Congratulations! You just booked a therapy appointment and have taken an important and brave step to becoming a better version of yourself. The only thing is, you’re not quite sure what to expect out of therapy. Sure, you’ve seen therapy portrayed in all sorts of television shows and movies before. Usually, some sage-looking person is nodding, saying “uh-huh,” and taking furious notes on the pad in front of them. But what is therapy in real life? What differentiates “good therapy” from “bad therapy?” How do you know if you’re working with the right person for you? Well, never fear: I’ve got the answers to those questions and more below. Read on!
What Therapy is (and what it is not)
In order to know how well something is going, you have to know what the nature of that something is. So let’s first talk about what therapy really is. And to do that, we need to talk about what therapy isn’t! Therapy is not a place where you go just to “vent” to someone else, or to be given advice on what to do with your life. Therapy is a place where you go to share what you’re struggling with and what’s on your mind, and then have a trained professional assist you in learning the skills and tools you need to effectively handle those challenges. This can look like a lot of different things depending on the nature of what you’re coming into therapy for, but most importantly, therapy is about empowering an individual to eventually solve their problems on their own, not to become dependent on someone else for advice. (For more examples of what therapy or psychiatry is NOT supposed to be, check out the super interesting podcast “The Shrink Next Door.”)
Think of therapy like a dark cave; you enter this cave of yourself, wanting to explore all the nooks and crannies to gain a better understanding of yourself, your struggles, and how you relate to other people. The therapist is not your tour guide of the cave: they don’t know this dark cave any better than you do! The therapist’s role, however, is to hold the flashlight, to help you illuminate and explore small parts of the cave to gather a more complete picture of it overall and to understand how each part interplays with the other parts.
The Therapeutic Relationship
The therapeutic relationship is very important to understand because it is a very unique kind of relationship that really isn’t replicated in any other domain. After all, how often do you share about yourself exclusively with someone, while not knowing much about the other person at all? (If the answer is frequently, that’s something that should be addressed in therapy!) The therapy relationship is first and foremost defined by boundaries, which involves the emotional distance from a client to be able to keep the nature of the relationship professional and safe. These boundaries are established in many different ways. One way is by keeping contact outside of sessions professional and appropriate (some therapists give out their personal cell phones for scheduling, others do not and communicate by office phone or e-mail instead.) Another way is by establishing firm rules about the timing of sessions: not constantly letting sessions run way over or way under time, being respectful of the schedule agreed upon by both parties, etc. A therapist’s ability to maintain appropriate boundaries is especially important when clients struggle with boundaries themselves: it can model how to set boundaries and can help communicate to a client when their behavior may be inappropriate. Additionally, your therapist’s ability to set appropriate boundaries demonstrates that you are getting the best version of them, the one who is aware of their own needs and prepared to be most helpful to you, as opposed to one who is emotionally overwhelmed to the point where their own boundary-setting suffers.
Now that we’ve established the basics, let’s get into the specifics of the relationship with your therapist itself. This relationship should be one that is secure, trusting, and non-judgmental. Yes, you hear those buzzwords all the time when it comes to therapy, but I really mean it! If you’ve spent a few sessions with a therapist and don’t feel like you’re able to trust them with sensitive information or feel that you’re being judged by them, that does not bode well for a positive outcome to therapy. Of course, it takes time to get to know someone and trust is something that is built upon gradually, but even from the outset the environment in the therapy room should feel safe and comfortable to you.
Normal Ebbs and Flows In Treatment
One of the most important things I talk about with my clients in therapy is having reasonable expectations of themselves and of the therapy. I like to use the metaphor of a dimmer vs. a light switch: rather than flicking on a light, the process of therapy takes time and is much more comparable to slowly turning up a dimmer switch. With that in mind, though, it’s important that over the course of time in therapy, you do feel like you’re making progress. Even though this progress will be slow (and is often quite challenging,) you should be moving forward. If you’re feeling stagnant, or like you’re not meeting your goals in therapy, that needs to be addressed.
Walking the Line
You may want to check in with yourself and your therapist: is my therapy teaching me new skills, and showing me new perspectives? Good therapy walks the fine line of being validating of a person’s struggles, while simultaneously- and gently- helping the client gain insight into ways in which they may be contributing to their own struggles. If you just have the validation piece, your therapist is doing you a major disservice. Therapy is not supposed to be easy or fun (although hopefully there is some fun mixed in there too!). It is more often than not a lot of very hard work, which is exactly what is necessary to make changes to long-standing habits in your life.
When it comes to seeking the right therapist, their educational background and training matter! It is important that you find a professional who has the appropriate knowledge to be able to help you, which may sometimes involve finding someone who specializes in what you are seeking treatment for. For example, if you were seeking therapy for trauma, it would be important to find someone with training in this area to ensure that you were getting the best empirically-supported treatment possible. An ethical therapist will not treat a patient who is seeking services for something in which they are not trained!
It’s Okay to Ask for What You Want!
I would be remiss if I didn’t address the inherent power differential in the therapy relationship. As a trained and licensed professional, your therapist is in a role of authority in the relationship with you as their client. They are the expert in their field, and (hopefully) have the skills and clinical judgment to know what is best for their clients. This does not mean, however, that the client should not play a role in determining the course of their own therapy! Goals at the outset of therapy should be set collaboratively between the therapist and the client and agreed upon by both parties.
As therapy progresses, if you feel like your immediate concerns and needs aren’t being addressed, it is totally appropriate to share these concerns with your therapist. Perhaps they’ve gotten a little off topic with what they think would be most helpful to you vs. what you think would be most helpful. After all, this is your life, and the changes that you want to make are very important. Especially for clients who struggle with assertiveness, it can be very hard to challenge or question an authority figure like your therapist. Which, again, is why my points above about having a safe, trusting relationship are so vitally important.
What to do Between Sessions
Now you’re in the groove, and if you’re like most people, you’re spending about an hour a week in therapy. Excellent! But what do you do with the other 167 hours of the week? Hopefully, at least sometimes, you and your therapist work together to design “homework” assignments to help you continue to work on your new skills or gain more data or information between sessions. This could look a lot of different ways: like journaling, doing worksheets, conducting behavioral experiments (AKA trying on new behaviors and collecting some data on the results), testing out new skills, engaging in exposures to things that make you anxious… the possibilities are only limited by your creativity! Engaging in work between sessions is the best way to maximize your results and speed up your progress in therapy.
Red Flags for your Therapist
Most therapists are awesome and know exactly what to do to help individuals achieve their goals in a safe and healthy way. That being said, there are bad apples in every profession, and psychology is no exception! Therefore, I want to include a list of some of the red flags to look for. If your therapist exhibits any of these behaviors, it might be time to move on and find someone else to work with:
- Oversharing: while sharing some details is appropriate (after all, therapists are people too!), oversharing demonstrates that the therapist struggles with setting boundaries themselves. Sharing things from their life that may be relevant to you or what you’re talking about is appropriate occasionally. However, if it starts to feel like you’re learning more about them than they’re learning about you, you’ve got a big problem.
- Struggling to remember what you share: we’re all human, and occasional lapses in memory are normal. But given that a therapist’s job is mainly to listen to you, it would be very concerning if you found that your therapist frequently didn’t remember important details you had discussed with them, or there were other cues to indicate that they may not have been listening as attentively as they should have.
- They disrupt the session: if your therapist is frequently interrupting or pausing your sessions to take phone calls, respond to texts, or answer e-mails, they are not doing their job. During your 50 minutes a week with your therapist, you should be the sole focus and priority, period.
- They behave unethically in any way: this could mean a lot of things, from outright sexual advances by a therapist to more subtle breaches of professionalism, including suggestions to engage in any contact outside of the role of therapist and patient. For example, it wouldn’t be appropriate for your therapist to invite you out to coffee or to a social event, since that would be in conflict with the nature of your doctor-patient relationship.
- You feel judged, pathologized, or blamed in therapy: again, there is a difference between helping someone recognize their part in an unhealthy dynamic with empathy and compassion vs. blaming them for their problems. If you often leave therapy sessions feeling worse than when you came in, that is definitely a red flag. To be clear, you don’t always necessarily feel better, even after an awesome and insightful session, but it shouldn’t be a consistent pattern of feeling worse after each session.
Finding the right “fit” with a therapist can be a challenging and frustrating process. Or, sometimes you get lucky on your first try and just “click” with the first therapist you meet! Either way, taking the time and effort to find a good therapist for yourself can be literally life-changing. While it can seem daunting at first, I hope that the tips listed above can provide some guidance in what to look for and what to avoid as you search for the person who can help you gain a better understanding of yourself and how you function within this world.
If you are looking for the right therapist, why not give one of our highly-trained clinicians a try? At Integrated Care Clinic, we pride ourselves on providing the most up-to-date evidence-based treatments to ensure that you are getting the best care possible. Make an appointment online or give us a call today!