10 Things I Wish People Knew about Therapy

Recently I heard from a friend of mine the struggles she was having with her therapist.  It made me realize how some of the most basic things I know as a therapist are not as readily known by the rest of the world. After the conversation with my friend, I got to work writing this article with the same information I gave her in hopes of letting others find clarity in their own therapeutic process, and maybe clean up some misconceptions.

  1. There must be a therapeutic relationship for it to work. In therapy, there are four factors that pertain to the potential success of it.  The first is external factors, such as being able to get to the office, being able to pay for services, etc.  The second most important is your relationship with your therapist! This by far is more significant than the third (internal factors) and fourth (intervention used) factors.  If you do not feel a comfortable, safe, non-judgmental, professional yet genuine connection with your therapist, little to no progress will be made. You might not feel a click in the first session, but don’t immediately give up hope. To establish this relationship you and your therapist will probably take part in some “rapport building” in the first few sessions.  If after five sessions you still don’t feel that connection, move on to another therapist. Feel free to even bring this up in a session and ask for referrals. To find the best fit for you, shop around! Read bios, ask questions when you call, ask for word of mouth referrals.
  2. Your therapist cannot be your friend. This is a protective boundary for both you and your therapist. The relationship with your therapist is an interactive one, and they do have genuine compassion for you but with professional boundaries. It is ok to laugh, chit chat, and sometimes even cry together but only when these things are done to help build the rapport and in a therapeutically appropriate way. However, don’t be afraid to ask your therapist questions. They are responsible for setting a boundary if they feel it is too personal. Also, your questions might initiate a great discussion about you. Your therapist may use personal disclosure in your session, but they are trained to do so only when clinically appropriate. Overall, your therapist is there for you, not the other way around.
  3. You have the right to make your own choices. This is called “self determination” and is a primary principle (and sometimes ethic) in any therapeutic setting. You will not be told what to do by your therapist, unless there is threat of you harming yourself or others. You will set your own treatment goals with help and support from therapist, but they will not create them for you. Your therapist will start where you are at, but might push you in areas they feel you are ready to address based on what you have been able to work on. A therapist’s job is to help you explore your options objectively, recognize what your potential outcome might be, help you decide on a solution you feel will help you grow or achieve your goals. A therapist who is imposing their own moral values or judgments on you is not doing their job ethically. Ultimately, you make your own decisions regarding your treatment – when to end therapy, if you want to switch therapists, and if you are uncomfortable with an intervention make sure you speak up.
  4. Seeking or being in therapy does not mean you are crazy or weak. I’ve already written an article on this here, but to reiterate – it takes a very strong person to recognize they are in need of some extra support or guidance and to ask for it. You may or may not receive a mental health diagnosis when you begin therapy, but this means very little to your involvement in therapy. A therapist will treat a person, not their diagnosis.
  5. No therapist can “fix” you. You are not broken. It is your own job to be open to learning your own strengths and develop new skills, which will be done when you have an objective therapist helping you identify and teach these. You might feel “fixed” but really you have learned to improve your own quality of life.
  6. You do not need medication just because you are in therapy. If you are experiencing a significant impact on your life from your symptoms, medication might be an option, but it is not a guarantee. Your therapist cannot prescribe to you, so you would be referred to a psychiatrist if you do make the choice to try medication. Your therapist would then work in cohesion with your psychiatrist to make sure you are receiving well rounded services that are complementary of each other and your progress.
  7. Therapy is a process that does not only happen in the office. Prepare to work. You will get out what you put into it. In fact, you are expected to work harder than your therapist. If your therapist is doing all of the work for you, you are not learning. Therapy does not end when your session time is up and you leave the office. You must actually apply your new skills to your life in order to truly get something out of it. And don’t be shocked when these skills don’t work perfectly the first time you use them. Talk about what went well or didn’t in your next session and try, try again.
  8. You do not have to come into your session with a crisis each time. Short term or solution focused therapy is available, but if you continue seeking this out there is probably something underlying to be addressed. If the only time you come to session is anytime you are at a peak level of stress, not much will actually be done. You will need to get to the deeper issue, not just the surface, in order to learn about your patterns and make necessary changes. It is just as important to celebrate positive progress and emotions in session as it is to work on weaknesses and process discomfort. You can learn a great deal from yourself when you are stable and what you did to get there. This is also the best time for you to grow and reach your next level of potential.
  9. Consistency is key. This is being proactive, the opposite of only coming to therapy with crises. Although, the frequency at which you attend sessions may change based on your needs, it is important to be consistent in your participation if you are also expecting consistent progress. With that being said, you also do not need to be in therapy for life once you start. There will come a natural time for you and your therapist to decide you have met your goals and have gained the skills you need to continue your progress on your own.
  10. Therapists practice what they preach…and sometimes have their own therapists. It is definitely important for the person guiding you to also do all they can to be a participant in their own strong self care routine. Sometimes this means they have their own clinician with whom they work therapeutically as a client. Without healthy self care and strong boundaries the therapist would be putting themself at significant burn-out risk or letting their own emotions begin impacting your therapeutic process, a big “no no!” We do learn from our clients often, and you do have impact on your therapist but their job is to keep all of this in check and within professional boundaries. Therapists use all of the same tips and techniques that we teach you, and also supervision from other clinicians in the field.