What happens in therapy?
Therapy can be a mysterious process. You hear your friend talk about how counseling helped her get her daughter’s behavior under control. Or you hear a couple at game night talk about how marriage counseling saved their relationship. Or your mother might say how counseling has helped her feel more in control of her emotions. But what exactly happens behind the closed door of the therapists’ office?
There are a number of reasons it can be unclear what happens in therapy.
First of all, since every person who walks in the door for counseling has different needs, every person’s experience of counseling is a bit different.
Second, everyone processes things differently. Some people are “externalizers” and figure out their problems by talking. Some are “internalizers”, and process their thoughts inside and only speak when there is a formed thought or conclusion. Even the timeline that we process things can be different.
Third, all of your information in counseling is completely confidential, so unless your friends talk about what goes on in counseling sessions, the therapist sure won’t tell you.
Fourth, each therapist can be different. Not only are we different people with different characteristics (introverted/extroverted, forward/couched, etc.) but there are tons of different approaches to therapy.
So really, it is no wonder that therapy is different for each person. It can be hard to buy in to a process that you don’t know and aren’t familiar with. All you really have to go on is the word of friends and family who have seen the benefits of therapy. Or worse, have had a bad experience with therapy in the past. As a therapist, I cannot speak to specifics of actual sessions I have had with clients, but I can paint some broad strokes of what therapy looks like with hopes that it sheds a little light on the process. Please know that I can only speak to how I operate in therapy, and not to all therapists in general…though many aspects may be similar.
Therapy is an individual process.
Like I said, therapy is individual to you and your concerns. Whether you are bringing your child in to get him to brush her teeth and sit still for once, you and your partner are constantly arguing, or you are wrestling with anxiety. Therapy gets tailored to meet your individual goals. As a therapist, I make it a rule to set goals with clients at the start of therapy. Those goals may change as you progress, but it allows us to stay focused, and assess the effectiveness of therapy as a whole.
Therapy is also tailored to your own personality and values. If you would like to sit in the counseling office and vent, you can. Sometimes talking things out is therapeutic on its own. Your therapist may interject or offer alternative ways to view a situation, in hops of achieving your goals. For example, if you are struggling with depression and a friend cancels plans they had to see you, you might say “I can’t believe she doesn’t want to spend time with me.” Your therapist might suggest alternative explanation for the same event. How to look at things differently.
If you are someone who likes to implement practical, step-by-step interventions in between sessions, therapy can include that. Your therapist can provide worksheets, articles, or charts to explain concepts discussed in sessions. You may even receive written homework assignments to try in between sessions to improve your symptoms. For example, you might get a sticker chart to plot the success of your child in their quest to take a bath during the week. Or you may get an assignment to write down three things you are grateful for each day. It is tailored to how you make the most progress, which is a learning experience for both you and your therapist.
You talk about your concerns.
Many times when you see therapists portrayed on TV, they are holding a notepad and scribbling notes while smiling and nodding to their client. No, that’s not typically how therapy works. In most cases, your therapist should not be talking more than you do during the session. Therapy is your time to express how you are feeling, talk through your concerns, and work out solutions. It is often a conversation between you and your therapist.
Therapy provides a unique opportunity to talk about what is bothering you to an objective third-party who has no personal stake in your situation. For example, if you want to vent about your husband, but all of your friends interact with him regularly and your mom already has a poor opinion of him, your therapist can be the person to talk to. Or if you and your partner are trying to have a baby, but you don’t want the pressure of people in your life knowing about it, counseling can be the place to voice your concerns and frustrations.
You say what works and what doesn’t.
You are the expert of your own life. Yes, your therapist knows what science suggests is the best course of action to relieve depression, manage emotions, or curb problem behavior. And while it helps to have an open mind, to try new things, you are the one who knows what will work and what won’t for you or your child.
If your therapist suggests going outside for a walk, but you have terrible allergies this time of year, tell them. When they suggest talking to your estranged mother who you fought with years ago, but you aren’t ready, tell them. If your child doesn’t respond to sticker charts, tell them. Therapy works best with your input, and the only way your therapist can help you find strategies that work is by giving feedback for what doesn’t.
Similarly, if you aren’t enjoying your sessions, want more or less structure, or are upset by a way your therapist is handling something, speak up. Often times your therapist can adjust their approach and make it more comfortable for you. Therapists are humans, with their own personality. Our primary concern is that you are getting the best and most effective help for what you need.
Your therapist will work as hard as you do.
Your therapist is a trained professional in providing counseling, so they have a lot of skill in helping you discover what’s wrong and what will work to fix it. However, therapy does take work on both sides. You have to put into practice the things learned in sessions in your daily life. One 50-minute sessions every week or two is not going to change habits that you are doing 24 hours a day, 7 days a week.
Therapy is work simply by being there. It can be difficult to tolerate talking about vulnerable situations with negative emotions included. Therapy can also include learning new skills or habits to make life go a bit better. So there is an expectation that you will put new skills into action. This can be as simple as noticing your emotions throughout the week, or it can be something that takes more effort like journaling.
Please note that this does not mean you implement new things perfectly. Just simply that you try.
As a direct result, you make more progress and get farther the more work you put into the sessions. Your therapist will be able to provide new skills to address your problems next time you come in.
So, what do you do now?
Hopefully this gives some indication of what happens in therapy. Many people are wary of therapy because of the unknowns. Here are some tips for going into therapy and making your first appointment:
Be picky about your therapist. Since therapy can be different for everyone, try and choose a therapist that you connect with. Read over their website, blog or online profile. And if you attend your first few sessions and don’t feel you connect with them, try someone else.
Keep and open mind. Be willing to try something new, or retry something that you tried in the past.
Communicate with your therapist. Tell them what you like and what you don’t like about sessions.
Make an Appointment. Nothing can get better unless you make the choice to change. To do something different than how things are now. Do the work, find a therapist you like, and make the call.
I’d love to hear from you. What do you hope therapy does for you? What have your experiences in therapy looked like behind the closed door of the therapy office?
Erica K. Cieri, LCSW is a therapist and trainer at Made to Thrive in Williamsville, NY. She specializes in working with kids, teens and college students dealing with anxiety, behavior problems, tough relationships and difficulty managing their emotions. She collaborates with her clients to develop strategies to manage their current issues, but also to discover long term how to find peace. Erica can be reached at firstname.lastname@example.org.