Therapy

How to Get the Most Out of Therapy

How to advocate for yourself and find a therapist who suits your needs.

Posted Nov 16, 2020

Photo by Youssef Naddam/Unsplash
Two arms outstretched toward one another.
Source: Photo by Youssef Naddam/Unsplash

I started therapy two years ago, after many years of fits and starts. Every previous time I’d tried to start therapy, it had been a mild catastrophe. Every prior therapist had either been unable to see who I was, or I was too emotionally shut down to really show myself to them. 

But this time, it’s been different. My therapist and I have truly connected. He's accepting and involved, and can see me for the ambitious, genderqueer,  insecure, codependent, lovable wreck that I am. I’m different now too. I’m not the withdrawn, chilly person I was when I tried to get help all those times in the past. I came into my current therapist’s office ready to make changes, and willing to take steps that could initially hurt. I was also open with him about any concerns or doubts I had about his approach. And that has made all the difference.

Here are my five tips for maximizing what you get out of therapy. They’re rooted in my own experiences, but also backed by the scientific literature on the subject.

1. Be picky about who you work with

Researchers find it time and time again: The quality of the therapeutic relationship really matters. You have to work with someone who can respect your goals while also challenging you to shake up old patterns and question your priorities. You also have to feel safe around your therapist. If their way of listening bugs you out or makes you feel like a specimen under a microscope, you’re not going to feel comfortable bearing your soul to them.

During my past attempts at therapy, I always accepted the first person I got. I’d take whoever was available at my university’s wellness center, or I’d sign up for online therapy and be assigned a provider by an algorithm. I’d usually wind up with a soft-spoken, smiling, white cishet lady whose therapeutic style involved a lot of listening, nodding, and saying things like, “That must have been hard.” That type of presence appeals to many people, but I always found it cloying.

This time around, I trawled Psychology Today’s Therapist Finder. I used the advanced search options to identify someone who matched my needs in terms of expertise and outlook. After weighing a couple of options, I found a guy who was highly informed on trans issues, anxiety, and trauma. He was covered in nerdy tattoos and played Dungeons & Dragons

I instantly felt at ease with this person. I knew he wouldn’t see me as a freak.  Because he was as strange and nerdy as I was, we immediately got off on the right foot.

The first therapist you see might not be a good fit for you. Remember you deserve to be picky. Give a new person a try — see them two or three times, just to be sure — but if you feel judged, uncomfortable, or misunderstood when you’re around them, that’s a good sign it’s time to move on.

2. Do the homework, even if it sounds pointless

At some point, your therapist is probably going to assign you some homework. It might look like actual homework — some therapists really do hand out worksheets and reading lists — or it might just be a recommendation to meditate two nights a week. When you first get assigned homework, you’re probably going to want to resist it. 

But if you want to get the most out of therapy, you really should play along. Studies consistently show that patients who complete their therapeutic homework do much better than patients who don’t. That’s because therapeutic homework helps to deepen learning, and it encourages patients to develop new social and emotional skills.

One hour of therapy per week isn’t enough time to fundamentally shake up your life. Try to think of your therapist not as a doctor providing you with treatment, but as a personal trainer giving you a workout plan. You have to take the exercises they teach you and use them on your own time if they’re really going to pay off.

I was initially resistant, for example, when my therapist assigned me the "homework" of spending a half hour per week just "sitting with my feelings." The idea was cringe-inducing and mortifying to me at first. Yet after a few weeks of begrudgingly trying it, I found I was more aware of my emotions, had fewer rage explosions, and cried myself to sleep far less. I shared with my therapists that I was reticent to do the homework — but I still gave it a try, and that made a huge difference. 

3. Supplement therapy with outside reading

When my therapist suggested I might have been emotionally abused as a kid, I initially felt pretty defensive. My dad was an unstable, unpredictable person, sure, but he hadn’t meant to do me any harm. It seemed unfair to call what I had experienced abuse.

I told my therapist about my reservations. He pondered for a moment and said to me, “Look, if I was a surgeon, and you came to the ER with an arm that was broken in a way that was consistent with physical abuse, I couldn’t really prove that you’d been physically abused. But I could tell you, hey, the way you’re hurting is consistent with abuse.”

His comments left me feeling curious and receptive, rather than defensive. I resolved to learn more about childhood emotional abuse and the impact it has on adults. I read the book Adult Children of Emotionally Immature Parents, and How to Deal with Emotionally Explosive People, and caught glimpses of both my father and myself in each of them. 

I used to hate self-help books. I found them preachy, superficial, and corny. But the things I read helped to deepen the conversations I had during my therapy sessions. They left me with useful questions and insights that wouldn't have occurred to me otherwise. I brought those into therapy, of course. 

This is a pretty common experience among patients. Research suggests reading high-quality self-help books improves patients' outcomes by giving them a greater context for their learning, and more opportunities to reflect on new ideas and skills. Don’t be afraid to seek out additional resources for yourself, or to ask your therapist for their recommendations. Just make sure to select self-help books that are rooted in the scientific literature, and written by professionals with relevant expertise. 

4. Show your ugly side

Many people struggle with being emotionally vulnerable, both in and out of therapy. Until recently, I couldn’t remember a time when I had cried in front of someone without apologizing for it. 

I brought this conflicted, shameful tangle of feelings with me into therapy. For months, I’d try to avoid any subject or line of conversation that would make me sob. This got in the way of me talking about the problems that brought me into therapy in the first place. 

My therapist really had to push back against that. He reinforced that it was normal and good to cry in front of people, especially a therapist. He reminded me that if being around emotionally distressed people was annoying to him, he should have picked a different job.

Slowly, painfully, I got better at letting the tears come. Eventually, I learned to bring up other feelings I was ashamed of having — anger and irritation, years-old resentments, and selfish desires I initially tried to hide. Finally, I started addressing the problems and patterns that gave rise to those tricky emotions.

For decades, studies have found that clients who show their feelings get much more out of therapy than those that don’t. Clients also benefit when their therapists are emotionally expressive — so seek out a provider who can be real with you, rather than one who wears an impassive, neutral mask.

5. Tell your therapist when their advice sucks

Being honest and authentic in therapy doesn’t end at being openly angry or sad. You also have to be real with your therapist about how therapy is going — and that includes telling them when you think their advice sucks.

Last year, I noticed a pattern in my therapist’s advice that was starting to worry me. Any time I told him about a struggle with a friend, he seemed to want me to end the relationship. I told him about my concerns. 

“I’ve noticed that whenever I tell you about a friend who demands a lot out of me,” I said, “your advice kind of points toward me cutting them off. But if I did that with everyone who overstepped the line, I’d be really lonely.”

My therapist  thought about it a moment, and said, “I’m sorry I’ve been implying that. I don’t think you have to stop talking or hanging out with each of these people. But I have noticed that you have a pattern with being afraid to disappoint people, and let other people’s expectations influence your decisions.”

Together, we brainstormed alternate solutions to this problem that didn’t involve burning bridges. One solution we hit on was that I should practice disappointing people more. If I could get more comfortable with being my full self in my friendships, warts and limitations and all, I could repair some of the ones that weren’t well-balanced.

If your therapist cares about doing their job well, they’ll want to hear when you have worries about how therapy is going. Don't let your therapist's many degrees or credentials intimidate you; the therapeutic relationship offers only a small snapshot into your life; your therapist may miss things at times, or make assumptions that are incorrect, and it's helpful to correct those. 

Research suggests it’s useful for a client to bring up when a therapist has said or done something that’s hurt them, or misread a situation. Not only will these conversations improve the therapeutic relationship, but they’re also good practice for addressing conflict out in the real world.

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If you’ve been contemplating therapy, or you just started up the process of asking for help, give these tips a try. Just remember: therapy is not magic. It's a dynamic, collaborative relationship with another person, who has flaws and gaps in their knowledge just like anybody else. Don't be afraid to be picky, ask questions, and share when you are feeling doubts. A good therapist will not only provide you with useful tools and homework, they'll be receptive to your concerns. 

References

Kazantzis N, Whittington C, Zelencich L, Kyrios M, Norton PJ, Hofmann SG. Quantity and Quality of Homework Compliance: A Meta-Analysis of Relations With Outcome in Cognitive Behavior Therapy. Behav Ther. 2016 Sep;47(5):755-772. doi: 10.1016/j.beth.2016.05.002. Epub 2016 May 19. PMID: 27816086.

Martin, D.J., Garske, J.P., & Davis, K.M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Clinical and Consulting Psychology, 68, 438-450.

Peluso, P. R., & Freund, R. R. (2018). Therapist and client emotional expression and psychotherapy outcomes: A meta-analysis. Psychotherapy, 55(4), 461–472. https://doi.org/10.1037/pst0000165

Williams, C., Morrison, J., McConnachie, A., Mcclay, C.-A., Matthews, L., and Haig, C. A randomised controlled trial of a community based group guided self-help intervention for low mood and stress. [Key Findings]