How to Get the Most Out of Therapy

Overview

If you are new to therapy, you need to know some important things. While some of these things may seem obvious, other things (particularly my points about the therapeutic relationship) might not. Although you may be in a hurry to find answers to your problems, if you have a poor understanding about how therapy works or your role as a client, you could be missing out on being truly being helped.

Your Job:

Firstly – early in therapy – your job is to determine whether you and your psychologist can work together. After all, it is your difficulty – your life experience – and YOU get to choose with whom you share it (!).

The therapeutic relationship is one of the most important things that leads to success in psychotherapy (this is even more important than ‘what model’ or ‘which type’ of psychotherapy is being used).

Ideally, your psychologist should be someone who understands your goals for therapy, someone you feel you can trust, and someone with whom you feel safe sharing personal material. After all, therapy is an interpersonal exchange!

However, keep in mind that trusting and safe relationships can take some time (sometimes months) to develop. Yet, in therapy, the therapeutic hour is only 50 mins. That’s all you get!

Therefore, I do NOT encourage you to doctor-shop after just 2-3 sessions. Why? This is because the first few sessions of any therapy are not only geared toward ‘getting to know each other’ (the relationship), but also you and the psychologist determining what the main issues are, and your psychologist determining ‘how’ therapy might best help you – and all of this must happen before the ‘therapy’ begins!

What do you bring to therapy?

My goal as a psychologist is to ultimately become redundant in your life (vs being your life-long all-seeing, all knowing ‘Buddha’, ‘Guru’, ‘Yoda’, or ‘Master’). This means I am committed to helping you develop a vast array of inner skills and resources that you can apply to not only your current difficulties, but that will also assist you with future challenging situations.

Although psychologists know many things about many aspects of human nature and suffering, NO psychologist has all the answers to all of life’s challenges.

Check-in with yourself (right now): What expectations do you have about therapy?

Are you hoping for a psychologist to ‘fix’ your difficulties for you – or are you prepared to learn about what you can do to approach your situation in new ways? This may include reading the material recommended by your therapist, doing some self-reflection, or practising skills learned in therapy between therapy sessions.

Do you come to therapy with a time-pressure (or deadline) to ‘get better’? For example, many clients new to therapy say “Medicare gives me rebates for 10 sessions, therefore I need to be better within 10 sessions!”. Yet, ‘how long’ therapy takes is not determined by how many Medicare rebates you have.

Are you being realistic, given the effort you are prepared to ‘put in’? Remember that a therapy session typically lasts 50 minutes. This equates to less than 1% of your week (there are 168 hours in a week). Thus, to get the most out of your therapy, how you reflect upon the work you are doing (what you do in between therapy sessions) is very important.

Things you can do in between your sessions (may) include: Giving yourself time and space to process and reflect on your last session; Keeping a journal; Preparing some notes to discuss for your next session; Reading the material recommended by your psychologist; Practising the therapy skills you are learning; or, to pay attention to your thoughts and feelings throughout the next week (which may generate additional material for future sessions).

Note: this is not ‘homework’ – and although sometimes self-practice of skills may be set as homework – the above examples are simply things that you can do for yourself that will assist you to reflect upon and to apply the work you are doing in therapy to your everyday life. In doing so, this will help you to get the most out of your therapy.

Do you have unrealistic expectations?

On the one hand, although people who have a single, isolated issue can do very well in less than 10 sessions, these people are also often: Highly functioning, with zero negative childhood experiences / past trauma; have minimal previous difficulties with anxiety / depression / self-criticism, have good relationships with their parents and family members, have a healthy social support network; have meaningful and sufficiently-paid employment from a supportive and flexible employer; are capable of being self-compassionate (vs being highly self-critical); are healthy in terms of having a good sleep routine and diet (i.e., including no substance use); have meaningful leisure activities / hobbies and are working towards meaningful life goals; are highly motivated to discuss challenging material – including if this relates to the dynamic between them and their psychologist, and, are willing to learn new information and implement therapy-skills in their lives.

However, in practice, it is rare an issue that someone is having is a single, isolated event. It is more commonplace to find that most of us have difficulties in many of the areas listed above. This, combined with your expectations, and your previous therapy experiences (if any), are what you bring to therapy.

Psychologists are not Psychics

It might seem silly, but psychologists are NOT psychics – they do not know what you are thinking and they CANNOT read your mind. (A psychologist is someone trained in the science of behaviour change – they can help you change your behaviour and your life, but they cannot know what is inside you unless you share it with them).

Therefore, it is YOUR responsibility to let your psychologist know what is going on. You can’t be helped by someone if they do not know what the problem is – and this is what the initial assessment sessions of therapy are about (i.e., What are the problems you are experiencing?, What would you like out of therapy?, What have you tried so far?, and, What is / isn’t working?).

Therapy does not ‘fix’ you

Psychotherapy is not medicine – you do not improve ‘just because’ you attend therapy. Unfortunately, unlike medicine, with therapy: YOU have to do the work.

Said differently, therapy is not ‘done’ to you. Rather, therapy happens when you work on a problem together with a psychologist. This means that therapy is an active process, which requires YOU to participate.

Therapy is like walking up a staircase: Your psychologist is like the bannister of the staircase (there with you as you take each step). However, YOU need to walk up each of the steps.

Problems – The Relationship

The issues you have outside of therapy often show up in session. This is helpful because it gives you an opportunity to practice healthy coping and relational skills in a safe environment with your psychologist.

It is also a good idea to talk about your relationship with your therapist in therapy. If you realise that you are not fitting well with your psychologist – it is YOUR responsibility to do something about it.  Firstly, bring this up with your psychologist (!) – talk about your relationship with your therapist in therapy. Give them some feedback and tell them what is not working for you and what you need from them, in order to do the work that you need to do. Often, a psychologist is trying hard to work with you the way that they think will be of most benefit – So, help them help YOU, by vocalising how they can best help you.

If the psychologist can change how they work with you, then this problem has been solved. If not – then you have a choice – you can decide to find another psychologist who you do feel safe doing the work with.

Keep in mind that experienced psychologists will also draw attention to aspects of the therapy relationship that they see as problematic (after all, this forms part of their training). However, it is important to remember that a psychologist is not a psychic and they cannot read your mind.

Think about the following analogy: Going to a psychologist is much like going to get a haircut. You must explain what you want and, while the haircut is underway, you must continue to give feedback to the hairdresser to ensure that you will be ultimately satisfied. If you do not give any feedback, you are essentially placing all of your hope in the psychic abilities of your hairdresser – and a hairdresser is not psychic (so you could end up with a haircut you did not want). When this happens, if the next time you get a haircut you explain what you want, you then give your hairdresser the best chance to adjust their approach to meet your needs. If this still results in nothing changing, then you might consider finding a different hairdresser. The same thing should apply with your psychologist.

Take home message:

It’s good to talk about therapy in therapy.

What if You’re Getting Worse ?

As illustrated beautifully in the above image: Change is NOT linear (!). Sometimes things may seem they are getting worse before you feel they are getting better. This means that strong emotions may come to the surface either during your session, or between your therapy sessions.

Firstly, understand that you do NOT have to do anything in therapy that you do not feel comfortable doing – all psychologists are bound by a Code of Ethics which means they must explain any procedure fully with you before you try it. Secondly, know that it is the responsibility of your psychologist to teach you skills to help you self-regulate before working with challenging material so that you have a way to soothe and settle yourself both during and between your sessions.

However, sometimes after a session you may feel that you are either more contemplative, self-reflective or preoccupied while you process the information covered in therapy (this could last for up to 2-3 days after your session). When working on processing challenging (but significant) material, this is quite normal and is OK – as long as you have self-regulation skills in place (discussed above) and the right approach to this process.

By this, I mean remembering the ‘bigger picture’. That is, that you are working through this challenge for a greater future: A more rich, full, and meaningful life where you are freer to be the person, and to have the relationships, that you truly desire.

Sometimes, things may even show up in your interactions with your psychologist that reflect or demonstrate the EXACT same interpersonal struggles that you face with others – after all, the relationship you have with your psychologist is like a magnifying glass on many of the issues that show up in your relationships outside of the therapy room.

When this happens – it is hugely important to discuss your internal experiences, with your psychologist. Again: Talk about therapy in therapy.

For instance, I once received after-hours messages from a client who grew increasingly agitated that I had not responded (despite him being well-aware of my work hours). However, at our next session when we unpacked this client’s reaction – we discovered that what really was going on was that this experience had reminded him of early childhood feelings of being abandoned by his father (an experience he had created a narrative around, whereby he ran with a story “I’m not important / I don’t matter to my therapist”). We were able to see that this was not what actually happened, and he could see how the anger had spiraled him into self-criticism which made his mood plummet.

Because we were able to talk about his reaction towards me, this uncovered an important deeper ‘lens’ through which he was viewing ALL unrequited bids for connection with others. Once this made sense to him, he was in a position to be more aware of his own unworkable commentary (and how much this often led him to attack others and push them away, leaving him trapped in a self-fulfilling cycle of loneliness…!).

After discussing the way this pattern had unfolded between us, we could then work towards finding adaptive ways for him to “check in with others” (vs jumping to false conclusions), to soothe and to reassure himself in moments requiring patience, and also to express his needs for connection in ways that were workable. In the end, instead of continuing to take actions that were destructive to his relationships with others, he was able to learn that moments such as these were opportunities to strengthen them. In turn, these new skills became a source of resilience.

Knowing when it’s not working: When to find someone else

Therapy is a choice – it’s your responsibility to share the material that you want to work on, it’s your responsibility to share when you are challenged by therapeutic material, and it’s your responsibility to share when you are challenged by aspects of the therapeutic relationship.

Although therapy can be difficult, ideally you want to feel like you and your psychologist are working as a TEAM – a team that you want your psychologist to be part of.

However, if overall you consistently feel worse as a result of your therapy, or feel confused or feel worse about yourself or your situation after your sessions (and you have already discussed each of these with your psychologist), this may be a sign that you might want to consider trying another psychologist.

Ask yourself: ‘do I really want this?’ / ‘is this psychologist really working for me?’

Be realistic – realise that you cannot get along with everyone (and that’s OK!). You do not have to like everyone (it’s OK to feel like this!). What you should not do however, is jump to the conclusion that: ‘all psychologists are BAD’ or the conclusion that: ‘no one can help me!’.

Going back to the previously discussed ‘hairdresser’ example – if you are not happy with the way your hairdresser cuts your hair, it is unlikely that anyone would jump to the conclusion that: “all hairdressers are bad therefore I will never have another haircut ever again!” (you would simply go and find a new hairdresser!).

After all, it is your time, your money, and your life that you must live!

Summary:

  • Therapy is not something that is ‘done’ to you – it is an active process that requires YOU to do the work.
  • Therapy is different to seeing a doctor – you need to do MORE than just ‘turn up’ if you want things to change.
  • A good psychologist can support and guide you through the process (like a bannister on a staircase supporting someone walking up the steps), but YOU need to take each step.
  • Psychologists are NOT psychics – they cannot read your mind. Therefore, it is YOUR responsibility to openly share the things that need to be worked on.
  • The relationship between you and your psychologist is VERY important – it is more important than which ‘type’ of therapy is being used.
  • Difficulties in the therapy relationship and/or misunderstandings about what is discussed are VERY IMPORTANT things to share with your psychologist. Remember to talk about therapy in therapy with your psychologist – this is part of good therapy.
  • Often, interpersonal difficulties that you have (outside of the therapy room) will also show up in the relationship that you have with your psychologist. THIS IS ALSO VERY IMPORTANT MATERIAL TO WORK ON WITH YOUR PSYCHOLOGIST. So, again, don’t run from therapy at the first sign of interpersonal difficulties – STOP and share these with your psychologist so that you can potentially begin to learn about these patterns.
  • Remember, you are only spending 50 min each time with your psychologist. Yet, relationships can take time to develop – So, sometimes, it can take several sessions for your relationship to develop with your psychologist.
  • Finally, therapy is YOUR choice. If you have discussed problems between you and your psychologist and you have tried working through these (yet these problems continue to show up), consider trying another psychologist. After all, it is your time, your money, and your life that you must live!

Further articles: 

I write self-help articles that aim to be informative and helpful for all audiences, especially my clients. These articles cover many of the most common issues that I observe people struggling to with, and address common gaps in knowledge that I believe will be helpful for all people to understand. To view a list of all articles that I have written, click here.

 

If you would like to discuss working together, I would love to hear from you. I am a PhD Clinical Psychologist with over 10 years’ experience trained in Mindfulness, Cognitive Behaviour Therapy (CBT), Compassion Focused Therapy (CFT), and Acceptance & Commitment Therapy (ACT). 

To book in a session with me:

CONTACT ME

I will typically respond to you within 12-24 hrs.

If you would like to discuss working together, I would love to hear from you. I am a PhD Clinical Psychologist with over 10 years’ experience trained in Mindfulness, Cognitive Behaviour Therapy (CBT), Compassion Focused Therapy (CFT), and Acceptance & Commitment Therapy (ACT). 

To book in a session with me:

CONTACT ME

I will typically respond to you within 12-24 hrs.