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Unlike a visit to the dentist—“open, rinse, say ahhh, spit”—the rules for a psychotherapy session are not so simple or clear.   Most therapists are unlikely to give you step by step instructions for engaging the session—“talk about your mother, cry, tell me a story from your childhood.”  That’s partly because it’s the nature of psychotherapy for the patient or client to “show up” and initiate topics, set the initial direction, and open up. But that can be very difficult, especially if therapy is new to you or if trust is one of the issues you’re going to therapy to address. The question of how to “do” therapy is further complicated by the fact that there are many different therapeutic techniques, modalities, and styles out there, each one requiring a different type and level of patient involvement. These simple tips might make that sometimes challenging process easier.

  1. Just ask:  It’s absolutely your right to ask questions of your therapist.  If you have a concern or question or fear—anything from a billing question to why your therapist keeps giving you “that look”—ask it.  Asking questions (and getting honest, satisfactory answers) is a critical part of the trust-building process. Trust, of course, is fundamental to successful therapy.
  2. Understand and articulate your own reasons for going to therapy: It can help to journal or talk with a trusted friend about your reasons for going to therapy before you actually go.  Knowing what problem you’re trying to solve or what part of your life you want to be more effective in—even in broad strokes—can help make your initial conversations with a therapist more fruitful.  Your reasons for being in therapy may change over time, especially if the therapy is going well.  So continue to check in with yourself and appraise your therapist of evolving reasons for being in a therapeutic process.
  3. Understand the style of therapy and what’s required of you: Some styles of therapy are very interactive, with the therapist and client actively engaging and even pushing each other. Other forms are didactic or technique-oriented, with the therapist teaching specific skills or administering a treatment (like hypnotherapy or biofeedback). Still, other forms favor a passive role for the therapist, leaving the client to do virtually all of the initiating and talking. Ask your therapist about the style of therapy he or she favors in your case and what your respective roles are in the process.  If, for instance, you go to a hypnotherapist and talk the whole time, or to a psychoanalyst and don’t say a word, it won’t go very well!
  4. Speak: If you have a concern, a comment, or even a critique for your therapist, speak up!  Being transparent and open is the key to building trust.  If you feel overly hesitant to speak what’s on your mind with your therapist, it will limit your progress.  If you find yourself holding back in therapy, you might want to bring that up as a question to discuss with your therapist. Together you might be able to uncover—and remove—obstacles to building a truly trusting open therapeutic relationship.
  5. Practice: Being a good therapy client, i.e. making therapeutic progress, actually takes some practice.  Being an effective client requires engagement, trust, and openness.  All of those things can be tough to muster when you’re first in therapy because the whole context is an unfamiliar one.  With time and practice, though, you’ll find yourself more able to relax and engage in the process. Stick with it.
  6. Be open to surprises: As a caveat to the previous point of understanding your own reasons for going to therapy, be open to surprises.  Many, if not most, “breakthroughs” (i.e. experiences of sudden growth or insight) come completely by surprise.  That’s because one of the points of therapy is to move us through or to new and unexplored or highly protected parts of ourselves.  When we first enter therapy, we may only know that we’re tired of feeling depressed (or angry, or anxious, or frustrated, or numb…).  Our sole purpose for coming may be to seek emotional relief from that feeling.  But what we might discover along the way is that our depression is connected to something we didn’t even know bothered us—like resentment toward our spouse or a parent.  Communicating our feelings toward that person might be the key to relieving your depression, rather than tackling the depression (or other feelings) directly.  Being open to surprises even as you pursue your original objectives for therapy can create the greatest therapeutic opportunities.
  7. Give it a chance: It takes time to establish a trusting relationship.  This is true of friendships, romantic relationships, and work relationships. It’s just as true of a therapeutic relationship.  While a talented therapist may be able to shorten that time by creating a safe environment and skillfully building rapport, there is always a process involved in connecting and trusting—especially when the emotional stakes are high, as they generally are in therapy.
  8. It’s okay to take a break and it’s okay to try someone else: If, after making good progress, you’re feeling like you’ve reached a plateau in therapy, it might be time to take a break. Most therapists would agree that therapy is generally a periodic process that benefits from focused work with breaks in between.  If you’re feeling a bit bored or stuck or just out of things to talk about, discuss that with your therapist and consider a therapeutic hiatus.  On a related note, if you have several sessions with a therapist and “just ain’t feelin’ it,” consider trying a different therapist.  While it usually takes a little time to build up a comfort level with a new therapist, chemistry is an important part of the therapeutic process.  It’s a relationship, after all.  Sometimes, if the chemistry is just not there, it’s just not there. On the other hand, if you find yourself jumping from therapist to therapist you might need to just stick it out with someone and work through your end of the struggle to connect.