Getting the Most Out of Therapy

You Can Take Control of Your Counseling Experience

Counseling has come out of the closet. What use to be a taboo topic – going to a “shrink” – has become part of everyday conversation. The only oddball thing about going to psychotherapy these days is if you’re one of the few who haven’t done it. In fact, 91 percent of Americans are likely to consult or recommend that a family member consult with a mental health professional, according to a 2004 survey by the American Psychological Association (APA). If you or someone you know hasn’t already sought some sort of psychotherapy, chances are it will happen soon.

Know why you’re going
The reasons people go to therapy are as varied as their different personalities. Some have clear-cut diagnoses – phobias, depression, anxiety – that they can recognize and put a name to before they ever set foot in a therapist’s office. But many more just know that something isn’t right, and that’s okay. You don’t have to identify the problem and put a name to it before you go to a therapist; it’s part of the therapist’s job to help you figure out what isn’t working in your life and identify why.
“For a lot of people it’s when issues start getting in the way of relationships or work that they really become a problem,” says Dr. Patricia Daza, psychologist at Houston's Menninger Clinic. “Nobody really comes to therapy when things are going well – often they’re in a state of crisis, they’ve tried everything else and it’s not working.”
Whether you determine your issues and goals before you find your therapist or after, it is important to get specific about what’s bothering you and what you want to achieve. “Some patients say, ‘I don’t want to be depressed’ but what does that mean?” Gaza says. “Patients need to describe the problem in detail and be really clear on what they’re experiencing.”

Find the right therapist
When you’re already having a difficult time, trying to find the “right” therapist can feel like a Herculean task. Not only do people with all different types of education and certifications call themselves counselors, they also practice myriad different type of therapy. (For more detailed information on the varieties of counselors, see “???” in the ??? issue of Total Body magazine). Psychology Today lists 28 different methods of therapy including cognitive therapy, behavioral therapy and hypnosis.
How do you know which one is right for you? Without studying long enough to become a therapist yourself, you can’t really understand all the different therapeutic modalities and make a decision about which is the best treatment for your particular case. It’s your therapist’s job to determine that; it’s your job to find a therapist you trust to make that decision. The good news is that finding someone you trust and connect with is far more important to the outcome of your therapy than is the type of therapy in which they specialize.
“People often talk about theoretical orientation – cognitive, behavioral, etc. – but research has shown time and time again that it’s more important to connect with that person and be able to respect them,” Gaza says. “It’s more about a rapport and feeling safe. Part of that is experiment because you might think you’ll get along better with a male therapist, for example, but then learn from experience that you actually connect better with a woman.”
Your decision about which therapist to choose should start from the moment you pick up the phone to make an appointment. Do you feel comfortable with the way the therapist talks to you on the phone? If you feel threatened or condescended to at the first contact, you might want to make calls to a few more therapists until you find one who is a better “gut level” fit for you. Does it take forever to get the therapist to call you back, or do you have to wait weeks for an appointment? These are signs that the therapist is going to be just as hard to contact once you’re a patient, so if accessibility is important to you, keep shopping.
Once you’ve made the first appointment, you should be looking for someone you are able to talk to and respect, not necessarily love at first sight. “Connection is important, but it’s also important to give people a chance,” Gaza says. “It’s okay to be nervous and be uncomfortable at first, but you should feel rapport building through the first few sessions.”


Be honest
While it seems logical that once you’ve found a therapist and are investing money and time to talk with that person that you’d be honest with them, that can be easier said than done. “In theory it makes sense that people would be honest,” Gaza says, “But there are people who come back for additional therapy saying, ‘Look I wasn’t as honest as I should have been…’ It’s often because there’s a lot of shame and guilt involved. Honesty also has a lot to do with motivation to seek treatment, sometimes they’re just not ready.”
Being willing to be honest about your problems – about the deep, dark secrets that you may never have told anyone before – is one of the keys to successful therapy, but nobody said it was easy. The fact that your therapist will be entrusted with these secrets makes it even more important to choose someone with whom you feel a rapport. All therapists can be trusted to maintain the confidentiality of what you tell them, but you also have to trust that your therapist will react to what you say in a helpful, supportive way that encourages you to keep sharing more rather than clam up. Withholding information from your therapist is a sure-fire way to make the experience a waste of time for both of you.
“Therapists cannot read peoples minds,” Gaza says. “We rely on people being here and being open and honest.”

Expect discomfort
If you go into therapy expecting it to be a pleasant chat or a quick lecture from someone who has all the answers, you’re going to be disappointed. Therapy is a process, and not always a pleasant one, particularly at the beginning.
“It’s a Catch 22,” Gaza says. “On the one hand, people go to a therapist hoping to feel better, and initially that’s not really the case. There actually may be more anxiety in the beginning because you’re talking about some things you’ve held in for awhile.”
“The first couple of sessions are going to be tough,” she continues. “You should expect that so you don’t drop out after just one or two sessions. For many people, it’s about six weeks to three months into therapy that they really start feeling the rapport and being comfortable fully connecting with the therapist.”

Stick with it
Therapy isn’t a quick fix. You don’t go into the therapist’s office, tell him your problems and walk out an hour later with everything all better. How long therapy will take depends on the individual, the situation and the therapist, but the APA cites a study showing that 50 percent of patients noticeably improved after eight sessions while 75 percent of individuals in therapy improved by the end of six months.
How long your therapy will take is something you should discuss during the first couple of sessions with your therapist. After one or two sessions, the two of you should be able to talk about goals, expectations for improvement and timelines. While you might not know up front exactly how long it’s going to resolve the issues that brought you to therapy, you should be able to agree with your therapist that it’s reasonable to expect improvement after a certain number of sessions and plan on reviewing your progress at that time.
“Part of the treatment is education about how long it does take,” Gaza says. “It’s not necessarily three sessions. Realistic expectations are important.”

Move on
Once your symptoms start to subside or you once again feel like you’re dealing effectively with your life, you may think it’s fine to just stop going to sessions. It’s not. At least not without discussing it with your therapist.
“For a lot of people, as the symptoms start to subside, they decide to end treatment on their own,” Gaza says, “But for depression in particular if you leave treatment too soon and you don’t know how to handle issues, stressors, etc., it increases the likelihood of relapse. Talk with your therapist about whether or not you’re ready. There should be collaborative process about when to terminate therapy.”
On the other hand, some people get so use to therapy that it becomes a crutch, and they are afraid to lose that support. There’s no shame in getting attached to your therapist and feeling anxiety about ending the relationship. You don’t have to go cold turkey. Most therapists recommend tapering down the number of sessions before making a final break, and even after therapy has ended, it’s quite common to go in occasionally for booster sessions. Some also recommend that their clients get involved in support groups so that they still have a supportive environment in which to discuss problems.
However the relationship ends, though, it is important that it does end. Therapy isn’t for life; it’s to help you get through a rough patch or address specific problems so you can get back to being a healthier, happier you.