Firstly, it’s ok if you don’t know where to start. This is quite common, and we do not think you are a mess if you cannot eloquently describe your thoughts or feelings. We will be patient with you, and take as much time as necessary to help you find the right words to make sense of things.
Allow plenty of time to get to the session. This prevents you from being flustered when you arrive, and gives us optimal time to work productively. It is also a good idea to schedule your session (where possible) for a time when you do not have to rush back to work, to fully digest and process what has happened.
Take notes. We can cover a lot of ground in the therapeutic hour, and you are unlikely to remember everything. Some clients find it helpful to keep a “therapy journal” or notebook, where they jot down ideas during the session for later reflection, or to better remember strategies they will be practicing between sessions.
Have an agenda. Let us know what you want to talk about at the beginning of the session. Life throws curve balls, and it could be important to deviate from the established treatment plan to discuss it. We can jointly prioritise topics to be covered each session.
Be honest. Like really, really honest. We can’t help you with something that we don’t know about. Therapists are more intimately acquainted with the peculiarities of the human mind than most people. We understand that no one is their best self all of the time and everyone can seem a little crazy given the right circumstances. In the words of psychotherapist Irvin Yalom, we are the “cradlers of secrets”….and there is a reasonable chance you are not the first person to feel or think this way (remember, we routinely hear the stuff no one else shares on status updates).
Don’t leave it too long between sessions. Momentum is crucial. You need enough time to practice strategies between sessions, discuss their effectiveness, and tweak them as necessary. Cultivating new habits requires repetition and attention…however you if you leave it too long between sessions, you run the risk of drifting back to your default mode. Of course, most people do not have infinite financial resources, and naturally will want to make the most of sessions available on a Mental Health Care Plan, or through health insurance. Depending on the nature of your concerns, it could actually be more effective to have weekly therapy sessions for 10 weeks rather than space it to once a month over 10 months. Or the pace might vary. For example, we might meet weekly for the first 3 or 4 sessions and then switch to fortnightly or monthly as you are implementing changes more independently. Talk to your therapist about the optimal pace for you, based on your life circumstances and the issues you are working through.
Give us feedback. A good therapist should be striving to understand you, the way that your life experiences have shaped you, and how you want your life to be. While we are pretty good at understanding the workings of the human mind, we are (unfortunately) not psychic. You are unique. No two life stories are the same. It is perfectly ok (in fact I can’t recommend this strongly enough) to tell your therapist if they’re not quite getting you, or if something doesn’t sit well with you. They will not be
offended; therapists want this to work too, and will welcome feedback (if they don’t, consider getting another therapist).
How to raise an issue in therapy. Sometimes it’s hard to find the right words. You are welcome to borrow some of these:
“There was something you said last time that was confusing (confronting/difficult for me/jarring, etc)”
“Yeah, that’s not actually what I meant”
“I don’t understand what you mean by that”
“I’m not sure I understand when/how/why I should be using this strategy”
“Sometimes I feel we are not always on the same page”.
“I don’t understand why we are using this approach.”
“I think there are other things/topics that we haven’t talked about yet/I would like to focus on/are also really important to me”
“I’m not sure therapy is working for me”
Consider our feedback. Your therapist is trained and experienced in noticing details that other people may not (or do, but won’t tell you). Everyone has blind spots, and you can’t change something you don’t know about. For instance, there may be quirks in your communication style that could mean you are unintentionally putting people offside, or inadvertently disempowering yourself. Your therapist will be prepared to be (compassionately) honest in a way that other people may not. We really, truly, want the very best for you.
Be prepared to step out of your comfort zone. The industrial-sized box of tissues is there for a reason. If you are confronting difficult issues for the first time, it is normal (and healthy) to be emotional in therapy. We do not think you are silly or weak – actually, we admire your willingness to go there, and are grateful you trust us with your vulnerability. It means you are touching on important stuff, and therapy stands a much better chance of being effective when this happens.
Be aware that the change process can sometimes feel awkward, uncomfortable and unfamiliar. If it was easy, you would have already done it. Your therapist is not enjoying your discomfort, and if there was an easier/quicker way to do it, we would tell you. But do tell us when it is hard (see Give Us Feedback above).
Do the homework. We left our magic wand at home. Change can unfold through talking with your therapist (many people report a sense of relief from in-session processing), thinking about an issue differently, or developing new insight. Lightbulb moments happen, and are a thing to behold. But sometimes insight is not enough, and real change requires real work. Therapeutic change is accelerated and is more likely to be sustained when clients do their homework, and transfer insights into their daily life.
Tell us if you’re thinking about dropping out. It is important to note that you can end therapy at any time you wish, and you are not obliged to provide a reason. However, it could also be really helpful to firstly have a chat about this decision. As mentioned in the Giving Feedback section, if it is not working or feeling right, the therapist may be able to change some aspect. Or, maybe you are nervous about what change might mean, or perhaps have developed a habit of not quite seeing things through. This is an opportunity to do it differently. But do remember that you are not obliged to stay if you really don’t want to.
Bio: Dr. Angela Morgan is a clinical psychologist who operates her own private practice in Brisbane, Australia. She is an AHPRA- approved clinical supervisor and has previously been a lecturer in the School of Applied Psychology, Griffith University, in the undergraduate and postgraduate programs.
Angela enjoys working with adolescents and adults across a range of issues, with a particular interest in eating disorders and eating-related concerns. She is also an engaging presenter, and has provided professional development training for psychologists and other Allied Health Practitioners in Australia and New Zealand.
Find out more about Angela at www.drmorgan.com.au