Getting the Most out of Therapy and Counseling
Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D
Therapy can be an effective treatment for mental and emotional problems. But in order to reap its benefits, it’s important to choose the right therapist—someone you trust who makes you feel cared for and has the experience to help you make changes for the better in your life. A good therapist helps you to become stronger and more self-aware. But your therapist cannot do the work for you. In order to make the most of your sessions, you must be an active participant.
How therapy and counseling can help
Talking about your thoughts and feelings with a supportive person makes you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help.
It can be very helpful to talk about your problems to close friends and family members. But sometimes, we need help that the people around us aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life.
You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as a divorce.
Why therapy and not medication?
The thought of being able to solve your problems with taking a pill each day can sound appealing. If only it was that easy! Mental and emotional problems have multiple causes, and medication is not a one-stop cure.
Medication may help ease certain symptoms, but it comes with side effects. Furthermore, it cannot solve the “big picture” problems. Medication won’t fix your relationships, help you figure out what to do with your life, or give you insight into why you continue to do things you know are bad for you.
Therapy can be time consuming and challenging, as uncomfortable emotions and thoughts often arise as part of the treatment process. However, therapy provides long-lasting benefits that go beyond symptom relief. Therapy gives you the tools for transforming your life—for relating better to others, building the life you want for yourself, and coping with whatever curveballs come your way.
|Myths about therapy|
|MYTH: I don’t need a therapist. I’m smart enough to solve my own problems. FACT: We all have our blind spots. Intelligence has nothing to do with it. A good therapist doesn’t tell you what to do or how to live your life. He or she will give you an experienced outside perspective and help you gain insight into yourself so you can make better choices.|
|MYTH: Therapy is for crazy people. FACT: Therapy is for people who have enough self-awareness to realize they need a helping hand, and want to learn tools and techniques to become more self-confident and emotionally balanced.|
|MYTH: All therapists want to talk about is my parents. FACT: While exploring family relationships can sometimes clarify thoughts and behaviors later in life, that is not the sole focus of therapy. The primary focus is what you need to change—unhealthy patterns and symptoms in your life. Therapy is not about blaming your parents or dwelling on the past.|
|MYTH: Therapy is self-indulgent. It’s for whiners and complainers. FACT: Therapy is hard work. Complaining won’t get you very far. Improvement in therapy comes from taking a hard look at yourself and your life, and taking responsibility for your own actions. Your therapist will help you, but ultimately you’re the one who must do the work.|
Finding the right therapist for you
Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery. Therapy won’t be effective unless you have this bond, so take some time at the beginning to find the right person. It’s okay to shop around and to ask questions when interviewing potential therapists.
Experience matters. One of the main reasons for seeing a therapist, rather than simply talking to a friend, is experience. Look for a therapist who is experienced in treating the problems that you have. Often, therapists have special areas of focus, such as depression or eating disorders. Experienced therapists have seen the problems you’re facing again and again, which broadens their view and gives them more insight. And for some problems, such as trauma or PTSD, seeing a specialist is absolutely essential.
Learn about different treatment orientations. Many therapists do a blend of orientations. However, it’s a good idea to learn about the different treatment types, because that can affect your therapist’s way of relating and suggested length of treatment.
Check licensing. Credentials aren’t everything, but if you’re paying for a licensed professional, make sure the therapist holds a current license and is in good standing with the state regulatory board. Regulatory boards vary by state and by profession. Also check for complaints against the therapist.
Trust your gut. Even if your therapist looks great on paper, if the connection doesn’t feel right—if you don’t trust the person or feel like they truly care—go with another choice. A good therapist will respect this choice and should never pressure you or make you feel guilty.
Questions to ask yourself when choosing a therapist
What’s most important in a therapist or counselor is a sense of connection, safety, and support. Ask yourself the following questions:
- Does it seem like the therapist truly cares about you and your problems?
- Do you feel as if the therapist understands you?
- Does the therapist accept you for who you are?
- Would you feel comfortable revealing personal information to this individual?
- Do you feel as if you can be honest and open with this therapist? That you don’t have to hide or pretend you’re someone that you’re not?
- Is the therapist a good listener? Does he or she listen without interrupting, criticizing, or judging? Pick up on your feelings and what you’re really saying? Make you feel heard?
Types of therapy and therapists
There are so many types of therapies and therapists; it might feel a little overwhelming to get started. Just remember that no one type of therapy is best, any more than any style of car is best. It all depends on your individual preferences and needs.
It is true that certain techniques are more useful than others in dealing with specific types of problems (phobias, for example). But in general, research about the “best” type of therapy always reaches the same conclusion: the philosophy behind the therapy is much less important than the relationship between you and your therapist.
If you feel comfortable and trusting in that relationship, the model of therapy, like your car, is just the vehicle that will help you move ahead to lead a more fulfilling life, regardless of the circumstances that brought you to therapy.
Common types of therapy
Most therapists don’t limit themselves to one specific type of therapy, instead blending different types in order to best fit the situation at hand. This can offer many powerful tools for the therapist to use. However, therapists often have a general orientation that guides them.
Individual therapy. Individual therapy explores negative thoughts and feelings, as well as the harmful or self-destructive behaviors that might accompany them. Individual therapy may delve into the underlying causes of current problems (such as unhealthy relationship patterns or a traumatic experience from your past), but the primary focus is on making positive changes in the here and now.
Family therapy. Family therapy involves treating more than one member of the family at the same time to help the family resolve conflicts and improve interaction. It is often based on the premise that families are a system. If one role in the family changes all are affected and need to change their behaviors as well.
Group therapy. Group therapy is facilitated by a professional therapist, and involves a group of peers working on the same problem, such as anxiety, depression or substance abuse, for example. Group therapy can be a valuable place to practice social dynamics in a safe environment and get inspiration and ideas from peers who are struggling with the same issues.
Couples therapy (marriage counseling). Couples therapy involves the two people in a committed relationship. People go to couples therapy to learn how to work through their differences, communicate better and problem-solve challenges in the relationship.
Types of therapists and counselors
The following types of mental health professionals have advanced training in therapy and are certified by their respective boards. Many professional organizations provide online searches for qualified professionals. You may also want to double check with your state regulatory board to make sure the therapist’s license is up to date and there are no ethical violations listed.
However, keep in mind that lay counselors—members of the clergy, life coaches, etc.—may be able to provide you with a supportive, listening ear. It’s not always the credentials that determine the quality of the therapy.
Common types of mental health professionals:
Psychologist — Psychologists have a doctoral degree in psychology (Ph.D. or Psy.D.) and are licensed in clinical psychology.
Social worker — Licensed Clinical Social Workers (LCSW) have a Master’s degree in social work (MSW) along with additional clinical training.
Marriage and family therapist — Marriage and Family Therapists (MFT) have a Master’s degree and clinical experience in marriage and family therapy.
Psychiatrist — A psychiatrist is a physician (M.D. or D.O.) who specialized in mental health. Because they are medical doctors, psychiatrists can prescribe medication.
What to expect in therapy or counseling
Every therapist is different, but there are usually some similarities to how therapy is structured. Normally, sessions will last about an hour, and often be about once a week, although for more intensive therapy they maybe more often. Therapy is normally conducted in the therapist’s office, but therapists also work in hospitals and nursing homes, and in some cases will do home visits.
Expect a good fit between you and your therapist. Don’t settle for bad fit. You may need to see one or more therapists until you experience feeling understood and accepted.
Therapy is a partnership. Both you and your therapist contribute to the healing process. You’re not expected to do the work of recovery all by yourself, but your therapist can’t do it for you either. Therapy should feel like a collaboration.
Therapy will not always feel pleasant. Painful memories, frustrations or feelings might surface. This is a normal part of therapy and your therapist will guide you through this process. Be sure to communicate with your therapist about how you are feeling.
Therapy should be a safe place. While there will be times when you’ll feel challenged or when you’re facing unpleasant feelings, you should always feel safe. If you’re starting to feel overwhelmed or you’re dreading your therapy sessions, talk to your therapist.
Your first therapy sessions
The first session or two of therapy is a time for mutual connection, a time for the therapist to learn about you and your issues. The therapist may ask for a mental and physical health history.
It’s also a good idea to talk to the therapist about what you hope to achieve in therapy. Together, you can set goals and benchmarks that you can use to measure your progress along the way.
This is also an important time for you to be evaluating your connection with your therapist. Do you feel like your therapist cares about your situation, and is invested in your recovery? Do you feel comfortable asking questions and sharing sensitive information? Remember, your feelings as well as your thoughts are important, so if you are feeling uncomfortable, don’t hesitate to consider another therapist.
How long does therapy last?
Everyone’s treatment is different. How long therapy lasts depends on many factors. You may have complicated issues, or a relatively straightforward problem that you want to address. Some therapy treatment types are short term, while others may be longer. Practically, you might also be limited by your insurance coverage.
However, discussing the length of therapy is important to bring up with your therapist at the beginning. This will give you an idea of starting goals to work towards and what you want to accomplish. Don’t be afraid to revisit this issue at any time as therapy progresses, as goals often are modified or changed during treatment.
Making the most of therapy and counseling
To make the most of therapy, you need to put what you’re learning in your sessions into practice in your real life. 50 minutes in therapy each week isn’t going to fix you; it’s how you use what you’ve learned with the rest of your time. Here are some tips for getting the most out of your therapy:
Make healthy lifestyle changes. There are many things you can do in your daily life to support your mood and improve your emotional health. Reach out to others for support. Get plenty of exercise and sleep. Eat well. Make time for relaxation and play. The list goes on…
Don’t expect the therapist to tell you what to do. You and your therapists are partners in your recovery. Your therapist can help guide you and make suggestions for treatment, but only you can make the changes you need to move forward.
Make a commitment to your treatment. Don’t skip sessions unless you absolutely have to. If your therapist gives you homework in between sessions, be sure to do it. If you find yourself skipping sessions or are reluctant to go, ask yourself why. Are you avoiding painful discussion? Did last session touch a nerve? Talk about your reluctance with your therapist.
Relaxation Techniques: Accessing the Relaxation Response
Share what you are feeling. You will get the most out of therapy if you are open and honest with your therapist about your feelings. If you feel embarrassed or ashamed, or something is too painful to talk about, don’t be afraid to tell your therapist. Slowly, you can work together to get at the issues.
Is therapy working?
You should be able to tell within a session or two whether you and your therapist are a good fit. But sometimes, you may like your therapist but feel like you aren’t making progress. It’s important to evaluate your progress to make sure you’re getting what you need from therapy.
A word of caution: There is no smooth, fast road to recovery. It’s a process that’s full of twists, turns, and the occasional backtrack. Sometimes, what originally seemed like a straightforward problem turns into a more complicated issue. Be patient and don’t get discouraged over temporary setbacks. It’s not easy to break old, entrenched patterns.
Remember that growth is difficult, and you won’t be a new person overnight. But you should notice positive changes in your life. Your overall mood might be improving, for example. You may feel more connected to family and friends. Or a crisis that might have overwhelmed you in the past doesn’t throw you as much this time.
Tips for evaluating your progress in therapy
- Is your life changing for the better? Look at different parts of your life: work, home, your social life.
- Are you meeting the goals you and your therapist have set?
- Is therapy challenging you? Is it stretching you beyond your comfort zone?
- Do you feel like you’re starting to understand yourself better?
- Do you feel more confident and empowered?
- Are your relationships improving?
Your therapist should work with you, reevaluating your goals and progress as necessary. However, remember that therapy isn’t a competition. You are not a failure if you don’t meet your goals in the number of sessions you originally planned. Focus instead on overall progress and what you’ve learned along the way.
When to stop therapy or counseling
When to stop therapy depends on you and your individual situation. Ideally, you will stop therapy when you and your therapist have decided that you have met your goals. However, you may feel at some point that you have got what you need out of therapy, even if your therapist feels differently.
Leaving therapy can be difficult. Remember that the therapeutic relationship is a strong bond, and ending this relationship is a loss – even if treatment has been successful. Talk about this with your therapist. These feelings are normal. It’s not uncommon for people to go back briefly to a therapist from time to time as needs arise.
As long as you continue to progress in therapy, it’s an option
Some people continue to go to therapy on an ongoing basis. That’s okay, especially if you don’t have other people to turn to for support in your life. Ideally, your therapist will be able to help you develop outside sources of support, but that’s not always possible. If therapy meets an important need in your life and the expense is not an issue, continuing indefinitely is a legitimate choice.
Signs that you may need to change therapists
- You don’t feel comfortable talking about something.
- Your therapist is dismissive of your problems or concerns.
- Your therapist seems to have a personal agenda.
- Your therapist does more talking than listening.
- Your therapist tells you what to do and how to live your life.
Paying for therapy and counseling
In the U.S., for example, many insurance companies provide limited coverage for psychotherapy—often as few as 6-12 sessions. Read through your plan carefully to see what benefits you have. Some types of mental health professionals might not be covered. You may need a referral through your primary care physician.
Also keep in mind that some therapists do not accept insurance, only payment directly from the patient. Sometimes these therapists will accept sliding scale payments, where you pay what you can afford for each session. Don’t be afraid to ask what arrangements can be made if you feel the therapist could be a good fit for you.
In other countries, insurance and eligibility requirements vary. See Resources & References below for links on finding therapy in your country.
Affordable therapy and counseling options
Take a look around your community for service agencies or organizations that may offer psychotherapy at discounted rates. Senior centers, family service agencies, and mental health clinics are good places to start. Many offer affordable options, including sliding payment scales.
Agencies that involve interns in training also can be an option for quality therapy. An intern may be a good choice for you if the intern is enthusiastic, empathetic, and has quality supervisory training. However, an intern’s time at the agency is limited, so when the training is finished, you either need to stop the therapy or find another therapist.
Another possible way to obtain affordable therapy is to try bartering with a therapist or mental health clinic. A few clinics and health centers across the U.S. already encourage bartering services, swapping health care for carpentry, plumbing, or hairdressing services, for example. If you have a useful skill or are willing to volunteer your time, it may be worth trying to strike a deal.