What is your therapist actually thinking?

Our relationship with our therapist is widely regarded as one of the key factors in promoting change. However, many of us may not know much about therapy, or the therapist’s process, when we make our choice of therapist: they may simply live nearby, their prices may be attractive, they may practice a modality we have heard of, and so on.

So when you sit down in front of your new therapist, what kinds of things might they be thinking as you begin your story? Each therapist, of course, is unique so I can’t speak for anyone else, but let’s explore some of the things I might be wondering if you were to sit down with me.

What’s the best way to meet you?

Each of us makes contact with the world around us in different ways: you may like to engage in thoughtful discussion, learn about theories or look at diagrams together with me. Or perhaps you prefer to express your felt senses and bodily sensations in the moment, perhaps doodle spontaneous pictures or use objects to feel and hold? Maybe you want ‘action’, to make concrete plans or set out timelines, ‘doing’ activities to be confident that something is being achieved?

Of course, you may not fit neatly into any of these boxes, being a complex blend of all the above at different moments throughout each session: there is no right or wrong way to do therapy.

When we first meet, therefore, it’s likely that I’m partly thinking about the best way to meet you: listening to your use of language and observing your gestures to understand which channels are most readily open for us to do our work together. I may offer some different ways of working to see which feels most comfortable for you, and this tends to naturally evolve as we get to know each other.

What is the problem?

Perhaps surprisingly, you may not actually know what the problem is when you first arrive to therapy – this is very, very common! You may have a general sense that something is wrong; you may feel depressed or anxious but not really understand why; or you may have a specific issue but not understand why it is affecting you so much, and so on.

Therefore, as you begin to describe your story, I might be listening for patterns, repeated phrases or feelings to try and understand what the underlying problem is that has brought you to therapy. As curiosities are evoked in me, I am likely to gently enquire about them to see if they resonate with you also: if they don’t, that’s fine, we keep going until something feels important to you.

As a hypothetical example, a client who initially arrives saying: “I just feel really bad most of the time” may eventually make connections to discover an underlying pattern in themselves, perhaps eventually being able to clarify: “Sometimes, I don’t listen to my own needs because it feels safer to put them aside and to please other people instead” – again, this being a hypothetical example.

So another part of my thinking, as we get to know each other, is to look out for patterns that may play out repeatedly within your inner world. Once we have identified these, we can explore when and why you may have developed these ‘survival strategies’: looking at situations when they work well; and when they cause issues for you (often, it’s these ingenious strategies we came up with as children that are no longer working so well for us as adults). As clients come to understand their own inner workings, they can experience a newfound sense of compassion toward themselves: a powerful healer in itself.

Which ‘parts’ need to be heard?

Most theories and modalities break the personality down into various ‘parts’: depending on the theory, different names may be given to these parts. As a therapist, I like to ask you to name the parts of you that emerge in our sessions - so that the language we use feels right for you.

I might ask something like: “If we could give that part of you a name, what would it be?” and we might continue using that name as we explore further. As trust builds, and more parts of you emerge, I may find myself wondering “Which parts don’t feel they are allowed to speak or show themselves?”

Many of us have learned as children - from our early caregivers, or from society - that certain parts of us are either ‘acceptable’ or ‘unacceptable’. In order to get what we need, we often learn to minimise the unacceptable parts of us. A rule of thumb I often hold in my mind as I listen to you is: if all parts of us feel heard, we tend to find balance; if there are parts of us that don’t feel heard, they can get stuck.

With this in mind, I think of the therapy room as a place where all parts of you are welcome and therefore, I’m often wondering how to invite those parts that don’t feel so confident to feel welcome, to feel safe and completely accepted.

What am I feeling as the therapist?

This may sound puzzling to hear, but as a therapist, I’m also involved in your therapy process. As I listen to you narrate your story, as empathy takes hold, my own feelings about your issues begin to resonate with my own experiences: sadness, joy, anger, fear and so on.

Sometimes the feelings shared between us create an environment where we can openly name and express those emotions freely, this often being very cathartic and healing. Sometimes, however, the feeling that I experience may not be the same as the feeling you are describing, and this can elicit curiosity in me.

For example, say you were telling me a story where you felt angry, and yet as I listen, I notice I’m feeling sadness instead of anger. Why is that I may wonder? Why am I feeling a different emotion to you? Sharing these types of curiosities with you can be revealing for both of us, unconscious processes can often become conscious to both of us in those moments.

So as I listen to your story, I’m also listening to myself and my responses to your story, and sharing these with you to see what emerges between us.

The takeaway

Each client is unique; each therapist is unique; and each client-therapist relationship is unique. There are many approaches to therapy out there and, no doubt, each therapist thinks in different ways. The examples above are the musings that often emerge for me as I get to know a new client.

The key takeaway is that the nature of our sessions - the content, the pace, my thinking as a therapist - is guided by you: the client, the expert in you.