What the heck is therapy?
Before I got into this field and someone mentioned counseling or therapy, I used to picture someone lying on a long couch and talking to a guy that had expired butterscotch candies in a crystal bowl asking, “how does that make you feel?” Ironically, this is the depiction of Sigmund Freud who has been coined as the father of psychology, and his “free association” technique. This was done in order to have the client think and feel freely without being visually influenced by the therapist working with them. It’s an interesting technique, but counseling has come a long way since that time.
What is Therapy? Counseling? Psychotherapy?
All those terms are pretty interchangeable. Depending upon the professional background, the provider may have a preference for what they call their services. A Psychologist may prefer to use psychotherapy, while a Licensed Professional Counselor would likely use counseling. At its foundation, therapy is a professional and collaborative process between a trained mental health or substance use practitioner and a client. The therapeutic alliance (therapy relationship) is aimed at creating and empowering emotional well-being, personal growth, and healing. Therapy provides a confidential space where people can freely express their thoughts, feelings, and concerns without fear of judgment.
How does therapy work?
Therapy works using various theoretical frameworks, including cognitive-behavioral therapy (CBT), psychodynamic therapy, family systems theory, and more. This sounds complicated, but I’ll be sure to break this down in a future blog post. The specific approach used depends on the therapist's training, the client's needs, and the therapeutic goals. Generally, therapy involves:
Assessment and Goal Setting:
In the initial sessions, the therapist completes an assessment to understand the client's concerns, history, and goals for therapy. Oftentimes the assessment is referred to as a diagnostic assessment, mental health assessment, or psychiatric evaluation. This is where the therapist would determine if the client meets criteria for a diagnosis. Not everyone who accesses therapy has a diagnosis.
Building a Therapeutic Relationship:
One of the most important parts of therapy is building a trusting and collaborative relationship between the therapist and client. This bond provides a secure and safe foundation for healing.
Exploration and Insight:
Through open discussion, reflection, and introspection (looking inward), clients can explore their thoughts, emotions, and behaviors. The therapist’s role is to guide the client as they go, offering insights and using therapeutic techniques when needed. The therapist should not be telling the client what they should or should not be thinking, feeling, or doing. Side note- this is a huge red flag if you’ve experienced this. Sometimes therapists will point out things like negative patterns of thinking or challenge you to consider other viewpoints to a situation, which is called reframing and is a helpful therapeutic technique. In non-therapeutic language and settings, this might sound like calling someone out on their BS. However, you should not feel pressured by your therapist to agree with them or change your opinion on something. At the end of the day, it is still your decision and your choice.
Skill Building and Coping Strategies:
Therapists teach and equip clients with practical skills, coping strategies, and tools to manage challenges, regulate emotions, and navigate life's stressors.
Integration and Application:
Clients apply insights gained in therapy to their daily lives, continuing growth and progress. This is where the real work happens, outside of sessions and managing life.
What to Expect During a Therapy Session?
Starting therapy for the first time can cause a mix of nervousness, anxiety, and sometimes shame or guilt. Hopefully this walk through can help give you more understanding of what to expect!
Introductions and Getting to Know You:
The therapist introduces themselves and their background, and covers any questions you may have before getting started. They may make small talk about your family, hobbies, and try to find some connections to help build your comfortability.
Exploration of Concerns:
You are invited to share your thoughts, feelings, and experiences, while the therapist listens attentively, asking clarifying questions and offering reflections. Sometimes there are pauses of silence, or you may not know what to say next. That is okay! It may feel uncomfortable or awkward, but I assure you, it’s a part of the healing process. It gives our brains a moment to process the thoughts and feelings.
Collaborative Problem-Solving:
The therapist and you work together to identify patterns, explore underlying issues, and develop strategies for coping and growth. As noted above, this should be done as a team effort, allowing you to make decisions independently.
Feedback and Homework:
Depending on the therapeutic approach, you may receive feedback, insights, or homework assignments to deepen self-awareness and practice new skills between sessions. If you don’t like the idea of homework, you can think of it as sharpening your skills or furthering your investment in your wellness. Another way to view it is if you go to a physical trainer 1 time a week but don’t exercise outside of your sessions, do you think you’ll make much progress?
Closure and Reflection:
Sessions typically conclude with a summary of key insights, a chance for you to reflect on your experiences and emotions, and a plan for in between now and your next scheduled session. It is important to get the next session scheduled before you leave, since often times we can put other priorities above taking care of ourselves.
Common Questions and Concerns
Will I feel judged?
Therapists are trained to offer empathy, understanding, and respect for your story, creating a non-judgmental space. If you are feeling judged in a session, speak up! There may be a moment for healthy exploration for both you and the therapist. If your therapist gets defensive at this, it may not be a good fit.
How long will therapy take?
The duration of therapy varies depending on individual needs and goals. Some issues may be resolved in a few sessions, while others may require longer-term exploration. It is common for clients to feel like they have made positive progress and terminate services, and then return to services after a significant life stressor or needing additional support.
What if I don't know what to talk about?
It's normal to feel uncertain or hesitant at first. Cue the awkward silence that really isn’t so awkward after all! Therapists are skilled at guiding the conversation and can help explore topics or identify progress you have made. Sessions are also not meant to talk entirely about problems, they are meant to empower and build strength.
Is therapy confidential?
Yes, therapy is confidential, with few exceptions outlined by law. These exceptions would be if you had a plan and intent to harm yourself, someone else, or there may be a child being abused or neglected. The therapist would be mandated to report this in the state or county to which it is occurring in. Sometimes clients are afraid to disclose if they’ve had suicidal thoughts out of fear of being judged, or even hospitalized. The therapist should be able to assess risk, and create a safety plan with you if needed. Only in extreme circumstances do therapists need to break confidentiality to keep you or others safe.
Alright, that should be it! Clear as mud?
If you have any questions, don’t hesitate to reach out. We are here to help.
