How to Be in Therapy

client on couch

In the previous issue of Madison Essentials , I talked about how to go to therapy. You’ve found a solid licensed psychotherapist who is a good fit for you and your needs. Now what?

The Intake

You will begin with an intake appointment. During this appointment, you will be asked questions about what brings you into therapy, your current life situation, and your personal history. Topics range from childhood experiences to your education and work history to your mental health and substance-use histories. The therapist will want to know about any symptoms you may be experiencing and what you would like to see change or improve in your life. There is a lot to cover in an hour, so it’s best to answer questions as succinctly as possible. You will have the opportunity to elaborate in future sessions.

During the intake, you should get an idea of whether the therapist seems to be understanding your point of view, has sufficient empathy, and is beginning to get a picture of how and why you are suffering. The therapist may offer brief summaries of what you have said and may even observe connections, have insights, or wonder about something you have not thought of before.

Treatment Planning

After the initial session, you and your therapist will develop a treatment plan to help you collaborate and work toward mutually agreed upon goals. This helps you know what to talk about during each session and keeps you on track. You should expect therapy to focus on your thoughts or cognitions, behaviors, emotions, relationships, and your sense of self. Common topics include relationships, low self-esteem, perfectionism, work dissatisfaction, motivational problems, attention and concentration difficulties, worries/obsessions, trauma, and grief.

Therapy Sessions

Psychotherapy treatment is conducted in weekly or biweekly sessions between the therapist and client to discuss problems presented. This is why it is often called “talk therapy.”

How does just talking to a stranger about your problems help? We’ve probably all had the experience of unloading our burdens on a family member or friend. It’s a big relief to get something off of our shoulders. Sharing concerns and having your perspective validated is instrumental in beginning the change process. Few of us are motivated to change if we don’t first feel our perspective has been understood and is legitimate.

Through talking and being asked the right kinds of questions, a therapist leads their client to experience feelings associated with the dilemmas they are facing. Experiencing and processing these feelings can make a stuck person feel unstuck and able to move forward. Processing feelings involves deeply experiencing the emotion associated with an unresolved issue, accepting the emotions, and coming out of the issue with a different perspective.

Sometimes talk therapy involves changing how we think about things. For example, a client with perfectionistic tendencies may think that the only way to do a project is to do it exactly the right way. The therapist may challenge the client to consider what the worst thing that could happen would be if a particular project was not performed perfectly. The therapist might even come up with a challenge for the client to deliberately not perform up to usual standards and face the consequences to learn that nothing terrible happens.

Another area of exploration is noticing patterns and themes in one’s life. Having the perspective of an outsider who is trained to notice patterns can lead to new discoveries. One common pattern is to find yourself with friends, romantic partners, and co-workers who treat you the same way or make you feel the way you did while growing up, for better or worse. For example, you may have had a parent who was often sick and relied on you for caretaking, and then in your adult life, you partner with or marry someone who is also quite dependent on you, perhaps just in a different way.

Another example of a pattern could be engaging in all-or-nothing thinking and behaviors. A good example of this would be a person who is working on sobriety having one drink, which leads to a binge. “If I had one, I obviously can’t do this, so I should give up.” At another point in their life, they may have done poorly in a class and decided that school or a certain college major was a poor fit and dropped out or switched majors. Thus, we see a pattern.

You can see how observing and understanding these patterns can be helpful for initiating change. Instead of putting out fires each time a problem comes up, a client can collaborate with the therapist to notice when the pattern arises, catch it sooner, and make a conscious, informed choice about how to handle the situation.

Psychotherapists can teach clients new coping skills that are more adaptive than the ones they have been using. For anxiety, practicing deep breathing, meditation, imagining a peaceful place, exercise, and problem-solving can be helpful tools. For depression, changing negative thoughts to more positive ones, recalling happier times, spending time with loved ones, engaging in meaningful work, and journaling can all be of use. Strategies for coping with grief might include setting aside a time each day to grieve; creating traditions and rituals for acknowledging the loss; and taking life one day, hour, or moment at a time.

Psychotherapists have a lot to offer to a wide range of people and variety of problems. Potential clients should not hesitate to seek professional help when usual methods of coping with the stresses of daily life are not sufficient. Asking for help can be hard, but it could be the first step on your way to a happier, more fulfilling life.

Photo by Maison Meredith Photography

Elizabeth H. Winston, PhD , is a Madison psychologist who provides psychotherapy, psychological assessment, and consultation. .