What happens in therapy?

Whats happens in therapy?

If you’re thinking about coming to therapy for the first time, various questions might be spinning through your mind. You may find yourself wondering “Can this person really help me?” or “How long might this take?”, perhaps “How much will it end up costing?” and, the big one, “What actually happens in therapy anyway?”.

The actual process of therapy can often seem a bit mysterious. Before you start this fascinating, challenging, potentially life-changing work, here are a few things which might be worth considering.

Be prepared to feel

It’s normal to feel emotional at times during therapy. Perhaps it’s been a while since anyone listened to you properly, or really wondered together with you about your life’s experiences. Remembering, an active process, can also be a painful one, and often our most natural response is to cry. This might feel strange at first, but therapists understand and empathise with how it feels to be in your chair. They will welcome any and all expressions of feeling from you, viewing them as opportunities to help you form deeper understandings about yourself and to find possible ways forward. Alternatively, some people might notice feeling numb or disconnected from their emotions. Feelings of detachment could possibly link back to your response to an earlier time in your life where you might have needed some emotional distance, perhaps to feel safer. Like all feelings, there are no ‘right’ or ‘wrong’ ones. Noticing these, and other less-than-conscious aspects of yourself in therapy might feel a little unnerving, however your therapist understands feelings as forming an important part of your inner experience of ‘you’ and as being worthy of care and attention. Depending on which therapy you choose, your therapist might encourage you, slowly and safely, to explore these sensations and gently expand your awareness, guiding you towards a space which feels more resolved and integrated.

It’s weird. My therapist never answers when I ask how they are.

Lots of people find it strange to be in a room with someone who doesn’t seem to engage in normal, human chit-chat. It can feel quite flattening when we ask our therapist, as we would anyone else, how they’re feeling that day and receive a rather muted reply. It might be useful to know this isn’t because your therapist is being deliberately rude or obtuse. It’s because your session is about you, not them. Many therapists, particularly psychotherapists, will invite you to start the session by speaking first. This is because only you can know what feels uppermost in your mind or lies most heavily on your heart that day. It’s important that these are the focus and drivers behind your sessions, not whether your therapist caught the football on TV last night. This doesn’t mean, however, that your therapist won’t sometimes share certain thoughts and feelings with you and, if done so skilfully, this can also prove very helpful for the therapy.

When will I start to feel better?

If you’ve had to manage life feeling troubled for a while it makes perfect sense to wish for a ‘magic cure’. You might feel disappointed if those changes you’d hoped to achieve don’t seem to be happening quickly enough. Remember, small changes lead to big changes, and small changes will be happening all the time throughout therapy. Sometimes frustrated feelings might also stem from part of our mind which functions like our ‘inner critic’ and can shout things at us like “You’re not doing this right!” or “Maybe you’re really broken!”. Exploring these unhelpful forms of self-talk with your therapist can be a powerful way of unpacking some of our most entrenched issues.

Can I go yet?

In therapy circles there is something known as ‘the lull’. Several sessions in, you might feel you’ve talked about your so-called ‘presenting’ problem, hopefully felt understood by your therapist, and made some useful progress. Then suddenly – crunch! - it can feel like your therapy is stalling. Perhaps you notice your mind wandering, or you feel tempted to skip sessions. Try not to. What might be happening here is that having begun to make progress on what seemed your ‘noisiest’ issue, you’re then left facing those problems you really came into therapy to address, but didn’t know. These problems might include feelings of low self-esteem, anger, resentment, envy, or shame. Lurking behind their highly-protected psychic ‘fence’, they are more resistant to exploration and change, but can be enormously beneficial to address. If you notice starting to prioritise other less important things over your therapy, try to keep coming at least long enough to talk about it with your therapist. They will not be upset or offended, nor will they try to ‘force’ you to stay if, after having discussed it, you’re no longer feeling therapy is helpful. What they might do is suggest some changes, or try a different approach, and this could prove even more effective.

Help! I think I hate/love my therapist!

Strong feelings in therapy are very common. Powerful loving, hateful, or confused emotions often emerge as ‘echoes’ from earlier in your life and can be, in a sense, ‘transferred’ onto your relationship with your therapist. These echoes can include remembered feelings, longings, and unmet needs. Certain therapies, including psychodynamic therapy, actively work with these feelings to explore and transform relational ‘roadblocks’ and can allow for profound healing to occur. If you can bear it, try to talk to your therapist about how you’re experiencing him or her. Often these ‘immediate’ (and occasionally awkward-seeming) conversations can end up strengthening your alliance with them and also accelerating your sense of progress in the therapy. Expressing these emotions can be a wonderful opportunity to safely explore what’s really going on for you inside, as well as between yourself and others.

Whose job is it anyway?

Your therapist’s job includes maintaining safe, helpful boundaries and keeping the work on track. As a client, you have responsibilities too. These are attending and paying for any agreed sessions and being an active participant in your healing journey. Therapists work with, not on, their clients. This isn’t because they’re lazy, but because evidence shows real, lasting change comes about when we take ownership of our own process and, ultimately, our own life.

Take a chance

We tend to get out of therapy what we put in. No therapist, no matter how skilful, can ever do the work for you. Take a chance in opening up to a new experience. As a therapist, I know this can take time and trust. But as a former client, I also know how precious your investment in your therapy is. The more you can practise bringing those aspects which you suspect might be holding you back, the more your therapist will be able, together with you, to find fruitful ways forward.

Good luck!