1.) Find a fit.
This is a necessary ingredient to all good therapy work. Therapist’s are people. They have their own personality, style, approach and training. Not everyone is going to be a fit for you and that’s ok. This is someone with whom you’re going to be sharing vulnerable parts of yourself and if you don’t feel comfortable with this person, you’re better off finding someone else. Give yourself permission to have consults with a few therapists so you have some options. Remember that a consult is not an agreement to work together; it is to talk about what you’re looking for, whether that person can help you and to decide if they seem like a good fit.
2.) Be prepared to do work outside sessions.
Fifty years ago, therapy was about going laying on a couch looking up at the ceiling and talking freely about whatever came into your mind for an hour while your therapist sat behind you taking notes. Times have changed! The thing is, if this really helped people in a significant way we would all still be doing it. There’s been a uptick in research in the last decade or so about what helps people make positive change and much of it has pointed to the importance of not just understanding something, but taking action to apply that understanding. When it comes to the brain and the Cognitive Behavioral work I offer, much of of the helping component relies heavily on clients building skill to manage their mind in more effective ways. This involves making a commitment to invest time into their own self-help outside sessions by reading, listening to podcasts, completing worksheets, applying information and doing experiments in their daily lives.
I spent a lot of years helping people understand their past, themselves and their loved ones and insight can be helpful but I’ve found that it’s not sufficient to translate to lasting change. It still amazes me to see the change that can happen in much shorter time when the treatment plan involves a clients active participation in the process.
3.) Don’t hold back
A relationship with a therapist is unique in that it is designed to be one-sided. This means you as the client are off the hook in terms of taking care of your therapists feelings or trying to control his/her thoughts and feelings about you. It can be challenging to leave this tendency at the door but the price is not getting the value from the therapy you would otherwise.
4.) Clarify goals
There’s a tendency for both therapist and client to slip into an ongoing, easy therapeutic relationship based on regularly schedule for extended periods of time without having a clear agenda or working toward identified goals for change. It’s easy to do this, particularly when you’re fond of each other and there’s a positive rapport. This arrangement can meet many needs and some would argue this is therapeutic in an of itself. I disagree and believe the costs outweigh the benefits of operating under the framework. There is a risk of creating dependency and relying on therapy as a substitute for “real life,” relationships. I always tell clients in the initial consult that my job is to make my job obsolete. I explain that the help I offer is to help them create a tool box to make the changes they want and support them applying these tools on their own so that they can build trust in themselves and their capability to manage their emotional lives.
5.) If it’s not helping, do something.
There is no one approach that will work for everyone and there is no therapist who can help everyone they see. If you’ve been seeing a therapist for more than 6 sessions and you’re not sure if it’s helping, it’s probably not. In this case, the first step is to tell your therapist directly. Often, this can open a dialogue to consider options to pivot the direction of the therapy, the approach or both. If things don’t shift into a more productive process after making adjustments, it may be time to bring up the possibility of a referral to another therapist or asking to arrange for an adjunct practitioner to assist in jump starting change.
