A couple years ago I wrote a blog that I’ve shared over and over again with friends and family, with information about how to find a therapist and what to expect as you start the process (https://thesibleygroupdc.com/new-to-therapy-heres-how-to-navigate-the-process/). I am writing this as a follow-up to that blog, because I still find myself talking with people fairly often who are unsure about the therapy process, unsure of whether it’s working or not, or convinced that therapy “isn’t for them” because of a bad experience with a past therapist. This is what I want people to know in order to make the most of their investment of time, money, and energy in therapy:
– Therapy should have a purpose and a plan. It can look a lot of different ways – talking, playing games, drawing pictures, meeting in a group, filling out worksheets – but the main point of it is to 1) manage symptoms and 2) treat root causes. If you don’t know how the therapy you are doing is achieving 1 or 2 for yourself or your child, then you need to discuss that with your therapist. You should know why you’re there, what your treatment plan is (your goals and the steps to get there), what type of therapy your therapist is doing and why, and you should have check-ins to update these plans/goals/approaches as needed.
– Therapy is collaborative and relationship-based. You and your therapist are both working on your goals; your therapist’s job is to offer treatment planning, strategies, and a safe space and relationship which enables you to do your work. Your job is to do the work- to show up, to use the strategies, face discomfort, and try new ways of being and feeling. The relationship with your therapist is a part of the process. You need to have a relationship with your therapist in which you are actively collaborating, trusting them and being honest, feeling seen and heard and understood, and respecting their judgment and ability to provide what you need. Not getting those needs met? Talk through it, see if you can improve the relationship, clarify what you want to change. Still not getting needs met? It’s probably just not the best match; find someone who gets you.
– Therapy should involve progress. If you’re not seeing progress towards your goals, you should have a conversation about that and make a plan- either changing approach, changing goals, changing therapists, or pausing treatment. You might not be able to have an exact timeline, and progress can be slow; but if you hit a plateau in therapy, it should be a discussion and a conscious choice about how to proceed. Do we wait for things to improve or do we try something different? Don’t just stick with the plan if the plan is not working and your gut tells you that you could be feeling better. You should feel empowered to talk through this with your provider.
– Therapy is only part of treatment; health & lifestyle changes make more difference than you think. Therapy is great, but mind and body are connected, so you can challenge cognitive distortions all you want but if you aren’t taking care of your body then therapy will only get you so far. The amount of rest and exercise we get, as well as the amount and the content of the foods we consume, have a big impact on mental health. Sometimes increasing sleep, getting healthy meals 3x a day, exercising regularly and taking a multivitamin makes a bigger impact for a client who is experiencing burnout than any cognitive treatment- so don’t limit your wellness efforts to the mental component of mental health. Think holistically. I ask all my clients to get bloodwork to rule out physical conditions and vitamin deficiencies, and ask them to set goals around eating, exercise, and sleep habits in addition to our therapeutic work together.
– Talk Therapy isn’t the only way. I’ve worked with clients who hate talking about their feelings. Sometimes that is a symptom of avoidance, which would be part of our work in therapy– to learn to tolerate and communicate emotions. But sometimes it’s an authentic preference to process emotions and express them in ways other than verbally communicating them. Honor your needs and explore your options. Art and expressive therapies, journaling, somatic therapy, mindfulness, all are ways to explore and process our emotions without talking. Other activities can be therapeutic too- like running, knitting, swimming, baking, doing volunteer work, or spending time off your phone with loved ones. When we do an activity that connects us to the best parts of ourselves, it’s therapeutic. That will look really different from one person to the next- listen to your gut and meet your needs in the way that is true to yourself.
– Sometimes things get worse before they get better. The reality is that change and growth involve some level of discomfort. Discomfort can be a sign that something is wrong- that treatment isn’t working, or that we’re causing further harm- but it can also be growing pains, and so we have to be reflective and curious about why symptoms might be increasing after we start therapy. Don’t jump to conclusions. Talk through it with your therapist.
– It’s okay to be scared, ashamed, resentful, or otherwise unhappy about showing up each week for therapy. There’s plenty of reason to not want to have to do hard work on uncomfortable symptoms. It’s ok and normal to feel any of that. And it is actually part of your healing/growth process to figure out why those feelings come up for you as you are trying to better yourself. What would you have to give up if you got better? How might your life or your relationships change and how would that feel? There’s a whole lot of self-compassion and self-acceptance that has to happen sometimes for us to work on ourselves.
– It’s also ok to love therapy 🙂 It is a wonderful investment in yourself that benefits you and all of the people in your life if you can heal trauma and grow from challenges. It is meaningful self-care, and an act of self-love. Yes, it is a privilege to be able to have the time and resources to go; and it is also something that we can appreciate, be grateful for, and even look forward to.
– Therapy isn’t supposed to be forever. Therapy is meant to come to an end once goals have been met. You should be thinking about ending therapy from the moment you get started, and you and your therapist should talk about that from time to time. Have symptoms improved? Have underlying causes been addressed? Have goals been achieved? Sometimes therapy continues out of habit or becomes an ongoing support system. I am always happy to have clients continue to check in when they want to work on something. And, I also believe that the goal is for them to not need me, for them to use internal resources and their support systems to meet their needs, unless a new trauma or new symptoms arise. Having a good “goodbye (for now)” is part of a good therapy experience. It is empowering, and it leaves an open door to return to if needed in the future.
– Therapy can be a process of coming and going, stopping and starting. Therapy is for people who continue to grow, change, and evolve. That means that you could do one portion of work during one phase of your life or your child’s development, and then find that down the road you need or want to work on something else in therapy. It’s natural and okay to stop and start therapy. What’s important is having good endings with positive closing conversations between you and your therapist that help you take the skills that you learned in therapy and use them in your daily life. You don’t have to work on everything at once. You can choose when you do certain work and when you pause. As long as you are trying to consciously approach the emotional work rather than avoiding it, then you will keep growing.
– Your therapist cares about you. Therapy matters to me, not just because of my job but because I actually care. And, your sharing is not a burden to me. People ask me about this pretty often so I’m adding it in here. I have real feelings of care, compassion, and concern for my clients, because I’m not a robot! I genuinely like, admire, respect, and value the people who entrust me with their stories and their care. It means a lot to me and I love my job. It is absolutely my calling and doesn’t feel like work. And it doesn’t depress me or traumatize me to hear about my clients’ experiences or to sit with people through their most awful emotions; the fact that people are unloading very heavy emotional backpacks with me doesn’t mean that I’m picking up that weight and carrying it myself. It means that I get the chance to guide people towards healing, and even if things are awful I can offer ways to access comfort, healing, or growth, and that is deeply gratifying to me. You deserve to feel cared for in therapy, and to let go of concern for your therapist.