Process This: Getting the Most Out of Therapy

We often suggest looking into therapy for those dealing with difficult issues or even just people who feel like they could use some help and support in their lives. We've written this piece, and this one as well, to help people understand what the process of seeking therapy looks like, and why seeing a therapist or counselor is nothing to be ashamed of.

What we've noticed lately is that some of our users start therapy, but then say they haven't gotten much out⁠ of their sessions. That's a bummer, because counseling or therapy can have a huge, positive and lasting effect. It occurred to me that most of us are never told what actions on our end are important so we can get the most out of therapy and counseling. With that in mind, let's take a look at some ways you can make therapy a worthwhile experience.

Screening Therapists

Let's say you've taken the leap and decided to look up therapists near you. If you're insured, or are under a parent's insurance, you can find them on your provider's website. You can also research local mental health clinics to see what counselors work there. If you're in school, a school counselor should be able to give you information on finding a therapist in your area. Too, if you're in college, most schools will offer student health resources that include mental health services.

Once you've found out the therapists in your area, the next task is to narrow down your options. The difficulty of this task is going to depend, in part, on where you live and what kind of insurance you have. The more populous your town, the more therapists you're going to find, but even less populous regions will hopefully have at least a few to choose from.

When you decide to visit a therapist for the first time, you're going to want to screen them to see if they're a good fit for you. Some of that screening will or can happen before you ever see them. For instance, if you have a particular issue you want to address, do what you can to find a therapist who specializes in that area. This is particularly relevant if you're healing from or dealing with things like sexual assault⁠ , abuse⁠ or other trauma⁠ or an eating disorder. A general therapist is better than no therapist, but someone who's trained to address specific issues, and chooses to specialize in them, is usually better.  Think of it like having a nest of angry badgers in your house. A general pest removal service can get rid of them eventually, but someone trained in badger removal is going to be more effective at doing so, and will have more practice, so they're more likely to do it well.

You can also do a lot of screening just through email or phone calls, and only go for an in-person visit once you're already pretty sure from some basic questions through those channels that a therapist is pretty likely to be a good fit for you.

What does screening a therapist look like once you're in the room with a therapist? Think of it like being on a first date with someone. You're looking for information about their approach to mental health, and you're also feeling out how compatible (or incompatible) you two are. Helpful questions to ask (which you can also ask via email or phone) include:

  • What is their treatment philosophy and what methods of intervention do they prefer? There is more than one kind of therapy in the world, and most counselors have a preferred set of techniques they use with clients. They're also going to have a framework from which they operate, one that influences what they think the causes (and solutions) of mental illness are, how they perceive trauma, and how savvy they are on issues of race, gender⁠ , and sexual orientation⁠ . You want to find out what that framework is because a mismatch between their philosophy and yours makes for a rocky relationship⁠ . You also want to use this meeting to see of the methods of intervention they use are ones that you can stand. Talk therapy, where you sit and tell the therapist your troubles and they nod sympathetically, is what most people picture when they hear the word therapy. For some people, it's great, while for others talk therapy makes them want to flip a table in frustration. If you're the table-flipping category and the therapist you meet with says they utilize talk therapy, you can ask them if there are other approaches the two of you could use. The therapist may know how to do those and, if not, should be able to help you find someone who uses alternative methods of counseling. If, in their answer to this question they use terms you don't understand, you have every right to ask for clarification. The better you understand where they're coming from in how they view mental health, the easier it will be to tell if they're the right counselor for you.
  • What will the timing of sessions be? Once a week? Once a month? If a therapist's schedule only allows them to see you once every three weeks and you need support every week, that's a sign that this may not be the best fit.
  • What is their protocol in case of emergency? If you find yourself in a crisis and you're five days away from seeing them, what is the therapist's preferred plan of action? Some therapists are open to you contacting them while you're in crisis, while others prefer to have you call a crisis hotline. Not only will this question tell you about how they view their role in your treatment and if it meshes with your view on their role, it's also helpful to know the plan for a crisis well before a crisis comes.
  • What is the payment plan? Find out from your potential therapist when they expect to be paid, both in terms of frequency (paying on each visit vs. paying for a months worth of visits) and in terms of when during the session you're expected to pay. If money is scarce for you, ask them if they have options in place for clients who need to pay in small installments. If you're using insurance to access therapy, you'll want to ask them what happens if your insurance suddenly disappears. If their expectations around payment don't align with your financial situation, then that eliminates them as a resource.

Screening your therapist this way also helps you establish a dynamic that will be helpful later on: active participation. If you want therapy to have any chance of being effective, you have to active and engaged during the sessions. Not understanding that therapy is a cooperative process -- rather than a therapist "fixing" you or the issue -- often seems to trip people up. There's a cultural image of the therapist/client interaction where the client lies on a couch and shares their troubles, the therapist analyzes them and then explains, in detail, what the client needs to do. In that image, the client passively accepts this advice and all is solved. Voila!

The truth and the reality is that the more you interact with your therapist to create a back and forth dialog, the more you're going to get out of the session. Part of that comes from the fact that, the more you communicate with your therapist, the more information they have to help them figure out what treatment approaches might work for you.

Active engagement also means doing any "homework" that your therapist gives you and really engaging with it, rather than doing it like an assignment that's due where you're just trying to pass. One hiccup there is that some people are in therapy to address an issue that inhibits their motivation, energy, or executive functioning. This can make out-of-session activities difficult to fulfill. If that's a concern of yours, discuss it with your counselor and see if the two of you can develop a series of small steps that will be manageable for you in the here and now while still building you towards larger changes.

Ongoing sessions

Establishing a good back and forth relationship with your counselor is not the final step in a successful therapeutic process. Honesty is another huge, important chunk of getting what you need from counseling. It's also something that we see our users struggle with. A common reason for this is that people in therapy have the impulse to be a "good" client. Sometimes the good client is an extension of  our instinct to present the "best" version of ourselves to people. We generally want to look kind, brave, capable, strong, or smart. We avoid looking selfish, angry, sad, or scared whenever we can. It's that second set of emotions that's usually relevant to therapy. That's not to say that positive emotions and traits don't come up.  But if you're getting counseling it's probably due to some not so shiny-happy emotions cropping up in your head. Therapy is a space where it's safe to express those emotions. There's no need to present a front, and in fact it's better if you don't. When you're honest about what's going on in your head and heart, it helps your therapist understand the kind of help you need. If you don't share the bad or embarrassing stuff with them, they can't help you with it.

The desire⁠ to be seen as "good" can trip you up in other ways. We often see users not being honest about what's bothering them, which leads to their counselor giving them advice or techniques that don't help with the core issue. The reason for this is that they think, or fear their counselor will think, the issue is shameful. A user may have ongoing anxiety about getting pregnant, but not bring it up with their therapist out of fear of judgment. This creates a vicious cycle where you're frustrated because therapy isn't working and are not getting the root cause of an issue addressed. The way to break that cycle is, you guessed it,  to be honest about what is bothering you. "But" I hear some of you say, "the thought of talking with a therapist about anything remotely related to sex⁠ makes me want to burrow underground and never come out!" If that's the case, try slipping your counselor a note that explains the situation. That communicates your needs to them while decreasing your odds of feeling self-conscious (which, by the way, is a completely normal and okay way to feel during counseling).

Another place where honesty is important is discussions of whether treatments and approaches are working. We talk to many users who are in the midst of therapy and finding that the techniques their therapist has them use aren't working. But they don't tell their therapist that it isn't working, but instead, often just ditch therapy or stop participating. That hesitancy to be honest about that can come from a number of places, one of which is that desire to be a good client. There's a fear that admitting a treatment isn't working is a sign that you're not doing what a "good" patient would do and your therapist will be disappointed in you. And sometimes there's a deeper worry that because this method isn't working, no method ever will and you will be stuck how you are forever, so it's better to pretend it's working in hopes that said fear will go away.  Many therapists have a variety of approaches they know how to use, and they genuinely want to know if the one they suggested to you is not working so they can offer other possibilities. If you need to have the, "this isn't working" conversation, it could look something like this.

You: I've been trying the taste, smell, touch grounding exercise for  few weeks now and I feel like it's not working. Are there other techniques I could try?

Therapist: Let's see, can you tell me what about that exercise isn't working?

You: Whenever I try it, it only grounds me for a minute or two. Then I'm right back to feeling panicky.

Therapist: I see. Then let's talk about some other methods you could try.

You may need to have this conversation multiple times during your course of counseling depending on how much trial and error it takes to find the strategies that work best for you.

Relationship Troubles

Even if you screened your therapist to the best of your abilities, after a few sessions you may discover there's something about the relationship that makes it unsustainable. Those issues can range from the annoying to the toxic. No matter how severe the reasons are, you are allowed to switch therapists

One potential issue is you and your therapist don't identify the same thing as being your biggest need. There can be instances where the therapist is spotting a pattern or an issue that you're not, and they think drawing your attention to it will be beneficial. After all, even the most self-aware of us have blind-spots that, once another person points them out to us, make us go "Oh, that's what's happening." Other times, there may be a genuine conflict in what you and your therapist think is important. If your therapist wants to work on your interpersonal skills and your primary concern is managing your suicidal thoughts, that's not going to be a workable relationship.

It also goes without saying that if a therapist is unaccepting or hostile towards a part of your identity⁠ , be that your sexual orientation, gender identity⁠ , race, or religion, get the heck out of dodge.

You deserve a therapist who provides a space where all parts of your identity are validated and respected.

I'll emphasize: you're allowed to switch therapists. Finding a therapist is a lot like dating; most people have to shop around before they find someone to be with for a few months or years. As with any relationship, those mismatches can be due to a number of things.  Sometimes the approaches your counselor is well-versed in don't work for you, sometimes getting to their office is too much of struggle. And, just like romantic⁠ relationships, sometimes you and a counselor simply don't mesh.

Finally, a common complaint I hear from users and friends alike is that treatment is not working fast enough. One of the frustrating realities of therapy (and of medication) is that it takes time to create big -- and sometimes even small -- change. Your wish may be to go to sleep and wake up the next day free from any and all mental health issues, but the process just doesn't work that way. If you're prescribed medication, it takes time for the drug to influence your brain. Likewise, if you've adopted exercises to manage your emotions or thoughts it will take practice and time before you start to see a change. Think of it like taking your brain to the gym. In the beginning it's hard and frustrating and frequently leaves you feeling sore. But over time the actions and thoughts become easier, more automatic, even if they still leave you sore or tired every now and then. Patience and perseverance are as much a part of mental health treatment as soft chairs and boxes of Kleenex.

Hopefully this article has given you some ideas of what to do if you're struggling with therapy. Remember, getting help is a huge step in taking care of yourself. The more confident you feel in customizing that help to your needs, the more benefit you'll see from it in the long run.

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