What do i want out of therapy

Overview

If you are new to therapy, you need to know some important things. While some of these things may seem obvious, other things (particularly my points about the therapeutic relationship) might not. Although you may be in a hurry to find answers to your problems, if you have a poor understanding about how therapy works or your role as a client, you could miss out on being truly being helped. 

Your Job:

Firstly—early in therapy—your job is to determine whether you and your psychologist can work together. After all, it is your difficulty—your life experience—and YOU get to choose with whom you share it (!). The therapeutic relationship is one of the most important things that leads to success in psychotherapy (this is even more important than ‘what model’ or ‘which type’ of psychotherapy is being used).

Ideally, your psychologist should be someone who understands your goals for therapy, someone you feel you can trust, and someone with whom you feel safe sharing personal material. After all, therapy is an interpersonal exchange! However, keep in mind that trusting and safe relationships can take some time (sometimes months) to develop. Yet, in therapy, the therapeutic hour is only 50 mins. That’s all you get!

Therefore, I do NOT encourage you to doctor-shop after just 2-3 sessions. Why? This is because the first few sessions of any therapy are not only geared toward ‘getting to know each other’ (the relationship), but also you and your psychologist determining what the main issues are (including understanding the relevant historical factors), discussing ‘how’ therapy might best help you given your current needs and current level of psychological awareness, and then agreeing upon an agenda for the direction of therapy – and all of this must happen before the ‘therapy’ begins!

Although it could be said that good therapy trains you to be your own therapist–it can help you understand the causes of your own ongoing suffering and it can help you develop the skills to enable your salvation–being a client in therapy is not a passive role. Therapy is not simply something that is ‘done’ to you. Rather, the more active you can be, the better the outcome.

What do you bring to therapy?

My goal as a psychologist is to become ultimately redundant in your life (vs being your lifelong all-seeing, all knowing ‘Buddha’, ‘Guru’, ‘Yoda’, or ‘Master’). This means I am committed to helping you develop a vast array of inner skills and resources that you can apply to not only your current difficulties, but that will also assist you with future challenging situations.

Although psychologists know many things about many aspects of human nature and suffering, NO psychologist has all the answers to all of life’s challenges. Check-in with yourself (right now): What expectations do you have about therapy?

Are you hoping for a psychologist to ‘fix’ your difficulties for you – or are you prepared to learn about what you can do to approach your situation in new ways? This may include reading the material recommended by your therapist, doing some self-reflection, or practising skills learned in therapy between therapy sessions. 

Do you come to therapy with a time-pressure (or deadline) to ‘get better’? For example, many clients new to therapy say “Medicare gives me rebates for 10 sessions, therefore I need to be better within 10 sessions!”. Yet, ‘how long’ therapy takes is not determined by how many Medicare rebates you have.

Are you being realistic, given the effort you are willing to ‘put in’? Remember that a therapy session typically lasts 50 minutes. This equates to less than 1% of your week (there are 168 hours in a week). Thus, to get the most out of your therapy, how you reflect upon the work you are doing (what you do in between therapy sessions) is very important.

Things you can do in between your sessions (may) include: Giving yourself time and space to process and reflect on your last session; Keeping a journal; Preparing some notes to discuss for your next session; Reading the material recommended by your psychologist; Practising the therapy skills you are learning; or, to pay attention to your thoughts and feelings throughout the next week (which may generate additional material for future sessions). 

Note: this is not ‘homework’ – and although sometimes self-practice of skills may be set as homework – the above examples are simply things that you can do for yourself that will assist you to reflect upon and to apply the work you are doing in therapy to your everyday life. In doing so, this will help you get the most out of your therapy.

Do you have unrealistic expectations?

On the one hand, although people who have a single, isolated issue can do very well in less than 10 sessions, these people are also often: Highly functioning, with zero negative childhood experiences / past trauma; have minimal previous difficulties with anxiety / depression / self-criticism, have good relationships with their parents and family members, have a healthy social support network; have meaningful and sufficiently-paid employment from a supportive and flexible employer; are capable of being self-compassionate (vs being highly self-critical) when needed; are healthy in terms of having a good sleep routine and diet (i.e., including no substance use); have meaningful leisure activities / hobbies and are working towards meaningful life goals; are highly motivated to discuss challenging material – including if this relates to the dynamic between them and their psychologist, and, are willing to learn new information and implement therapy-skills in their lives.

However, it is rare for any issue to be a single, isolated event. It is more common to find that many of us have difficulties in most of the areas listed above. Yet, these areas, combined with relevant historical factors, your expectations and willingness to do the work, your current needs and current level of psychological awareness, and your previous therapy experiences (if any), are what you bring to therapy. Again, these all need to be determined before therapy can proceed.

Therapy does not ‘fix’ you

Psychotherapy is not medicine—you do not improve ‘just because’ you attend therapy. Unfortunately, unlike medicine, with therapy YOU have to do the work. 

Said differently, therapy is not ‘done’ to you. Rather, therapy happens when you work on a problem together with a psychologist. This means that therapy is an active process, which requires YOU to take part actively. 

Think of the following analogy: Therapy is like walking up a staircase. Your psychologist is like the bannister of that staircase (they are there to support you as you take each step). However, it is YOU who needs to walk up each of the steps. 

Psychologists are not Psychics

It might seem silly, but a common misconception is that psychologists can ‘read’ minds. Sadly, psychologists are NOT psychics—they do not know what you are thinking and they CANNOT read your mind. (A psychologist is simply trained in the science of behaviour change—they can help you heal old wounds, and learn new skills to help you change your behaviour and in turn your life, but they cannot know what is inside you unless you share it with them). 

Therefore, it is YOUR responsibility to let your psychologist know what is going on. After all, no-one can help you if they do not know what the problem is—and this is what the initial assessment sessions of therapy are about (i.e., What are the problems you are experiencing?, What would you like out of therapy?, What have you tried so far?, and, What is / isn’t working?). 

Good therapy trains you to be your own therapist: it can help you understand the causes of your own ongoing suffering and it can help you develop the skills to enable your salvation.

Fast Tracking Your Therapy with Authenticity

Good therapy can take time. But, it can be hugely valuable—both for you AND for your therapist—if you can be ‘real’ (i.e., authentic) with yourself and with your therapist. This can ultimately save you time. 

An example would be to share how you are feeling moment-to-moment—not just about the feelings that bought you to therapy—but also about how you are feeling about being in therapy, including your feelings towards your therapist and/or any fears, difficulties, or concerns you may have about them or (perhaps) what you may have (or may not have) discussed with them.

Although this might seem unusual at first (because this degree of moment-to-moment ‘sharing’ or authenticity might not be how you normally communicate with others), the following is a list of suggestions to get you started. Note—these are just suggestions. Being able to share your inner world with your therapist is an attribute that will really fast-track your therapy (and can give you an opportunity to practise assertiveness skills safely with your therapist that can literally transform your life beyond the therapy room). 

Statements such as the ones below will hugely help your therapist better understand both your inner world and your experience in therapy:  

• “I have a lot to unpack but my biggest fear is that you, my therapist, may judge or reject me”
• “This is what I want to get out of my therapy sessions with you”
• “When you just said that, I noticed my mind had the following thought…”
• “Something has been troubling me about my last session – here’s what it is…”  
• “This is what I need from you (i.e., this is what I am hoping to get from our session) today…”
• “I don’t really feel like we have talked about… but I think we need to”
• “I don’t think I fully understand why you are making the recommendations that you are making”
• “I would prefer to do ‘X’ vs ‘Y’ in our session today…”
• “Part of me is really struggling to be in therapy because…”

Fast Tracking your Therapy: Take Notes

Take notes. Do this before you start therapy. Do it during therapy. Do it after your session.

Before you begin therapy (and in-between your therapy sessions) take notes that capture your thoughts, your concerns, your emotions, or your triggers. This will give you something to help remind you if you find you loose focus in your session (often people ‘forget’ what happens to then during the course of a week). Your notes can also help you with setting an agenda, if that is something that is important to you.

The benefits of writing your thoughts and feelings are well-documented. Some of the immediate benefits are that it allows you to ‘have’ the emotions / experiences that you are having, while you are documenting them. This can give certain ‘parts’ of yourself a voice (vs trying to push away or distract from an experience).

Another benefit is that once you have captured your experience with a pen, you do not have to keep trying to remember it (‘better out than in!’). This means that once documented, you do not need to revisit it again until your session. This can free you up to have new experiences (it might not—there are no guarantees—but writing things down at least makes this possible).

I also recommend taking notes during (or immediately after) your therapy sessions. Sometimes you (or your therapist) may say something hugely insightful that you want to capture. Often, this can happen multiple times within a session, and it may be difficult to recall ‘what’ or the precise way things were said. Having a pen (or a notepad app on a phone) can be a very useful way to capture this information. 

Finally, being able to document your ideas and reflections can be a useful way to consolidate things you are learning. There may be a specific way that you prefer to do this, or there may be ways to do this that tie in well with how you and your therapist are working. If in doubt, discuss this with your therapist.

Problems: The Relationship

The issues you have outside of therapy often show up in session. This is helpful because it gives you an opportunity to practice healthy coping and relational skills in a safe environment with your psychologist.

It is also a good idea to talk about your relationship with your therapist in therapy. If you realise you are not fitting well with your psychologist—it is YOUR responsibility to do something about it.  First, bring this up with your psychologist (!) – talk about your relationship with your therapist in therapy. Give them some feedback and tell them what is not working for you and what you need from them, in order to do the work that you need to do. Often, a psychologist is trying hard to work with you in ways that they think will be ultimately of most benefit to you. So, help them help YOU, by vocalising how they can best help you. 

If the psychologist can change how they work with you, then this problem has been solved. If not, then you have a choice: you can decide to persist a little longer either to see if problem resolves itself naturally (or whether the benefits of continuing with therapy outweigh the issue), or you can consider working with another psychologist.

Keep in mind that experienced psychologists will also draw attention to aspects of the therapy relationship that they see as problematic (after all, this forms part of their training). However, it is important to remember that a psychologist is not a psychic and they cannot read your mind. The section above ‘Fast Track Your Therapy with Authenticity’  contains some key phrases that you could use (or could adapt) to help direct your therapist’s attention to your experience. 

Think about the following analogy: Going to a psychologist is much like going to get a haircut. You must explain what you want and, while the haircut is underway, you must continue to give feedback to the hairdresser to ensure that you will be ultimately satisfied. If you do not give any feedback, you are essentially placing all of your hope in the psychic abilities of your hairdresser – and a hairdresser is not psychic (so you could end up with a haircut you did not want). When this happens, if the next time you get a haircut you explain what you want, you then give your hairdresser the best chance to adjust their approach to meet your needs. If this still results in nothing changing, then you might consider a different hairdresser. The same thing should apply with your psychologist.

Take home message:

It’s good to talk about your feelings about therapy in therapy.

What if You’re Getting Worse ?

As illustrated beautifully in the above image: Change is NOT linear (!). Sometimes things may seem they are getting worse before you feel they are getting better. This means that strong emotions may come to the surface either during your session, or between your therapy sessions.

First, understand that you do NOT have to do anything in therapy that you do not feel comfortable doing—all psychologists are bound by a Code of Ethics, which means they must explain any procedure fully with you before you try it. Second, know that it is the responsibility of your psychologist to teach you skills to help you self-regulate before working with challenging material so that you have a way to soothe and settle yourself both during and between your sessions. In this way, although therapy may sometimes challenge you, this should be kept within a range that is tolerable (commonly referred to as the Window of Tolerance). 

However, sometimes after a session you may feel that you are more contemplative, self-reflective or preoccupied while you process the information covered in therapy (this could last for up to 2-3 days after your session). When working on processing challenging (but significant) material, this is quite normal and is OK – as long as you have self-regulation skills in place (discussed above) and the right approach to this process. 

By this, I mean remembering the ‘bigger picture’: That you are working through this challenge for a greater future, a more rich and meaningful life where you are freer to be the person (and to have the relationships), that you ultimately desire.

Sometimes, things may even show up in your interactions with your psychologist that reflect or recreate the SAME interpersonal struggles that you face with others—after all, the relationship you have with your psychologist is like a magnifying glass on many of the issues that show up in your relationships outside of the therapy room.

When this happens—it is hugely important to discuss your internal experiences, with your psychologist. Again: Talk about therapy in therapy (use the suggestions in the bullet points on Fast Tracking your therapy above). 

For instance, I once received after-hours messages from a client who grew increasingly agitated that I had not responded (despite him being well-aware of my work hours). However, at our next session when we unpacked this client’s reaction – we discovered that what really was going on was that this experience had reminded him of early childhood feelings of being abandoned by his father (an experience he had created a narrative around, whereby he ran with a story “I’m not important / I don’t matter to my therapist”). Because he had been willing to share how the experience had made him feel, once he was about to understand that what his mind had been telling him was not what had actually happened, we could then look at how his intense anger had spiraled him into feeling worthless, isolated and self-critical which made his mood plummet.

Because he shared his inner reaction with me, we were able to unearth an important ‘lens’ through which he was viewing ALL unrequited bids for connection with others. Once this made sense to him, he could then be more aware of his own unworkable commentary (and how much this often led him to attack others and push them away, leaving him trapped in a self-fulfilling cycle of loneliness…!).

This event ultimately became a personal ‘breakthrough’ for this client – he realised he was doing this with everyone in his life, and his relationships (and his relationship with himself) were suffering as a result !

After discussing the way this pattern had unfolded between us, we were about to later work towards finding adaptive ways for him to “check in with others” (vs jumping to false conclusions), to soothe and to reassure himself in moments requiring patience, and also to express his need for ‘connection’ in ways that were workable. In the end, instead of continuing to take actions that were destroying his relationships with others, he was able to learn that moments such as the about example were opportunities to strengthen them. In turn, these new skills became a source of insight, resilience, and growth.   

Knowing when it’s not working: When to find someone else

Therapy is a choice – it’s your responsibility to share the material that you want to work on, it’s your responsibility to share when you are challenged by therapeutic material, and it’s your responsibility to share when you are challenged by aspects of the therapeutic relationship. 

Although therapy can be difficult, ideally you want to feel you and your psychologist are working as a TEAM – a team that you want your psychologist to be part of.

However, if overall you consistently feel worse because of your therapy, or if you consistently feel confused or feel worse about yourself or your situation after your sessions (and you have already discussed each of these with your psychologist), this may be a sign that you might want to consider trying another psychologist.

Ask yourself: ‘do I really want this?’ / ‘is seeing this psychologist really working for me?’

Be realistic – realise that you cannot get along with everyone (and that’s OK!). You do not have to like everyone (it’s OK to feel like this!). What you should not do however, is jump to the conclusion that: ‘all psychologists are BAD’ or the conclusion that: ‘no one can help me!’.

Going back to the previously discussed ‘hairdresser’ example – if you are not happy with the way your hairdresser cuts your hair, it is unlikely that anyone would jump to the conclusion that: “all hairdressers are bad therefore I will never have another haircut ever again!” (you would simply find a new hairdresser!).  

After all, it is your time, your money, and your life that you must live!

Summary:

• Therapy is not something that is ‘done’ to you – it is an active process that requires YOU to do the work.
• Good therapy trains you to be your own therapist: it can help you understand the causes of your own ongoing suffering and it can help you develop the skills to enable your salvation.
• Therapy is different to seeing a doctor – you need to do MORE than just ‘turn up’ if you want things to change.
• A good psychologist can support and guide you through the process (like a bannister on a staircase supporting someone walking up the steps), but YOU need to take each step.
• Psychologists are NOT psychics – they cannot read your mind. Therefore, it is YOUR responsibility to openly share the things that need to be worked on.
• The relationship between you and your psychologist is VERY important – it is more important than which ‘type’ of therapy is being used.
• Difficulties in the therapy relationship and/or misunderstandings about what is discussed are VERY IMPORTANT things to share with your psychologist. Remember to talk about therapy in therapy with your psychologist – this is part of any good therapy. 
• Often, interpersonal difficulties that you have (outside of the therapy room) will also show up in the relationship that you have with your psychologist. THIS IS ALSO VERY IMPORTANT MATERIAL TO WORK ON WITH YOUR PSYCHOLOGIST. So, again, don’t run from therapy at the first sign of interpersonal difficulties – STOP and share these with your psychologist so that you can learn about these patterns.
• Remember, you are only spending 50 min each time with your psychologist. Yet, relationships can take time to develop – So, sometimes, it can take several sessions for your relationship to develop with your psychologist.
• Finally, therapy is YOUR choice. If you have discussed problems between you and your psychologist and you have tried working through these (yet these problems continue to show up), consider trying another psychologist. After all, it is your time, your money, and your life that you must live!

Further articles: 

I write self-help articles that aim to be informative and helpful for all audiences, especially my clients. These articles cover many of the most common issues that I observe people struggling to with, and they address common knowledge gaps that I believe will be helpful for all people to understand. To view a list of all articles that I have written, click here.

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