What Really Happens in a Therapy Session
No, you don't have to talk about your mother (unless you want to).
Posted Dec 05, 2015
When you take your car to the car mechanic, you know what’s going to happen: Your car will get repaired.
When you break a bone and visit your doctor, you know what’s going to happen: Your bone will be set in a splint or cast and eventually heal.
But when you make an appointment to see a therapist, do you know what’s going to happen? Many people aren’t quite certain. Will you just talk? Will you have to discuss your childhood? Will you be “hypnotized?" And what’s the “point” of seeing a therapist, anyway? Why not just talk to a friend?
There is a great deal of uncertainty in our society about what actually happens during a therapy session, what types of issues and problems are suitable for therapy, and what benefits a therapy session can provide. I’d like to address a few typical questions—and misconceptions—about what therapy is, what it isn’t, and how it really works.
Q: Do I have to be “sick” or “disturbed” to go see a therapist?
A: No. Thinking that one has to be “seriously disturbed” in order to see a therapist is a myth.
While some therapists do specialize in severe emotional disturbances—including schizophrenia or suicidal thoughts—many focus on simply helping clients work through far more typical, everyday challenges like mapping out a career change, improving parenting skills, strengthening stress management skills, or navigating a divorce. Just as some physicians specialize in curing life-threatening illnesses, while others treat “everyday” illnesses like flus, coughs, and colds, psychotherapists can serve a wide range of clients with a range of needs and goals, too.
In fact, most of my clients are successful, high-achieving people who are quite healthy, overall. Most are challenged by a specific, personal goal—like losing weight, creating more work-life balance, finding ways to parent more effectively, or feeling anxious about dating again after a rough break up.
Q: How can I choose the right therapist for my goal/situation?
A: Choosing a therapist is like choosing any other service provider—it’s a good idea to visit the practitioner’s website, and read client testimonials or reviews (if they have any—many do not, for confidentiality reasons). It's also good to ask friends and family members, or your physician, for referrals (and of course, check to see who is covered in your health insurance network).
If you are hoping to work on a specific issue—overeating, smoking, making a career change—try to find a therapist with expertise in that area. Many list their specialties or areas of focus on their websites. There are therapists who specialize in relationship issues, parenting issues, anger management, weight issues, or sexuality—pretty much any issue, goal, or situation you can imagine. If you’re not sure about someone’s expertise, just call them and ask. If they can’t be of assistance with your issue, they may be able to refer you to someone who can.
Q: What actually happens during a therapy session?
A: Each session is, essentially, a problem-solving session. You describe your current situation, and your feelings about it, and then the therapist uses their expertise to assist you in trying to resolve that problem so you can move closer to having the life you wish to have.
At the beginning of a session, the therapist typically invites you to share what’s been going on in your life, what’s on your mind, what’s bothering you, or whether there are any goals you’d like to discuss. You’ll be invited to speak openly. The therapist will listen and may take notes as you speak; some, like myself, take notes after a session. You won’t be criticized, interrupted or judged as you speak. Your conversation will be kept in the strictest confidentiality. This is a special, unique type of conversation in which you can say exactly what you feel—total honesty—without worrying that you’re going to hurt someone’s feelings, damage a relationship, or be penalized in any way. Anything you want—or need—to say is OK.
Some therapists (like myself) may give clients some homework to complete after a session. That homework might be to set up an online dating profile and reach out for a first date, or to exercise three times a week. It may be to spend some time each day pounding a pillow to safely release pent-up emotions, make a nightly journal entry, or any number of “steps” and “challenges” relevant to your goals. During your next session, you might share your progress and address any areas where you got frustrated, stuck, or off-track.
Of course, every therapist is different, every client is unique, and every therapist-client relationship is distinct as well—which means that there is no universal description of a therapy session. Some therapists employ dream interpretation in their work. Others bring music or art therapy into their work. Others incorporate hypnotherapy, life coaching, meditation, visualization, or role-playing exercises to “rehearse” challenging conversations. The list goes on and on. Ultimately, regardless of their approach, a therapist will listen without judgment and help clients try to find solutions to the challenges they face.
Q: Will I have to talk about my childhood?
A: Not necessarily. Many people think that visiting a therapist means digging up old skeletons from your childhood, or talking about how awful your mother was, etc. That is a myth. What you talk about during a therapy session will largely depend on your unique situation and goals. And depending on your goals, you may not actually talk about your past that much. The focus of your therapy is as likely to be your present-day reality and the future that you wish to create.
That being said, if you really do not want to discuss your childhood, the intensity of your desire not to talk about it might suggest that you should! When people have strong negative emotions—about their childhood or any other topic—it’s typically worth doing some excavating to figure out why that is. Whatever is causing them to feel such strong emotions about the past is more than likely impacting their present-day life in some way, too.
Q: How long will I have to go to therapy?
A: This varies from person to person. I’ve had clients who booked one session, we worked out their issue(s), and they were all set: They marched out and didn’t need a follow-up session. Sometimes, one brave, honest conversation is really all you need.
Other clients have booked sessions with me over a period of several weeks or months, focusing on one issue, resolving that issue, then perhaps moving on to a different challenge. Then there are other clients who I’ve been working with for some time—they appreciate having a weekly, bi-weekly, or monthly “check-in.” They may share their feelings, sharpen their life skills as needed, or perhaps enjoy a deeply nourishing guided meditation or hypnotherapy experience to de-stress. As one client put it, “Every two weeks when I meet with you, I leave your office feeling like you pressed my reset button.”
Therapy is really about whatever a client needs—a one-time conversation, a temporary source of support during a life transition, or an ongoing experience to optimize health physically, mentally, emotionally and spiritually.
Q: Is meeting with a therapist over the phone—or through video chat—just as effective as meeting in person?
A: That depends on your personality and preferences. In the state of Hawaii, where I live, at least one insurer that I know of covers doing therapy virtually via video chat (like Skype or Facetime). This makes it a convenient option for people. Many of my clients do enjoy having some, or all, of their sessions via video chat because it means they don’t have to take time out of their busy schedules to drive, park, and so on. They can just close their bedroom or office door, pick up the phone or log in, and away we go—very convenient.
Where feasible, I suggest trying out both ways—do a traditional, in-person therapy session and then try a video session—and see which format is the best fit for you.
Q: Why see a therapist? Why not just talk to a friend or someone in my family?
A: If you are blessed with caring, supportive family members and friends, by all means, share your feelings, goals, and dreams with those people. They are a big part of your support network, and their insights and encouragement can be very helpful. However, people who already know you might not always be completely objective when listening to you. For example, you may want to change your career, and you confess this dream to your wife. She may want to support you 100%, and try her very best to do so, but she may also be dealing with emotions of her own—such as anxiety about how a career shift will change your lives, not to mention your income. These emotions could make it difficult for her to listen and support you objectively.
This is why working with a therapist can be so valuable. It's a unique opportunity to share everything you’re feeling, and everything you want to create, without anyone interrupting you, imposing his or her own anxieties onto the conversation, or telling you that you’re “wrong” or that you “can’t.”
A therapy session is a space where you don’t have to worry about hurting anyone else’s feelings—you can be totally honest. It also means you have the potential to solve problems faster and with greater success. In the long run, that’s better for you and everyone else involved in your life, too.
To sum it up:
Therapy is a valuable tool that can help you to solve problems, set and achieve goals, improve your communication skills, or teach you new ways to track your emotions and keep your stress levels in check. It can help you to build the life, career, and relationship that you want. Does everybody need it? No. But if you are curious about working with a therapist, that curiosity is worth pursuing. Consider setting up one or two sessions, keep an open mind, and see how things unfold. You have very little to lose and, potentially, a lot of clarity, self-understanding, and long-lasting happiness to gain.
Check Psychology Today's directory of therapists for a professional near you.
Disclaimer: This post is for informational purposes only. It is not a substitute for professional or psychological advice, diagnosis, or treatment. Always contact your qualified health provider before implementing any new personal growth or wellness technique and with any questions about your well-being.
Copyright © 2015 Suzanne Gelb. All rights reserved.
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