The Client Rules: How to Benefit Most From Therapy

Success in therapy depends heavily on the client.

Posted Aug 02, 2018

Photographee eu/Shutterstock
Source: Photographee eu/Shutterstock

Psychotherapy is effective in treating many psychological difficulties and disorders. Since it is costly in time, energy, and money, though, the decision to enter therapy should not be taken lightly. Success will depend on many factors, some of which are outside the client’s control. But client variables do matter, and there are certain steps clients can take to improve their odds of benefiting from therapy.

Here are a few things clients can do to help the process succeed:

1. Shop around. The most studied and most important predictor of therapy success is therapist-client rapport, a.k.a. the therapeutic alliance. Defined as a trusting, positive, and collaborative bond between therapist and client, rapport is considered a "common factor" in therapy, which means it's important across the board, over and above specific technical and theoretical aspects of the work. Rapport may not be sufficient for improvement, but it is necessary.

Now, clients and therapists are a diverse bunch, with different temperaments, backgrounds, styles, and worldviews. Moreover, interpersonal fit is not a one-size-fits-all proposition. The chemistry between two people is an emergent property of their unique interaction. Given all this, it’s worth your while to try several therapists before settling on the one with whom you fit best. This is not always possible. But when it is, it’s a good idea.

These days, some of the matchmaking can be done in advance by checking a therapist’s credentials online or scheduling a phone conversation to get a feel for his or her demeanor and style. (You can start that process here.) What you’re looking for initially is evidence of the therapist's professional competence and experience in your problem area. Building rapport will usually be easier with a therapist whose expertise you trust. But at the end of the day, what you feel in the room, face-to-face, matters most. As with dating, or buying a house, what looks good on paper or sounds good on the phone may fail to resonate in person. There is no substitute for a face-to-face encounter.

A common problem with this process is that some clients, having met the therapist face-to-face, feel awkward about "rejecting" them to look elsewhere. This concern is misplaced. A therapist is a professional. As such they know that rapport is important, and that it cannot happen with everyone. A therapist worth their salt will understand and appreciate your decision to move on. Moreover, you are not responsible for the therapist’s feelings. If there’s no fit, you’re doing both of you justice, and a favor, by moving on.

2. Show up (on time). Whether you’re on time or late for a session conveys important information about you. Now, we are all imperfect and human and busy, and sometimes we have legitimate reasons for being late. Sometimes a cigar is just a cigar, and being late is happenstance; an accident on the highway caused traffic delays. However, a pattern of persistent tardiness or frequent no-shows often denotes a lack of commitment, discipline, courage, and readiness for therapy. It impedes rapport building and slows down progress.

Therapy only works if you care about and are committed to it. Otherwise you’re likely wasting time, and one thing none of us really has is time to waste. Thought experiment: How would you feel if your therapist were consistently late for your sessions? Right. So, do onto others. Showing up on time communicates respect, commitment, and discipline—all of which are necessary for therapy to succeed.

3. Do the work. Therapy is an active, involved, and effortful process. It’s not like surgery but rather like rehab. You can’t just sit there and wait for it to be done to you or for you. You have to participate, communicate, and take action. In session, the work can be intimidating, frustrating, tiring, and sometimes bruising and emotionally exhausting. This is by design. If the workout isn’t challenging your limits of strength, flexibility, and stamina, it won’t improve your conditioning.

Moreover, contemporary therapy often involves out-of-session work in the form of self-monitoring tasks, homework assignments, practice drills, or behavioral challenges. As with other skill-building and conditioning endeavors, the more you put into it, the more you will get out of it.

4. Be honest. The clinical encounter is designed to allow and foster an honest dialogue, in which clients are able to speak and hear painful, non-obvious, and sometimes perplexing truths. In therapy, truth is valued, and you are safe and supported in speaking and examining it. In therapy, unlike in the outside world, being honest is more useful, effective, and appropriate than being polite, nice, agreeable, cunning, or clever.

Without honest discourse and feedback, progress cannot occur. The old computer maxim "garbage in, garbage out" is applicable here, only in reverse. If you put out garbage, then that’s what you’ll be taking back in. Now, a skilled therapist can nudge a client in the direction of honesty, model honesty, and sometimes spot a client’s waffle, dodge, or pattern of avoidance. But therapists are not lie detectors; they can’t force the truth out of you, and they can’t read your mind.

In fact, it’s quite easy to fool a therapist, and if you decide to do so, you will likely succeed—after all, your therapist doesn’t have much knowledge about you other than what you provide. But what have you actually succeeded at? Wading deeper into the morass from which you sought to extract yourself. Best to be honest, speak truth, and face facts.

5. Open up. If your discussions with your therapist resemble your conversations with friends, lovers, parents, or work colleagues, then you are not bringing it. In large part, therapy is for saying and feeling and understanding those aspects of your life/personality/relationships that are not spoken of, felt, or understood by others in your life. This is why, if you find yourself sharing everything that’s going on in session with your friends, then you’re not really doing therapy. Playing a client is not the same as being one.

Now, this doesn’t mean that you can’t make the important people in your life aware of your therapy. You can. And you may want to share with them some of the results of the process—new insights and habits, resonant moments, etc. Moreover, as a client you may sometimes want to bring an ally into session—a spouse, a sibling, etc.—to support you and gain a better understanding of your journey. That’s fine and often beneficial (when coordinated with the therapist, of course). But as a rule, you are better off keeping the therapy process private and letting the results of your work speak for themselves, as when your friends and acquaintances comment unprompted on your changes. One reliable sign that you are truly changing is if people who have no knowledge of the fact you’re trying to change nevertheless notice it.

6. Expect improvement (but not transformation). Most clients improve in therapy. But people who expect to improve do so more often. This is in part due to the placebo effect, which is powerful. Additionally, those who expect to succeed may get more deeply engaged in the process, and have more confidence and resilience in overcoming obstacles. A team that expects to win views falling behind as a temporary setback, while a team that expects to lose views it as prophecy fulfilled. 

At the same time, it’s important to remain realistic. Psychotherapy is a rather crude technology. It doesn’t always work; it works slowly when it does work; and it doesn’t work as well as we would like it to. In the field of psychotherapy, early fantasies of wholesale personality transformation, common in the times of Freud, have collapsed in the face of sobering data. Change is hard. Life, after all, is a chronic, incurable, and fatal condition. Psychotherapy can help you manage life’s punishments and savor more fully its rewards, but it doesn’t change the ultimate existential equation.

7. Take notes (and keep records). Part of therapy is learning—new skills, new insights, a new self-narrative, and a new terminology. Relying on memory alone in the process of learning is not the best strategy, as you may remember from your college years. Therefore, it’s a good idea to keep all kinds of therapy-related records and notes. For example, some clients keep a therapy journal in which they reflect on what they have learned and experienced in session. You’d want to keep the handouts and readings assigned by your therapist, so you can consult them again when needed. You can also take notes in session, in real time. You can take a photo of a helpful diagram (with the therapist’s permission). You can proactively ask your therapist to recommend readings for you. Ultimately, our job as therapists is to give psychology to the people—to make you an expert on mental health in the area of your particular concern. Good note taking and record keeping will help.

8. Cellphone off. Research has yet to probe the effects of cellphones on the therapy process per se. But my anecdotal sense is that the presence of the phone takes attention away from the work. It also represents a failure to demarcate clearly the therapy encounter as a sacred, unique space separated from the day-to-day. And it can disrupt or ruin delicate moments that emerge in the course of the therapy encounter. My rule (in my college classes and in therapy) is that cellphones need to be tucked away somewhere where neither you nor I can see them. And they should be turned off or silent.

Now, the phone may be used at certain times and in certain specific ways during session—to make a dreaded, avoided phone call, to practice social skills, to keep notes, to share information, to schedule future sessions, etc. But the default mode should be no phone. Make tucking your phone away upon entering the therapy room your habit. It is good style. If you find this difficult to do, then that's something worth processing with your therapist.