All Therapy Is Exposure Therapy

Let’s say you plop on my couch.

“So, what brings you in?” I ask.

You start with a sigh, and at first speak in short, vague statements.

“I’ve been feeling down,” you say. Or “I’m having problems in my relationship.”

“Tell me more,” I say.

As I start to get curious, you begin to recognize that you are accepted in this space. You start to feel a little more comfortable. Your sentences become longer; the words start flowing. Your story unfolds.

You open up about how tough things have been. It’s hard to talk about, and you’re still feeling nervous about “going there.” Part of you wants to change the subject or leave my office altogether. But you stay here, with me, and you feel all of the emotions that come with talking about this struggle, right here in this room. As tears leak out of your eyes, I let you know that you don’t have to hold them back. So you let them come, despite your fear that if you cry, you’ll never stop.

At the end of the session, you feel relief. You felt your feelings—you went there, and nothing terrible happened. Instead, you were met with empathy and care.

You still feel dread about coming to your second session, though. You think about how you’ll have to talk about everything again, and it just sounds draining and exhausting. You think about calling to cancel but don’t. Here you are on my couch again, and I ask, “Tell me more.”

There’s a reason therapy is tough at the beginning. All therapy is exposure therapy.

In traditional exposure therapy, clients face their fears so that they can desensitize to their anxiety triggers. In the first session, a client with a spider phobia might feel intense fear just by looking at a picture of a spider. The client is exposed to the picture until they become desensitized to it, and then they graduate to a real spider in a cage and repeat the process. The client, throughout time, learns that it can share space with the spider and not be harmed; the client’s fear system learns that the spider is not dangerous, and the phobia is extinguished.

As humans, we are not only afraid of snakes and spiders—we’re scared of our emotions. Just like anything that brings up fear, we avoid our emotions. It might seem like it will reduce pain to keep disowned feelings far away, but in reality, it only makes them grow stronger. What we resist persists. Therapy is exposure to tough emotions, exposure to problems that need to be worked out, exposure to the things that we avoid because they are painful and hard. In the therapy room, we look our feelings right in the face. Instead of avoiding them, we feel our feelings to learn how capable we are of feeling them, of getting through them. We learn that we don’t have to avoid the topics we’re scared of or our painful feelings about them. And in the process, we learn that they aren't so scary after all, and they don't need to be avoided. Tough feelings are just a part of life, for everyone.

Therapy gets easier over time. While at the beginning, every session might feel like opening a floodgate of things left unsaid and feelings unfelt, as you move through the therapy process you start to form a new relationship with your feelings. You learn just how strong you are, and how you can handle tough emotions and do hard things. You learn that your emotions are not dangerous, and you can share space with them without being harmed.

To find a therapist near you, visit the Psychology Today Therapy Directory.