Understanding How Therapy Works

Therapy is experienced differently by different individuals. There is no magic wand in therapy to quickly and easily fix all problems. Instead, therapy should be seen as an investment in yourself with benefits revealing themselves as the process unfolds. A couple of questions to ask yourself at this point may be:

• Why am I thinking about getting therapy at this time?
• What do I hope to get out of therapy?

The timing of starting therapy can be helpful for both you and your therapist. This question, “Why am I thinking about getting therapy at this time?” more than likely will be asked by the therapist to get an understanding as to what might currently be going on in your life. But it may also give you time to reflect on “Why now?” as well. The timing of you getting into therapy can often ascertain the degree or seriousness of your problems.

“What do I hope to get out of therapy?” may sound like a simple question. You may have tough decisions you are trying to make and would like to discuss your options with a therapist. You may have goals you want to achieve and would like direction in getting started. You may need support in trying to tackle an addiction. Know that your decision to get into therapy may not necessarily be caused by a terrible or serious event. Perhaps today is just the day you decide to make the call to get relief from your nagging, time-worn symptoms. It doesn’t matter how you arrive at therapy as long as you get there sooner than later.

The therapist you select will have their own style and training. In order to get the most out of the process, the relationship between you and your therapist should take priority. Without a mutually respectful and trusting relationship, one in which you feel safe divulging your innermost thoughts and feelings, the therapy process will be superficial at best. Only when you do not feel judged and that the problems you present are being taken seriously can you truly open up and discuss your fears and concerns. You need to feel you are being heard and understood. An astute therapist may repeat what you say to get a better understanding of your unique circumstances. This allows the therapist to work with clarity and effectiveness. It is also a good indication that the therapist is invested in completely understanding your concerns. Two more questions to assess the therapeutic bond may be:

• Is the relationship with my therapist a good fit?
• Do I feel comfortable sharing the intimate details of my life with my therapist?

Ask yourself these questions shortly after starting therapy. Do you have a sense that you and your therapist can work closely together concerning your issues? Does your therapist make you feel at ease in discussing your concerns? Therapy is a two-way street with mutual dialogue occurring during the course of the session. It is important that you and your therapist are both vested in the outcome of your work together to get the best results. As the therapy progresses, these questions may come to mind:

• Do I feel my therapist has the experience needed to help resolve my issues?
• Do I believe my therapist has the proper skill level in order to guide me?

Another important factor in the therapy process is the knowledge base of the therapist in relation to your particular issues. Many therapists have a lot of training and experience, but no one is a specialist in all areas. This can be discussed in the initial session when you present the problems for which you are seeking help.

If your issues are outside the scope of the training of the therapist, he or she should make that known and offer you a referral to a therapist with more experience. You have decided to seek therapy in order to learn coping skills, to discuss a difficult decision to be made, or to feel better in general. That can’t happen if you don’t feel your therapist understands your situation or is well trained enough to work with you on your particular problems.

Chances are, you will establish a connection with your therapist right away. However, if for some reason you don’t feel like it’s a good fit, it’s better to take the time to discuss this with your therapist as opposed to just dropping out of treatment. Leaving therapy abruptly may put your progress on the back burner. Even if you decide to seek out other therapy options, I recommend being open and honest with your therapist throughout the treatment process.

Client Responsibility

Therapy sessions are usually scheduled just one or two times a week, so you will be with your thoughts and feelings many more hours outside the therapeutic environment. Therefore, it is important that you practice the skills learned in the sessions and engage in introspection (the ability to sit and think about what transpired in the sessions) prior to subsequent sessions. Being motivated to feel better will be invaluable to you, not only in the face-to-face interactions with your therapist but in your time outside therapy as well. Motivated clients are better invested in the therapy process and progress faster. Ultimately, the client is responsible for their own healing.

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Therapy is hard work and is a nonlinear process. Invariably, there will be many steps forward, but also some back. This is part of the process. The more you work on your issues on your own and the stronger you become, the more you’ll feel a sense of accomplishment. And with each accomplishment, another “step” will have been climbed on your way to reaching your goals. This is the growth you will notice, where greater confidence and self-esteem are established.

A Sanctuary

A therapeutic environment has been described by some as a “sacred” place. It should be a comfortable and safe space, unlike any other place where you can talk about your issues. Where else can you get the attention of an objective, non-judgmental person where confidentiality is assured?

Many clients have told me they have confided in family and friends only to see their issues become more complicated. Families have been splintered, “secrets” revealed, and friends lost over “advice” that may have not been in the person’s best interest. This is what makes the clinical environment so special. In order to maintain the integrity of the therapy process, I would like to list what I will call “clinical interrupters” that can get in the way of any progress that has been made:

• Setting up your appointment. If you call your therapist and do not reach him or her directly, leave a clear message so a return call can readily be made. Repeating your phone number a second time is a good idea.
• Keep your appointment. Outside of a true emergency, therapy sessions should not be canceled, as to do so can have a negative effect on any progress achieved. Also, not showing for a session and not calling the therapist is a clinical issue and should be discussed in the next session.
• Avoid distractions. In order to keep focus in the therapy session, cell phones and electronic devices should be turned off. (In the case of a potential emergency, let the therapist know your phone will be on at the beginning of the session.)
• Therapist guidance. Although the session is yours, allow the therapist to provide structure. Initial paperwork should be completed and questions may be asked so that the therapist can get a better understanding of the clinical issues.
• End of session. With a cue from the therapist, let the session wind to completion. Avoid “doorknob confessions,” or bringing up important information as you are walking out the door. Sensitive issues should be discussed at the beginning of the session, not at the end. The clinical dynamics of exiting “revelations” should be discussed in the next session.
• Completion of therapy. It is imperative you do not leave therapy suddenly. There is a therapeutic process for termination, and leaving abruptly before the clinical process has been completed can damage your progress. Therapy is a special commitment that can help minimize or elevate troubling issues in your life. It is a professional, confidential, non-judgmental, and uplifting experience that can truly be life-changing. Most people experience a sense of relief right after setting up the appointment and report feeling better as they get into their treatment.

As always, make a call to a therapist sooner rather than later.

This post was adapted from the book, When to Call a Therapist (Scrivener, 2019), by Robert C. Ciampi, LCSW.

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