like giving up?
These are just a few of the issues that clients act out with time and money as cover. If patients are able to acknowledge the behavior and explore what’s happening with their clinician, some startling things might be revealed. Even if they are not, the bravery needed to own up to less than flattering behaviors builds our emotional strength.
Don’t assume your therapist knows more about you than you.
I often tell clients, “you’re the expert on you, I’m just interning.”
What I mean by this is, though I may have psychological expertise that my client does not, no matter how hard I try, I will never know or understand them completely (and if I think I do, I need a visit from the Narcissism Police).
If your clinician speculates about something and it just seems wrong, speak up! We won’t get offended, we’ll just work harder to get it right.
The human mind is not a place of absolutes, and shades of meaning can get lost in translation. Don’t hesitate to value your translation as much or more than anyone else, including your therapist. Of course, sometimes other people can see us much more clearly than we can see ourselves, so try not to dismiss your clinician’s ideas out of hand either—just know it’s okay to openly and respectfully challenge them.
Don’t be afraid to “break up” with your clinician.
Which leads us to this—sometimes we need the courage to accept that a particular therapist is not a great fit and give ourselves permission to move on.
This could be true for any number of reasons: you never fully establish trust, something seems off, you consistently feel misunderstood, your clinician is sending confusing messages or blurring boundaries, or is often late or cancels at the last minute frequently.
Many clients will stick with a counselor far too long, both because they feel guilty about leaving them, and because they don’t want to start all over with somebody new. While these concerns are absolutely valid, like any other dysfunctional relationship, this one needs to be laid to rest.
You can do this in any way that you need to—you don’t owe anyone any explanations—but if you are comfortable enough, consider having one last session with your therapist to wrap things up. As with frankly dealing with your potential forms of resistance, owning up to what you are doing and why grows you into an emotional superhero.
Therapy is such a magical, mysterious gift to those who can avail themselves of it, but it can also be frightening, overwhelming, or even morph into an unhealthy relationship.
By noticing and verbalizing your emotions throughout, getting comfortable with not having all the answers right now, sticking with the process after the first rush of relief subsides, making time to reflect, finding a therapist from a similar cultural background, questioning your styles of resistance, valuing your own thoughts and opinions, and not being afraid to “break up” with your therapist if you need to, you’ll up the odds of finding the magic and the mystery—and the healing—we all deserve.
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