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Getting the most out of your therapy

by Toronto psychotherapist and counsellor Beth Mares

Choosing a therapist  -  The first session  -  When you have misgivings  -  Leaving therapy

Choosing a psychotherapist

Much has been written on this topic, so I will just add a couple of points that I think have been neglected.
 

You don't have to figure out what type of therapy you need by yourself

Many people assume that they need to figure out the type of therapy that is right for their problem, and then find a professional who does it. That can be a very confusing task. For one thing, there are many "brand names" used, and in most cases the descriptions of how they work are descriptions of psychotherapy in general; that is, the rationale would apply to any type of psychotherapy.

But suppose you look for a modality that is backed by research. For example, you are depressed, and you see that there is a large body of research demonstrating that cognitive psychotherapy helps depression. It sounds simple. But you do not know whether you would have been accepted for one of those studies. Researchers have to define a term such as depression narrowly enough for the results to be interpretable. In most cases they also have to exclude people with co-existing problems, because if they did not the results would be hopelessly confusing. Most people who enter psychotherapy have more than one problem. Furthermore, research has pretty consistently backed the "dodo bird hypothesis"; that is, when different types of psychotheraputic intervention have been tested in relation to each other (instead of in relation to no psychotherapy) they have been found to be equally effective. This does not mean that all methods are equally effective for an individual, and indeed they are not. Some methods are completely useless for some clients, even harmful in some cases.

If you are a psychologist, psychiatrist or clinical counsellor, you may be in a good position to evaluate how the research applies to you and what might be the best approach for your problem. If not, there is a lot to gain by discussing it with a professional. An integrative therapist who uses different methods would be ideal for this, but any well-educated, experienced and effective professional who deals with your issue or issues should be able to guide you.
 

Therapist availability and continuity

Continuity is an issue for people who are doing long term therapy and/or have deep-seated problems. For many people regular weekly or twice weekly sessions are important. And if you are on a roll, or if you are having a crisis, it is not good to have your work interrupted. Some interruptions are inevitable. But if regularity is important for you, you might not want to choose a counsellor who takes month-long vacations, or who is unable to maintain regular sessions because of giving workshops or doing lecture tours. Also, if your therapist relocates, retires, goes on maternity leave, or gets another job, you would probably need a new one. For some people this is not a big problem. However when someone is working on attachment issues and/or working with transference (usually the case in long term therapy, regardless of what the presenting problem was) such changes can be disruptive to the therapy and in extreme cases to the person's life. You have a right to to ask questions about the therapist's future availability up front.

The first session

The purpose of the first session is to do a brief assessment and to check that the therapist-client match is a good one. Many clients are happy to let the professional take the lead in this, and decide to go ahead if they feel comfortable with his recommendations. However, some clients want to make a more active choice. If you have an agenda, say so at the beginning of the session. If you are looking for answers to particular questions, or if there are things you want to know about the counsellor, ask. Otherwise, he will probably just go ahead with his default agenda, which will be to find out about the problem and the context, check that he is the right person to help you, figure out a good way to start approaching the problem, and give you some feedback, which might be brief and right at the end (when there is no time to answer questions) if you have not requested more detail.

For most people it is a bad idea to discuss their therapy sessions with anyone. You can say things like "I found it helpful", "I'm planning to continue", "I'm still evaluating", "I have some things to think about", but not discuss the content. There are exceptions to this rule, though. I would suggest you get your counsellor's input before discussing the content of your sessions with anyone. When it is appropriate to share things from your session, it is usually best to wait at least 24 hours so that you can process your thoughts first.

When you have misgivings

Let us say you have started counselling, and you are afraid that it is not working, or are uncomfortable with the counsellor or what he is doing, or feel that he just does not get you. If you have only had one or two sessions it is sometimes best to just find another counsellor, especially if you have been in successful therapy before and you know what works for you. Otherwise, the thing to do is speak up. In most cases the problem can be resolved if you do, and if it cannot that will become clear. Psychotherapy is teamwork. The professional is the guide, particularly in the beginning when the client lacks experience; but it does not work for the client to be the "patient" in the traditional sense. If you are unable to assert yourself or are dissatisfied with the discussion, there is a further option: consulting another psychotherapist to get a second opinion on whether the work is on track, and/or to get help with communicating with your counsellor.

Leaving therapy

It is customary to have a discussion with the therapist about termination before leaving, and in the case of long term therapy, to spend three or more sessions processing and winding down.  Unfortunately some people just decide to leave and announce it at the end of the last session or by a phone message. This does not allow for any input from the counsellor, getting his support, goodbyes, planning for going it alone, or discussion about how to tell if one needs to come back for something. For some people it is best to wind down by reducing the frequency of sessions before termination.

Usually when people terminate it is because they feel they have done what they needed to do. However sometimes it is because they feel that their counsellor cannot help them or cannot help them further. Sometimes they start working with another counsellor. It is worth knowing that in many cases when the client does not seem to be able to get into the deeper work (or in some cases into any useful work at all) the turning point is when he is so frustrated that he is ready to leave therapy and starts a discussion about it in a session. (For some people breakthroughs are regularly preceded by a buildup of frustration and/or discomfort, often with a sense of futility or of being blocked.) When people just leave without fully discussing the matter, the chances are they will go through the same thing with the next therapist--terminating just when the most productive work could start.  When a professional counsellor really is not the right person to continue the work, he or she will likely be able to give some thoughts about how to proceed and/or to suggest a suitable colleague.

This by no means exhausts the subject, of course. Your own therapist can give you ideas about enhancing your own personal journey.

Copyright © 2006 Beth Mares

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