Understanding How Therapy Works

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Amy Boshell, MS, a counselor at the CHH Counseling Center, has found that many clients who come to therapy don’t actually know what to expect or what to address in therapy. To help you have a better understanding of how the process works, she shared an article by former classmate Liz Lin, and an edited version of that article is below. Read on to learn how you can reap the most benefits from counseling.

Many clients are thrown for a loop when they start the process and find that it’s not exactly what they expected. This can frustrate client and therapist alike, so in the interest of all parties, here are a few things you should know before you begin.

You should have a goal in mind.

Simply walking into the office and expecting the therapist to pull something helpful out of thin air isn’t reasonable; you need to have a sense of what you want to work toward. Wanting to learn how to manage your stress, to understand why you interact in a certain way with others, to feel less sad, to stop obsessing about food, to figure out your sexuality, to understand why your kid throws tantrums, to communicate better with your partner — these are all reasonable goals. Wanting your therapist to amaze you is not. (That may happen, but it shouldn’t be your main objective, because you’ll probably be disappointed.) This leads to my next point...

Therapy takes work.

I’ve had any number of clients who seemed to think that simply coming to therapy was the big accomplishment, and now that they had made it into my office, I would reward them by producing a prescription for happiness or doing some kind of alchemy that would magically make them feel better. Don’t get me wrong— making it into a therapist’s office is a big deal. But that is not the ultimate goal. Therapy requires you, the client, to do a lot of work. You have to be open and honest about your experiences, past and present, and your fears and concerns about the future, however embarrassing or unrealistic they might be. You have to reflect on your feelings, thoughts, and actions; you may have to revisit painful experiences; you may have to sit in uncomfortable feelings; you may have to put some things into practice outside of your sessions and come back and report how they went. 

Yes, your therapist will be working too; it takes a lot of effort and skill to see how all of the pieces come together, how your past experiences shape your current ones, how your behavior is reinforced by your environment, why you feel and think and act the way you do — all while keeping tabs on your behavior in the session and their own feelings and using all these factors to determine where to go next.  Your therapist is tracking things on multiple levels, and that kind of work is no joke.  So therapy is a lot of work for the therapist — but it’s also a lot of work for the client, and you should know that going in.

The best time to go to therapy is when you are not in crisis. 

When it comes to your physical health, you wouldn’t want your first encounter with a doctor to be in the ER when you’re having a heart attack. At that point, their main goal will be simply to keep you alive. Ideally, you’d first see a doctor when you’re feeling well to make sure that everything looks okay, to establish a game plan to manage anything out of the ordinary, and to avert a heart attack in the first place. The same is true for your mental health. If you go to therapy only when you’re in crisis, the main goal for you and your therapist will be to get you back to a place where you can function. You won’t have a lot of margin to think about much more than that. The best time to see a therapist is long before the crisis happens so you can develop healthy patterns and prevent the crisis altogether.

You should like your therapist. 

When you think about it, it doesn’t really matter if you like your dentist or your mechanic; it helps, certainly, but at the end of the day, how you feel about them personally has little bearing on how well they fill your cavities or check your brakes. In contrast, you share with your therapist your deepest vulnerabilities, wounds, and pain. Not liking him or her will significantly impact your ability to do that— and to be open to their feedback. So find a therapist you like.  You may have to visit a few before you find one, but many will do a first session or a phone consult for free. 

… but therapy is not the same as talking with a friend. 

If it were, you could simply talk with a friend and save yourself the money. Your therapist may do things that a friend might not, like make observations about your body language and how they’re experiencing you in the moment. On the flip side, they might not do things that a friend probably would, like tell you about themselves or give you advice about what they think you should do. Some things that aren’t normal in the real world are par for the course in therapy. The point is to get you as aware as possible about yourself— your thoughts, your feelings, the messages you send and receive from the people around you.

Therapy is not cheap.

Many people assume that therapy won’t cost much, perhaps because it requires no fancy equipment. They are wrong. Depending on where you live, therapy can run anywhere from $80 to $200 an hour. This, to some, seems unreasonable, but

• your therapist is working hard
• the therapist's education and experience weren’t free
• your payment for therapy signifies your investment in it. 

Even agencies that serve the lowest-income clients almost never provide free services, because when people regularly get something for free, they tend not to take it seriously.  We pay for what we value.

That being said, many clients do not pay full price for therapy.  Many therapists have sliding-scale fees, so if you legitimately cannot afford their services because of your income, they can offer a reduced rate.  Also, many insurance plans cover mental health services; some cover a certain number of sessions a year and some even cover unlimited sessions, usually with a small co-pay. 


Things might get worse before they get better.

People vary in their responses to the first few sessions of therapy. Some feel so much relief from talking about their issues that they feel better immediately. Others, however, find that facing their problem head-on is painful, or that the problem is deeper and more complicated than they realized. They may realize that their depression is related to a loss in childhood that they never fully processed, for example, or that their issue will take more than a few sessions to fix. And instead of feeling better right away, sometimes they feel worse than they did when they first went in. It’s very common for people to drop out of therapy at this point.

Yes, sometimes, things get worse before they get better. This is completely normal. You have to acknowledge the problem in its entirety in order to address it. You need to face the pain in order to heal from it.  So as uncomfortable as it might be, if it gets worse before it gets better, I urge you to stick with it.  If you keep working at it, it will get better.  And you’ll be better off for it in the end.

This article was recommended by Amy Boshell, a counselor at Cabell Huntington Hospital's Counseling Center. Amy earned her Masters of Science in Marital & Family Therapy, and she is currently serving as a provisionally licensed marriage and family therapist until she completes her WV supervision hours after transferring from California. Amy enjoys working with couples and families. and she is also working toward her certification in Emotionally Focused Therapy under Christie Eastman. If you'd like to learn more about the benefits of counseling, please call the Counseling Center at 304-526-2049.

You can read the unedited version of this article by therapist, youth worker, professor and consultant Liz Lin here. You can find her blog at mynameiselizabeth.com or follow her on Twitter @curiousliz.



  • Last updated: 05/12/2014
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