New to Therapy? What it is and what it is not.

Since becoming a therapist, I have been asked many times what it is that I do exactly. In fact, at the end of one of my sessions a little while ago, I had a patient turn around and say, “So you just do this all day long with other people as well?” This person was not being facetious; the individual (who will remain unidentified) was honestly curious about the process and I suspect, wondering what it must be like from my perspective. So, I said simply, “Yes this is what I do all day, and I really love it. There is never a dull moment.” I was also being honest, if a little simplistic. Largely because of this conversation, I was inspired to write a guide about therapy from a therapists’ perspective and also to clarify some misleading information that is often found on TV, social media, or in the general public. Read on to find out more.

What It Is

The process of therapy is pretty simple. An individual seeking treatment walks into an office, sits down with a therapist and describes what they are currently struggling with or would like to change. The therapist then proceeds to gather more information about this issue, and also gathers information about the person them self in order to get a better sense of how to guide sessions. Together, the therapist and individual come up with goals and begin to work on a plan or method of achieving these goals. All of this happens within the context of a private conversation, normally held once per week, between two individuals who basically want the same thing - for the person seeking therapy to feel, act or change for the better. That’s really it. Although there is a slew of research that informs much of how modern therapists practice, and just as many theoretical approaches (also called “orientations”) that various therapists use, this is really all that therapy is. It is a conversation between two people striving towards improvement in a particular person’s quality of life.

How It Works

It starts with a first meeting or consultation where you’ll be asked what brought you to seek treatment, and as mentioned earlier, the therapist will ask many questions to better understand what’s going on with you. Once this is done and goals for treatment are set, you will start the process of working through the issues that brought you to therapy while building familiarity, and a sense of comfort and trust in your relationship with your therapist. This part is essential because without the comfort and trust in this individual, it is likely that you won't be able to express yourself in a way that will enable you to make progress. So, building a strong sense of rapport with your therapist is the first ingredient in a successful counseling relationship, and the next is working specifically on the problems that brought you in.

Working on your goals or issues can be done in so many different ways, but it generally starts with information gathering (e.g. what is the problem and when did it develop?), and then moves to discovering how you reacted or were affected by it, and what is happening now that is being impacted negatively. Very often it is difficult to fully understand how events or things in your life may have affected you, and even harder to change these patterns on your own. This is where a therapist is really helpful as they are removed from your life enough to have an outsider's perspective while also being educated and trained in a way that can give you tools to change and grow.

The ending of treatment generally happens when the problem(s) that a person was seeking treatment for has(ve) been resolved. Typically, a conversation between the therapist and individual happens over several sessions where it is mutually agreed upon that treatment is no longer necessary or useful. There are times when treatment is ended abruptly, either because circumstances in someone’s life have changed, they have moved, or choose not to return for any reason. These are less than ideal circumstance to be sure, but life happens, and endings cannot always be planned. When this happens, therapists will usually make every effort to ensure that this person receives referrals for other therapists or health care workers that can better help them with their issues.

What it is not or “Common Myths”

1)    Everything will be blamed on my parents or my childhood. Generally speaking, at some point in treatment, your upbringing will be discussed. The extent to which this comes up depends on the kind of treatment being sought out, the individual style of the therapist, and the problems that are being addressed. Unless expressly asked to focus on childhood and parental figures, this is only done to the extent that it is helpful to the person seeking treatment.  

2)    Therapy is just expensive ‘advice’. Psychotherapists are normally trained not to give advice unless it is for rehabilitation purposes or choosing the best kind of treatment for an individual problem. This is because therapy is intended to help people get through issues that stop them from being able to make effective decisions or find answers to problems on their own. For this reason, therapy can seem frustrating at the outset because why wouldn’t you want to get the answers to hard questions that have been bothering you? Basically, it’s the difference between cooking a meal for someone and teaching them how to cook for themselves. While the former gets the job done quickly and benefits you immediately, the skill of cooking itself is something that will continue to impact your life (and eating habits) for the rest of your life indefinitely. Therapy is like learning a new skill. It takes work and effort but it’s definitely worth it!

3)    Therapy is the purchase of friendship. There are many ways that a therapist can resemble other close relationships in your life. For example, a therapist will generally be super supportive or seemingly ‘on your side’ and will never reveal your secrets. Like other good relationships, they will care and show concern for you, will validate and listen when you need them to. However, it is a one-sided relationship in that a therapist will not vent their frustrations to you or ask you for support in return. In fact, most details of their lives are usually kept to themselves unless in the interest of being helpful to your treatment. They also differ from friendships in that a therapist is trained in human behavior and will be using years of research on effective treatments for mental health, and applying it to your experiences.

4)    It will be on my ‘permanent record’.  Your privacy and confidentiality is something that is protected by law and by all therapists’ code of ethics. Unless there is a major safety concern, or you are court mandated to attend a specific form of treatment (e.g. alcohol or substance treatment, anger management, etc.) what is said in session is entirely confidential and any violation of this privacy can be addressed in a court of law. Therefore, unless therapy is mandated by a court of law for reasons related to harming someone, it cannot be accessed by anyone for any reason without your written consent.

5)    People are usually in therapy for years and years and they don’t change. From the outside, this can sometimes appear to be the case. However, in cases where progress is limited or change doesn’t appear to be happening, it could be that a person simply needs an on-going level of maintenance treatment to function at their best. Unfortunately, however, sometimes it is the case that someone stays in treatment much longer than needed or past the point where it is beneficial. In such cases, it always best to examine reasons why this may be happening and consider a different type of treatment, a different therapist, or ending treatment altogether. Most therapists do not want their patients to continue for ever and ever without results. We generally want to see people improving and getting to a point where they don’t need it (or us) anymore.

6)    Lastly, can therapists read my mind? Simply put, no. But it would be nice if we could!

Final Thoughts

Therapy is an investment of time and resources to change and ultimately improve your life circumstances. It is not a quick fix nor is there a ‘magic pill’ that can be prescribed to fix something that in all likelihood, has taken a long time to develop. However, it is a commitment that is worth the time and investment as it can truly be life changing. I have personally witnessed this kind of improvement and can honestly say that is the most gratifying part of my job.