Really, truthfully, actually… what happens in therapy? What will I have to do in therapy? These are common question for lots of people coming to it new. Here are some general procedural elements you can expect from your process, regardless of the type of therapy you opt for.
Getting started in therapy
Most therapists will begin by taking a ‘case history.’ This involves gathering information about your background, experiences, and some rough goals or outcomes you’d like to work towards. Finding the words for a definable ‘goal’ or a clear desired outcome can be almost impossible at the start. So, don’t feel pressured to come up with something articulate. It might be as simple as “I’m down and wanna get out of it,” or “my anxiety has been really bad lately and I don’t know why.” Your therapist also forms a contract with you. This may be written or verbal. This will set the conditions for therapeutic work (i.e., fees, frequency of sessions, cancellation policy), collect practical info like an emergency contact, and also make clear the limits of confidentiality they can provide. This is all part of keeping you safe and setting expectations from the outset.
Your therapy relationship
The working alliance, forming a therapeutic relationship with your therapist is critical to what happens in therapy. Research shows this to be the single biggest predictor of successful or helpful therapy (Wampold and Imel, 2015). So, do allow time for developing this, you each have to learn what it’s like to be together. Its development and growth will help you feel like you can settle into therapy and be safe investing emotional energy in your process. Further, the nature of the relationship will reflect the type of therapy. Many psychotherapists make use of this relationship as a source of information. They may notice habits in how you relate to them as another person, and use these for reflection. Relationships with others, like CBT therapists, may be more directive and structured, a bit more mentor-like as they guide you through exercises and tasks.
The core of your therapy process
Next we turn to the heart of the process. Much of what happens in therapy is to explore thoughts, emotions, and behaviors in a supportive, intimate, private setting. You might just talk together, or use exercises to help explore and gain insight. These enrich your self-knowledge, self-understanding, perspective on your situation, they help you think about meaningful possible changes. This all happens in a neutral space, away from the expectations, prejudgments, opinions, or well-meaning intentions of others in your life. However, here, please be clear that I am not suggesting people in your life hold malicious or harmful intent. This is simply an observation on the contrasting freedom that the therapy room provides. It’s a place where you can explore thoughts and feelings that elsewhere might feel inappropriate. What do I mean by inappropriate? Think destructive, damaging, unsafe, immoral, embarrassing, shameful, scandalous, threatening, disrespected, blasphemous…
Learning, growing, developing
Another core element of therapy is skills building. Many of these skills are qualitative, and hard to measure precisely. Examples include: increased ability to understand your own emotional reactions and responses to the world; increased tolerance of automatic thoughts, the mind’s wanderings, and your internal fantasy life; increased resilience in dealing with other’s unpredictability or hostility; more interest in being ‘out there’ in the world; feeling more peace with past experiences; feeling more accepting of parts of you that you have always been uncomfortable with; being more attuned to a sense of your own core values; identifying parts of yourself that need some development… In summary, you and your therapist will determine what matters to your life.
Staying focused
It is typical to routinely review progress that both yourself and your therapist feel is being made. This might focus on core feelings, thought, and behaviours, and is likely to consider ‘goals’ or desired outcomes that you’ve gradually come to articulate. You or your therapist might also feel, during review, that you’ve reached a natural endpoint for this particular therapy process. Therapy rarely ends like the movies or a novel, where there is some perfect conclusion tied in a silk bow. Normal life is just too dynamic; there are too many layers! A good sign that you’re ready to move on however is that the problems feel a smaller part of your everyday, you feel less stuck and more able to immerse yourself in life.
Where is my therapist in all of this?
Finally, what does the therapist actually do? They help you create an emotionally safe environment and ensure its continuing stability. You will be guided in self-reflection. They offer compassionate warmth and human reassurance during times of grief or pain. You will be supported to identify patterns in relationships gone wrong. They can hold secrets, contain shameful experiences in a safe way. Further, they can assist you in gaining greater understanding of what it means to be human, the good parts and the darker, shadowy parts. Additionally, they may challenge you on aspects of your thinking, when their expertise suggests it could benefit you and provide an opportunity for growth. Psychotherapist Karen Maroda suggests that an important part of the job is to gently, humanely help clients see blind spots, weaknesses or shortcomings that others may be afraid to point out. And, there is more, these are just crude indicators.
In closing
I hope this is helpful information for increasingly your knowledge of what happens in therapy. Remember, always ask your therapist for clear information whenever you are unsure. If you feel you might be ready to talk with a therapist, I welcome you to be in touch.
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