Therapy 103 : Defining Counseling
[PART THREE of THREE]
In Therapy 101 and 102, we talked about the various terminology associated with going to therapy, including who is licensed to bill for what and how to get help with insurance coverage. Today, I’m answering some frequently asked questions which tend to arise at the outset of therapy. Let’s start with perhaps the most important:
Am I supposed to lie down on the couch?
Ok, maybe not the most important, but certainly the most emblematic of therapy cartoons. The short answer is no. The tradition of laying down for therapy is associated mostly with psychoanalysis (e.g. Freud) and most therapists aren’t psychoanalysts. However, if you find it comfortable to lie down on the couch, the world is your oyster! or... your couch.
What am I supposed to say?
Your first session will likely take the form of an intake, meaning your therapist will ask more questions and generally provide more structure. She will almost certainly ask, "Why are you here?" -- or some less-accusatory relative of that -- but it is more than fine to just say "Because I feel like garbage." Therapists like it when you talk, but good therapists know there is a whole host of reasons why you might not be talking. Even if you’re unsure of what to say, remember it's quite hard to say something that truly irrelevant to a therapist.
How long do I need to go to therapy before things get better?
I include this question because it is frequently asked - not because it has a satisfying answer. Change can occur in as little as one session, and change can also fail to occur in 20 sessions. That being said, let your therapist know if you have expectations about how quickly a problem needs to be resolved, because that can shape treatment planning. In addition, let us know what kind of "evidence" of progress you need to see. Good therapists can respond to your needs by frequently reviewing short-term goals, for example, or by administering brief assessments to measure progress towards desired outcomes.
My therapist isn’t saying anything. Is that normal?
Mmhmm. Interesting. Uh huh. Your therapist is just sitting there. STARING AT YOU!
A couple things could be happening. Your therapist may be trying to digest and synthesize the information you’re giving her. She also might be debating how or whether to make a suggestion to you. Or, you might not have stopped talking yet, and maybe she's averse to interruption. But if you’re leaving her plenty of room and she’s still not talking, you can (and should) say: “What do you think?”
(I always sort of admire when a client says, “Tell me what you’re thinking!”)
My therapist is saying a lot. Is that normal?
In a word, no. As a therapist, I think the only reasons for me to talk for more than a minute or two are to give the client a chance to regroup emotionally or to explain a particularly complicated concept or bit of homework. Typically, I don’t see my own chatter as a good use of time; and if you’re feeling weird about how much your therapist is talking, she is probably, in fact, being weird.
What do I do if I don’t like my therapist?
The therapeutic relationship is dissimilar from other professional relationships. If you don’t like your mechanic, she can still fix your car. Unfortunately, if after several sessions you really don’t feel connected to your therapist, she may not be great for your mental health. I encourage anyone seeing a therapist to let that therapist know what isn't working. (Something as simple as, "I really don't feel connected to you" is BEAUTIFUL.) Not only is it very helpful for the therapist to hear that, but more importantly it’s great practice for your other interpersonal relationships. It’s a risk to tell someone how you feel, but there’s no safer place to start than with a person who’s being paid to listen!
Oh yeah. About that "being paid to listen" thing. How do I know my therapist really cares?
Usually, that's why she's a therapist.
Do you have a question about counseling that wasn't mentioned here? We would love to hear it using the comment section below!
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[This article does not create a client-counselor relationship. This article is general counseling information and is not to be considered legal or medical advice. Please consult with your mental health professional before you rely on this information.]