What to Expect In Therapy

If you’re thinking of starting therapy, and don’t know what to expect, you’re not alone. Most therapy clients don’t know what to expect before they begin. Unless you’ve been in therapy before, how could you know?

Spoiler alert:

Therapy is not always like Robin Williams and Matt Damon in ‘Good Will Hunting.’ 

(I know, bummer.)
via GIPHY

Nor is therapy like Will Ferrell and Paul Rudd in ‘The Shrink Next Door.’ 

(Because…Wow…)

via GIPHY

Your experience of therapy will be unique to you and your therapist. Your dynamic with your therapist is different than your therapist’s dynamic with their other clients because you are a unique individual.

How cool is that?

via Gfycat

You will bring your unique patterns of relating into your therapy sessions. Because of your therapist’s education, training, and work with other unique clients, your therapist should be able to uncover different aspects of your relationship patterns that you may not know about. 

And that’s ok. When we come to therapy, we tend to have blind spots. Your therapist will help you identify them and sort through them. This will be an ongoing task that happens in stages as your therapist learns more about you throughout your work together.

Knowing the stages of therapy will help you understand what to expect.

The first stage of therapy: Commitment

Commitment is the first stage of therapy, and arguably the hardest. Paradoxically, commitment is an issue that many people want to seek therapy for, but commitment issues also keep individuals from coming to or staying in therapy.

Commitment can be a loaded word filled with many emotions. Perhaps you’ve had partners in the past who’ve had difficulty committing. Perhaps you’ve been the one who’s avoided committing to relationships, jobs, or even therapy.

What commitment means in therapy:

Commitment happens when both you and your therapist decide to work together toward agreed-upon goals. 

Your therapist will inquire about your goals to determine if they are properly trained in therapeutic modalities and interventions to help you achieve them. If they do not feel equipped to help you meet your particular therapeutic goals, they will refer you to someone who is.

For example, if you struggle with anxiety and depression and have a history of trauma, a therapist may decide to treat your anxiety and depression and refer you to a trauma therapist if they are not trained to treat trauma. Ask your therapist from the start if they are trained to treat your presenting concerns. 

When committing to therapy, it’s important to understand just what you’re committing to. Your therapist should be able to tell you the cost of individual therapy sessions upfront, their theory or modality,  confidentiality issues, boundary issues, and expectations. However, many therapists agree it is difficult to know the length of treatment upfront. Length of treatment is determined by many variables that are often unknown by the client and therapist at the start of therapy.

As you work together, you and your therapist will have the opportunity to discuss the length and timing of treatment depending on your unique circumstances and progress toward goals.

Important note about your commitment to therapy:

You do not have to stay committed to a therapist who doesn’t feel like a good fit. 

If you have reservations about your therapist, it’s important to address them with your therapist. Your reservations may be projections or misunderstandings that you can work through. But having reservations could also be a sign of a bad fit.

Important questions to ask yourself if you’re unsure about committing to your work with your therapist:

1. Do I feel heard and understood?

It is important that your therapist ask clarifying questions. Your therapist will sometimes be a bit “off” in their interpretation of what you’re saying and will seek to understand better. It’s important that you communicate with your therapist to help them understand. When you’re both trying to achieve clarity, your response to a therapist’s reflection may sound like, “No, It’s more like… Not really…. I don’t think so… That’s not it at all…” You can even say to your therapist, “I think you’re wrong.” 

Whatever you do, don’t hold back from correcting your therapist. They shouldn’t be defensive. They’re just trying to clarify and understand.

2. Do I feel respected and supported?

Your therapist should make every attempt to keep your appointments, show up on time, and give you their full attention during your sessions. Emergencies happen to everyone, even therapists, but if you notice a pattern where you feel disrespected by your therapist, it’s time for a change. 

Therapists are taught not to work harder than their clients, as that would be enabling. However, if you feel that you are putting loads of effort into your therapy, but your therapist is kind of checked out and not offering guidance or insight, that’s on them. They’re not doing their job.

Furthermore, you should NEVER feel creeped out, belittled, or berated by your therapist. Therapists are aware of the inherent power differential in therapy and are taught not to abuse their role. While you can talk about your sex life with your therapist, your therapist should not make sexually suggestive comments to you or look at you inappropriately. Your therapist should not be condescending, defensive, and they should never EVER yell at you. 

The second stage of therapy: Process

Process is the next stage of therapy, which is the core or essence of therapy.

This stage consists of (but is certainly not limited to) information gathering, case conceptualization, relationship building, and pattern identification. These aspects are intermixed and interrelated.

Information Gathering

The information-gathering part of the process often consists of interviewing and assessment. Your therapist will likely ask you questions about

• What brings you to therapy
• What your goals are or what you hope to achieve
• Current mental and physiological symptoms
• Family or relationship dynamics
• Your family history of mental issues 
• Your history of trauma or adverse childhood experiences
• Seminal moments in your life
• Your current ways of coping

Some therapists, such as myself, are interested in learning about you as a whole person beyond just your problems. 

Some things I like to know about my therapy clients include:

• What drives you or brings your life meaning?
• What is your personality like?
• How would you describe yourself?
• How would others describe you?
• What are you into? What do you enjoy?
• What are your current ways of coping?
• Who are the important people in your life?

Your therapist may want to utilize formal assessments to ascertain whether you fit the criteria for a mental health disorder. Assessments are also helpful in gathering data about the state of your mental health before you begin therapy. They can be used throughout the course of therapy to understand your progression. 

Your therapist will also want to know if you’re experiencing any suicidal thoughts or urges. They may ask you directly if you’ve had thoughts of killing yourself or that you’d be better off dead. While you may be hesitant to answer in the affirmative, it’s important to let your therapist know the extent of any suicidal thoughts. You will not frighten or freak out your therapist. They hear this all the time. They know how to help.

If you are currently experiencing suicidal thoughts, you can do any of the following:

• Go  to your nearest emergency room. They can help you there.
• Call  1-800-273-8255 (This is the National Suicide Prevention Hotline.)
• Text TWLOHA or 741741 (To Write Love on Her Arms)

Relationship Building

Therapy is a relationship. In fact, research shows that the relationship between the therapist and client is the most important aspect of therapy. Though the therapeutic relationship is important, it is also one-sided. The therapist is there to meet your needs. You are not there to meet theirs. It is not mutual in that way, but it should be egalitarian.

Sigmund Freud asserted in 1913 that the therapeutic relationship or alliance was imperative to successful therapy. Since then, research has shown that the relationship between a client and therapist is the strongest predictor of a successful outcome in therapy.

Qualities of a good therapeutic alliance include:

• Collaboration
• Safety and trust
• Freedom to share freely
• Mutual respect and caring
• Mutually engaging in therapy “work”
• Agreement of therapy goals and interventions
• A shared sense of dedication to the process of therapy
• Openness to discussion of the therapeutic relationship
• Ability to repair ruptures that may arise between client and therapist

Research shows that having good interpersonal and communication skills is the key to good relationships. The same is true in the therapeutic relationship.

Want to do your part to foster a good therapeutic relationship?

Be open and honest about your feelings and needs in therapy. Your therapist wants to know these things, but cannot read your mind. As intimidating as it may be, expressing concerns about your therapist or things that were said in therapy to your therapist is healthy. 

Another very important aspect of the relationship between therapist and client is that of attachment. For many people, their relationship with their therapist may be the first truly healthy relationship they have. Individuals who struggle with attachment styles such as anxious, avoidant, insecure, or disorganized may benefit the most. Forming a secure attachment with a therapist can be healing for attachment wounds. 

It is, however, worth noting that a secure attachment to your therapist is different from being dependent on your therapist. You can expect your therapist to have your best interests in mind, to provide unconditional positive regard, and to provide safety and reliability.

Pattern Identification

There are many ways your therapist may be able to help you identify your patterns. Identifying patterns includes observation of your thought process, behavior, emotions, underlying issues, and the conditions of your upbringing.

Identifying patterns includes observing:

• Triggers
• Vicious circles
• Interpersonal and intrapersonal interactions
• Repetitive thoughts, feelings, and behaviors
• Your core beliefs about yourself, others, and the world

When patterns affect your life, chances are that some are more obvious than others. Many clients bring up specific patterns that they’re already aware are causing problems. Often, clients are aware of other people’s patterns more than their own.

You may have patterns of behaving differently in different areas of your life. For example, you may be confident and self-assured at work while feeling inadequate and clingy or avoidant in relationships. You may have a people-pleasing pattern with your family, but a pattern of being distant in other relationships. Your therapist may want to identify under what circumstances your patterns are activated.

Therapists also actively monitor transference issues in therapy as a way to identify patterns.

Transference happens when clients attach feelings such as anger, love, or desire to their therapist. An example of transference in therapy is when clients who have a pattern of entitlement push therapeutic boundaries and expect special treatment. Clients with a dependent pattern may desire their therapist to be available for them 24/7.

Sometimes, personality characteristics or disorders can be identified by observing patterns.

For example:

Important to note: Not all individuals who share the patterns above fit the criteria for a personality disorder. Only a trained professional, such as a therapist or psychologist, can provide an accurate diagnosis of a personality disorder. 

The third stage of therapy: Change

Therapists work from a theory that explains the change process. The therapist’s theory informs their interventions. Your therapist should create an individualized plan for your treatment that includes interventions.

Throughout the therapy process, your therapist will implement interventions meant to help create change in your thoughts, feelings, behavior, or relationship patterns.

Interventions are important in the therapeutic process. Interventions are structured considering the problem, the timing, and available tools. They are often implemented in the action stage.

When your therapist engages you in interventions or encourages “homework,” it’s important that you are consistent with these changes.

Remember, consistency is the key to change.

How do you know when you’re not consistent in your therapy work?

Inconsistency sounds like:

• Yeah, but…
• I can’t…
• I tried that once, and it didn’t work.

The Stages of Change

There are five stages of change:

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

When in the pre-contemplation stage, you probably aren’t aware of the problem even though those around you may see it.

In the contemplation stage, you’ve become aware of the problem, but you’re not yet ready to address it. Perhaps you decide you’ll get to it later.

In the preparation stage, you’ve decided to make the change and plan to take action. 

The action stage includes modification of problem behavior and implementing self-directed change. 

The maintenance stage is the sustained change you’ve achieved.

Remember, relapse happens, and we sometimes go back to our old thinking, feeling, and behavioral patterns. It doesn’t mean you’ve failed. It means you’re human. 

Progress is not always linear.

The final stage of therapy: Consolidation

The terminology for ending therapy includes: termination, graduation, consolidation, or referral. Sometimes instead of ending therapy altogether, you are referred to another provider for the continuation of therapy. Sometimes you graduate, meaning your goals are met. And sometimes your therapy is terminated due to factors such as meeting goals, a mutual decision between client and therapist, timing, financial purposes, or moving. 

Consolidation involves synthesizing what was covered, uncovered, and learned in the previous stages. You and your therapist have collaboratively developed ways to address the problem, and you have taken action necessary for change.

According to Professional Psychology: Research and Practice, “The process of ending psychotherapy typically involves solidifying improvements made over the course of psychotherapy and reorienting clients to live outside of formal psychotherapy—a consolidation conceptualization.” 

Many individuals think of therapy as a necessary part of a healthy lifestyle. And it can be. Therapists are ethically unable to over-treat a client or foster dependence, so your therapist may work with you so long as you continue to work toward goals.  

You and your therapist can discuss reducing frequency, termination, graduation, or referral. Whatever you and your therapist decide, it’s important to note that you can terminate your own therapy or ask for a referral at any time.

In fact, if you don’t believe your therapist is a good fit for you, I highly recommend that you find one that is. 

To find a good therapeutic fit, it is important to meet with your therapist before you begin. Many therapists offer free 10-20 minute consultation calls. 

If you’d like to schedule a consult call with me, you can do that here.