When you spend a lot of money on things, they usually come with an instruction manual to help you use them in the most effective possible way. Unfortunately, therapy doesn’t.
A common misconception about therapy held by many laypeople (and, unfortunately, some therapists) is that all you have to do as a client is show up and then…some vague hand-wavey magic stuff happens, and then the client gets better. Many people think of therapy like this:
- Go to therapy
Really, though, it’s more like this:
- Go to therapy
- Establish some rapport with the therapist before you can delve into the serious stuff
- Sometimes be really uncomfortable
- Have a lot of meta-conversations with your therapist–that is, talk to the therapist about the process of talking to the therapist
- Do homework (in some types of therapy)
- Get called on your shit by the therapist
- Be uncomfortable again
- Make changes in your life outside of therapy
As a therapist, it’s tempting to say that you should just show up and let the therapist do their job and you’ll feel better. Sometimes that’s exactly how it works. But ultimately, you can only get as much out of therapy as you put into it.
If you don’t tell the truth, or only tell little pieces of the truth, don’t try any of the therapist’s suggestions, always stay away from any topic that feels too painful or awkward, never think about therapy itself outside of sessions, and don’t have any idea of what it is you’d like to change in your life, you’re not going to get that much out of it. You’ll probably get something out of it–and some therapists are better than others at orienting clients to therapy and helping them figure out how to benefit fully from it–but the biggest change is only possible with the biggest effort.
This article is a compilation of suggestions for getting the most out of therapy. They come from my clinical experience as a therapist, my personal experience as a client, and feedback from a bunch of friends–clients and therapists both.
This article is not a list of things you must do in therapy. There could never be a list of that. Some of them will not be accessible or applicable to you, and that’s fine. As I said, these are suggestions. They’re not demands or requirements.
- Show up. It sounds silly when put that way, but a common cause of ineffective therapy is that the client does not show up often enough. Obviously things come up and everyone will miss sessions occasionally, but I have clients who miss most of their sessions–or insist that they only want to come once a month–and I don’t think they’re getting much use out of therapy. Ideally, go to therapy weekly or biweekly at minimum. Any less often than that, and you’ll spend your entire hour just rehashing what’s happened in your life over the past month or two. (An exception is people who have already done most of the work of therapy and are now just wanting “maintenance” sessions to make sure that they’re keeping up the progress they’ve made.) If you’re having trouble fitting therapy into your schedule, communicate with your therapist. They may have lots of suggestions or ways that they can accommodate you, such as phone or Skype sessions, different times, and so on.
- Let your therapist know how to communicate effectively with you. Do you prefer to schedule sessions by phone, email, or text message? Should your therapist use a particular nickname or set of pronouns to refer to you? If you’re going to be discussing issues of identity, how do you want your therapist to refer to your gender, sexual orientation, ethnicity, religious beliefs, etc? Do you shut down when your therapist begins a question with the word “Why”? Is it considered inappropriate in your culture to start “talking shop” before exchanging a few lines of small talk? Does direct eye contact make you uncomfortable? Do you need your therapist to speak louder, softer, or slower? These are all things you can discuss with your therapist if they’re important to you.
- Speak up if your therapist does something that bothers you. I have a whole article about setting boundaries with therapists, so I won’t rehash all of that here. The important thing to remember is that 1) as a client, you have the right to set boundaries, expect those boundaries to be respected, and fire the therapist if they’re not; and 2) therapists are not mind-readers. When I wrote about this topic for Everyday Feminism, I got a lot of pushback to the tune of “the therapist should just know what my boundaries are; I shouldn’t have to tell them.” That’s dangerous thinking in a therapeutic relationship and in any other relationship. Yes, sometimes people can pick up on your nonverbal cues and intuit your boundaries, but this is too important and nuanced for that. Please speak up.
- If it’s not working, find a new therapist. “Not working” doesn’t mean you’ve gone a few times and you don’t feel better yet; it means your therapist won’t respect your boundaries, is uninformed about your presenting issues, or can’t seem to establish a rapport with you. If you’ve been going regularly for weeks or months and there’s still no difference, and you’ve addressed that directly with the therapist to give them the chance to try another approach, then that’s a sign that things aren’t working, too. Some therapists are crappy therapists, but sometimes people just don’t mesh and it’s no one’s fault. Regardless, you don’t owe your therapist anything and you’re not obligated to stick around out of politeness or charity.
- Set goals for therapy. What made you decide to go to therapy? What are you hoping to get out of it? These are probably questions that your therapist will ask early on, and it helps to have answers for them. If you don’t know right away, that’s fine–often what sends people to therapy is a vague sense that things are wrong, and at first they don’t know exactly what. In therapy, almost any answer is better than “I don’t know,” so if all you’ve got is “a vague sense that things are wrong,” tell your therapist that. If you can, though, setting specific goals increases the likelihood that you’re going to get to where you want to be. Specific goals can look like: “Stop drinking,” “Reduce drinking to two nights per week and no more than four drinks per night,” “Find a reason to keep living,” “Stop having panic attacks in public,” “Learn how to keep my job despite my ADHD symptoms.”
- Take notes during the week about things you might want to discuss in therapy. This is especially helpful if you have mood swings, memory problems, or difficulty opening up in therapy. Folks with mood swings often find it difficult to “access” moods they’re not currently having, which makes it hard to talk about later. But mental illness isn’t always considerate enough to have a flare-up right during your therapy session so you can process it with your therapist in the moment. Taking notes when relevant things happen can help you talk about it later, when you’re no longer feeling that way or when your memory would’ve otherwise faded.
- Plan ahead for your sessions. The previous tip can help with this. Since most of us have way more than a weekly hour’s worth of things to talk about, it can be helpful to think about what you’d like to get out of each session and what you should prioritize talking about. I wish I’d known to do this when I was in therapy in college, because I also had the mood swings issue I discussed in the previous tip and was usually in a pretty decent mood when I actually went to therapy. Since I had no plan, and my therapists were nondirective and would never ask a question like “How has your depression been this past week?”, I’d inevitably just start babbling on about whatever stressful exam or argument with a partner was currently on my mind without ever connecting anything to my overarching issues or goals for therapy. I got exactly nowhere.
- Set aside time after sessions to do some self-care. Not possible or even necessary for everyone, but can be very important for some people. Remember that self-care doesn’t have to look like chocolate or bubble baths. I used to like going straight to work after therapy because it helped me get back into the swing of things and feel good about myself. Other people might prefer journaling, messaging a friend, taking a walk, working out, or any number of other restorative activities.
- Don’t just vent. Many people think that therapy is venting about your problems while someone listens attentively and says “Uh huh” and “Hmm” and “That must’ve been stressful.” While this is usually part of what happens in therapy, and it can build rapport between you and the therapist, and sometimes it’s all you can do, it’s not what therapy ultimately is. Therapy is learning to understand yourself and your patterns and then learning how to change them. A skilled therapist will eventually start to show you the patterns in your venting: “I notice you’re often upset because you feel like the people in your life aren’t really listening to you.” “It seems like you feel like things ‘just happen’ to you without you having much control over them.” Sometimes the therapist will be wrong about the patterns they perceive, but often they’ll be right even if you don’t initially think so. Follow these threads where they lead. That can be the key to creating a life where you don’t have to constantly rant about your stressful whatever or your disrespectful whoever.
- If you can’t talk about an issue in therapy, talk “around” it. Talking around an issue means exactly what it sounds like–talking about your own boundaries around that issue and why you feel like you can’t talk about it. A skilled therapist, when told “I don’t want to talk about that,” neither pushes it nor changes topics entirely, but will ask questions like, “What worries you about talking about that?” or “What would it be like to tell me about it?” That way, you can move forward on this issue in some way while giving your therapist some important information, without pushing yourself too far. Often, this also becomes a valuable opportunity to share your concerns about being judged or stigmatized by the therapist–concerns that they can then address in a way that might make it possible for you to talk about the issue after all.
- Try suggestions even if you don’t think they will work. At some point, depending on your therapist’s theoretical approach, they may start to work with you on practical ways to deal with some of your symptoms on your own–i.e. coping skills. A common experience in therapy for people who have depressive symptoms is that the therapist will suggest things for them to try and they’ll shoot down every suggestion, saying it could never work. (I’ve been there as a client, and as a friend/family member being supported by others. Have I ever.) You might very genuinely feel that it won’t work–you’re not just being difficult for its own sake. You might even be right. However, unless there is an actual barrier to trying the thing (therapists don’t always know the limits of your physical energy, schedule, or bank account), just try it. At worst, you’ll learn what doesn’t work and is a waste of your time. At best, you’ll take a significant step forward in managing your symptoms. And because depression tends to cloud our vision of what’s possible, trying as many things as you can even if you don’t think they’ll work can be a useful check on that.
- Don’t ask your therapist for advice. By “advice” I don’t mean “What are some ways to manage anxiety symptoms when I’m out in public” or “What are some lifestyle changes that have been proven to help with depression”; those are things therapists should work on with you (as discussed in the previous tip). I mean, “So do you think I should dump my partner?” or “Is this a wise financial investment?” or “Should I just tell my mother-in-law we’re not coming for Thanksgiving this year?” Therapists are not qualified to tell you what to do with your life. Good ones will gently steer you back towards making decisions based on your own values and priorities, but in any case, you’ll get more out of therapy if you don’t see it as a place to get life advice and therefore aren’t disappointed when your therapist doesn’t give it. Obviously, the line here can sometimes get a little blurry–while therapists aren’t qualified to tell you whether to dump your partner or punish your kid for something they did, they can tell you about best practices for strengthening relationships, communicating, and parenting. Remember that even there, though, research might be mixed and anything your therapist says is filtered through their own experiences, values, and social position. I’ve heard licensed mental health professionals insist that spanking children is not only morally acceptable but practically effective, even though the research strongly suggests otherwise.
- Practice the skills you learn in therapy throughout the rest of your life. A therapist’s ultimate goal is to make themselves unnecessary. In order for that to happen, you have to take what you learn in therapy and apply it elsewhere. This happens on two levels. One is the more surface level: practicing the coping skills, communication strategies, and other practical knowledge outside of the therapy session. The other takes place on a deeper level. In many schools of therapy, the relationship between the client and the therapist is meant to serve as a model for other relationships (in certain ways). When you learn how to open up to your therapist, set boundaries with them, and trust that they won’t judge or reject you because of your flaws or because you disagreed with them, you’re also learning how to do that with other people. Of course, it’s not easy–those other people probably aren’t getting paid to listen to you nonjudgmentally. But the point is that just as your therapist accepts you for who you are, so can other people. Once you’ve started to believe that about your therapist, practice placing that trust in other people. With this and with the practical skills, you can ask your therapist to help you find ways to practice if you’re not sure how.
- Try to let go of the idea of getting your therapist’s “approval.” A lot of people mess up in therapy by focusing way too much of their mental efforts on getting the therapist to like them or making sure that they don’t say anything that makes their therapist dislike them. Sometimes, this just means you’re not getting that much out of therapy; sometimes it actively causes harm, such as when my clients with substance use issues repeatedly tell me that they don’t have any cravings ever not at all nope and then weeks later it turns out that they had a massive relapse ages ago and never told me because it’s embarrassing. But if they’d told me as soon as they started getting cravings, we could’ve worked on ways to manage that and possibly prevented a relapse. I get it–facing someone’s judgment is never easy, especially not if that person is in a position of power or authority over you. But therapy can’t work if you only talk about what’s going well for you or what you’re good at. If your primary goal in therapy is to make sure the therapist likes you, you’re wasting your time and money.
- Tell the truth. In therapy, you get to be as petty, judgmental, whiny, pessimistic, jealous, bigoted, and callous as you are on your worst days. You get to be bitter that your sister’s married and you’re still not. You get to judge your friends for their sex lives. You get to admit that you’d rather get high every day than go to work. You get to insist that everyone hates you and they’re right. That doesn’t mean you have to lay out a complete catalog of your flaws right in the first session, but it does mean that you should tell the truth. Even saying “I don’t want to talk about that” or “I can’t talk about that yet” is better than saying something you know is untrue. But even if you do lie, it’s never too late to set the record straight. As a therapist, I’d much rather hear, “Actually, when I told you I don’t drink anymore, that wasn’t true,” than to continue not helping someone who needs help with their drinking.
- Push yourself. A lot of the suggestions on this list might have you thinking, “But I can’t do that! That’s too scary/triggering!” First of all, that’s why they’re only suggestions. But second, part of your work in therapy is learning more about yourself and your boundaries, deciding whether or not those boundaries are acceptable to you, and, if not, learning how to gently expand them. As a therapist, my job isn’t to pressure you to try things you don’t feel ready for; it’s to meet you in the middle and help you through it once you decide to try. And as a client, your job isn’t to blindly do what I suggest for you to do; it’s to choose your goals and the pace at which you’re going to move towards them, and then to push yourself to do that. Maybe being able to tell your therapist about your trauma isn’t one of your goals at all. But if it is, at some point you’ll need to turn “I don’t want to talk about that” into “Okay, I’m going to try talking about that even though it might hurt.” Only you get to decide when that moment comes.
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Although I’ve closed comments, I’d love to hear what you’ve done that’s helped you get the most out of therapy. Please tweet at me if you’d like to share, and I’ll update this post with responses.