How to Make the Most of Your Time in Therapy
If you're new to therapy, perhaps one of the most important things to know right off the bat is that seeing a therapist is very different from seeing a medical doctor. Generally speaking, the process of getting help from a medical doctor is a fairly straightforward endeavor — you tell them your symptoms, they prescribe any number of tests to gather objective data about your health, and they give you a diagnosis and a recommended course of treatment. If you adhere to the prescribed treatment regimen, then (hopefully) your condition improves. There just isn't a lot of guesswork about what you're supposed to do as a medical patient. Just follow your doctor's orders as closely as you're able, and get a free lollipop at the end of each appointment for your trouble.
If you're seeking mental health treatment, it's possible that you may receive care from a psychiatrist. Psychiatrists are medical practitioners specializing in mental illness, and they are typically able to prescribe psychiatric medications for the treatment of mental disorders. In many ways, unless your psychiatrist is also acting as your therapist, engaging in psychiatric treatment is mostly a matter of adhering to your prescribed medication regimen and checking in with them every so often to report how you've been doing. At times, your psychiatrist may adjust your medications depending on your progress. This process, often referred to as medication management, is also fairly straightforward and requires little guesswork on behalf of the client.
Psychotherapy, however, is quite different, and almost anyone who has participated in therapy for some time can tell you that there's something 'fuzzy' about the way it works. In therapy, there often aren't clear-cut guidelines or treatment regimens to follow, and — to be blunt — often times your therapist won't know what's best for you. This can initially be confusing or offputting for people who are new to therapy and expect treatment to work similar to medical treatment. After all, if therapists are supposed mental health experts, why can't they just tell you what steps you should take to improve your mental health?
Questions such as this are valid and deserve explanation. To help move clients forward and make the most of their time in therapy, we've created a list of therapy "do's and don'ts" to highlight the ways in which clients play a significant role in shaping their course of treatment and in their own success.
Don't: Don't expect your therapist to change you.
Do: Believe that you have the innate capacity to change yourself.
Explanation: You might hope that, from all of the words in the English language, a therapist could find just the right combination of words to spark the change within you that you've been seeking — a combination of words so powerful that you'll leave your appointment with a new outlook on life, and a better person because of it. After all, psychotherapy is often called "talk therapy" for a reason, isn't it? As much as we might wish it to be the case, this isn't how therapy works. While a therapist's job does involve the use of language to help elicit change, ultimately it's the active changes that you make which matter most. A skilled therapist will carefully listen to you and use language to not only help you clarify what's important to you, but to channel the motivation you need to accomplish your goals. That is the magic of counseling — the process of learning, in supportive collaboration with your therapist, how to become an unstoppable force for positive change in your life.
Don't: Don't hope or expect to be told what to do.
Do: Be willing to take ownership over your treatment plan.
Explanation: Clients who share decision-making responsibilities with their therapist and actively select the treatments they receive tend to experience better treatment outcomes, have a higher level of satisfaction with treatment, and are more likely to see treatment through to completion.1 Thus, a successful relationship between client and therapist is a collaborative one. While your therapist is an expert in how to administer psychotherapeutic treatment, you are an expert in what is most important to you. Instead of imposing various treatment goals upon you and expecting you to adhere to them, a skilled therapist will help you to clarify your values to create your own treatment goals. Achieving goals that you've set yourself is something to be proud of, and is a valuable skill that extends beyond the treatment setting and into all areas of your life.
Don't: Don't feel pressured to tell your therapist everything.
Do: Be honest.
Explanation: Therapy can be uncomfortable at times. Not only is it often difficult to talk about some of our deepest, darkest, and most sensitive issues, it can be even more difficult to talk about them with a relative stranger. Therapists understand that you might not be ready to talk about everything right from the start — and that's okay! It's much better to start therapy from a place where you feel comfortable rather than diving straight into a topic where your level of discomfort might do more harm than good. Just because you aren't ready talk about certain things — even if they're directly related to the reason you sought help to begin with — doesn't mean that there isn't valuable work to be done or progress to be made. Being honest with your therapist about what you're not ready or unwilling to discuss empowers you to take things at your own pace, and also helps to ensure that the things you do discuss will be the issues that you want to engage with and focus on the most. The more engaged you are in therapy, the more invested you'll become in your success. If and when you're ready to try to explore those more uncomfortable issues, your therapist will still be there to help you through them.
Don't: Don't assume your therapist should guide every therapy session.
Do: Spend some time before your appointment preparing what you'd like to discuss.
Explanation: It can be easy to fall into routines. It's almost certain that at every counseling appointment your therapist will ask you some variation of the same questions: How have things been since your last appointment? What are some of the challenges you've been facing? What are some of the things that have gone well for you? If you come to counseling without any idea of what you'll discuss, your counselor can certainly pepper you with all kinds of exploratory questions to try to get some type of meaningful discussion going. However, as comfortable and familiar as it can be for some to let their therapist take the reins and guide the conversation, this probably isn't the best way to make use of your time in therapy. Spending some time before your appointment thinking about the most important topics that you'd like to discuss (bonus points for writing them down) can help to make sure that you're spending as much time as you can addressing what matters most to you. This practice also gives you a dedicated opportunity to evaluate and reflect upon your progress, which is in itself a useful habit to develop.
Don't: Don't worry if you feel "stuck" or aren't making progress.
Do: Talk with your therapist if you feel you've hit a roadblock.
Explanation: Feeling stuck in therapy, also sometimes referred to as "deadlock," "impasse", or "plateau", is a common experience. The trajectory of mental health recovery can look different for each client. For example, some people may experience "stuckness" early in therapy and may only begin to experience significant improvement later in treatment, while others might experience rapid initial improvement which begins to plateau.2 Clents in the former group may wonder why they haven't experienced any significant progress after a few therapy sessions, while those in the latter group may wonder why their excellent initial progress seemed to suddenly screech to a halt. These experiences are normal, but it's important for clients and therapists to identify and address "stuckness" when it happens. Impasses and plateaus can occur for a variety of reasons, but they can also represent an important opportunity to take a step back, evaluate what is and isn't working in therapy, and recalibrate your treatment plan.
Don't: Don't be afraid to communicate feedback about how you feel therapy is going.
Do: Let your therapist know if you aren't satisfied or have concerns about your treatment.
Explanation: Therapy isn't a perfect science, and there are a number of reasons why you might not feel satisfied with the treatment you receive. For example, maybe you aren't seeing the results that you had initially expected, or perhaps you feel that your therapist isn't the best match for you. People enter therapy with a wide range of expectations, and it's not uncommon for one or more of these expectations to be unmet. When this happens, we recommend making your therapist aware of how you feel about your treatment so that it becomes possible to work toward a satisfactory resolution.
While it might be nerve-racking, fear-provoking, or intimidating to tell your therapist about your dissatisfaction, there are two very good reasons to do so: First, therapists are trained to respond impartially to criticism and other statements directed toward them. If your dissatisfaction concerns your therapist themselves, their treatment style, or the therapeutic process in general, skilled therapists know how to view your comments as an opportunity to pivot and work with you to find an adequate solution. Second, therapists want to see their clients succeed! Your therapist would much rather be aware of your dissatisfaction so that they are able to re-evaluate how to best support you, instead of being unaware of your dissatisfaction and continuing to provide you with suboptimal treatment.
Footnotes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176894/
https://www.sciencedirect.com/science/article/pii/S0165032718324443#bib0025
