What Should I Expect From Therapy?

I’ve recently seen a need to help clients understand more what therapy is and how best to use it.  There’s a lot of confusion or lack of knowledge in this area.  If you’ve seen counseling portrayed on tv and in movies please throw all of that out, like many things in the media, it is rarely accurate.  My wife can tell you that I usually sigh audibly when we're watching something and a counseling scene comes on.  But I digress.  Books and books could be written on this subject but I want to start by emphasizing 3 essentials that I have found to be important for clients to understand at the outset.

Counseling is a Relationship

Many clients are confused by the nature of the therapeutic relationship.  They have questions like,  “What is appropriate for you (the counselor) to share about yourself?”  “What is appropriate for me to share about myself?”  “How should I best use the therapy hour?”  “Do I just talk about what happened over the past week or are we talking about my childhood?”  “Do you decide what I need to work on or do I set my goals?”

I’ll start by saying that each hour we meet for therapy is your time, which means you have a lot of say in how the sessions will be structured.  There is no other relationship like therapy, in which you have the space to talk about whatever you need to without having to worry about whether you are talking too much.  I am a trained, confidential listener who is here to help.  I usually start therapy as more of a “blank slate”, meaning that I spend a lot of time listening and asking questions so I can get to know you and understand you.  It can be tempting to try and impress you with immediate advice or insights, but it is more important that you feel heard and understood before anything else happens.  I have a pretty firm belief that 80% of each session should be you talking and sharing and 20% should be me giving input, briefly educating, or asking more questions.  Some people like me to stay in that mode, others want more feedback and sharing about how I am experiencing the therapeutic relationship.  The key thing here that I want to emphasize again is that this is your time and this is a relationship, so I want to encourage you to process how therapy is going with me and how you are experiencing me.  I am a calm, laid back, quiet person and I don’t tend to show a ton of emotion, which has led some clients to wonder what’s going on in my mind.  This is a fine question to ask and one I enjoy answering! 

The therapeutic relationship is confusing largely because it lacks the typical mutuality and give and take of every other intimate relationship we cultivate, and it is a professional service that has an ending in mind when goals have been met.  But it is still a relationship, and we will be talking about some very intimate things as we meet.  You will hopefully find acceptance as we talk, and the opportunity to practice new ways of thinking and relating in a safe space.  Our sessions will mean something to me, and when therapy ends I will likely feel some sadness about no longer getting to talk and will wonder from time to time how you’re getting on out there in the world.

Counseling is at Times Painful, Hard Work

I also want to emphasize that therapy is hard work and it is painful emotionally, especially at first.  Many are surprised by this and drop out prematurely.  When you come in for counseling you are opening the lid on issues you have likely been avoiding or dealing with in unhealthy ways.  Part of my job may be to challenge some of your behaviors and thoughts.  I will be asking you to look at issues and to begin processing them, and for just about everyone, this is experienced as dysregulating at first.  I liken therapy to a bell shaped curve, where the initial phase is an uphill climb, but it does eventually peak and then move downhill to more peaceful and stable feelings.  So I encourage you not to give up just because it is hard or difficult at first.  Like anything in life, well-being will not be achieved without a fight.  Technology has given us the illusion that all things are instant, but things like relationships, healing, and moving toward maturity take time to grow. 

I’ll likely give you homework periodically- maybe a chapter or book to read or a writing exercise to process some emotions or a relationship in your life we have been talking about.  With many people I apply an approach called Lifespan Integration that will involve making a timeline of your life that we will use in our sessions.  All of this will require work and a willingness to face things in your past and begin changing things in your present.  The idea that the past should remain buried is frankly, a terrible one.  The longer I’ve counseled, the more clear it has become to me that the past dictates many of our current emotional responses, and if we ignore this we aren’t going to get anywhere.  Just giving you tools for how to respond differently to your spouse, for example, without getting at the roots of why you respond in a typical way each time a conflict comes up will give you relief for maybe a couple months until the strain of trying becomes too much and the old wounds open up once more.  There is a place for education, tools, and advice, but the proper order is after the younger parts of us have been cared for and are no longer getting activated each time we are in pain.

Counseling is a Commitment

The last thing I’ll say builds on the first two points- therapy is a commitment and it is not a superficial or quick process.  No relationship in your life thrives without some sense of commitment, and no growth happens without sustained effort.  Once we enter into treatment together, we are both committing to a period of hard work, of potentially having hard conversations where we challenge each other, and to growth.  I don’t want you to become dependent on me or in therapy for any longer than you need to be- it is my job to work myself out of a job.  But I encourage people once they start therapy to view it as entering a season of life, which would be at least 3 months of sustained effort.  I hope it is clear from what has come so far that I am not comfortable with quick, pat answers or with simply developing “coping tools.”  I do this work because I care about people and love to watch deep and lasting change take place.  Understanding these 3 elements before we begin will get us moving in this direction.