Get Therapy 201: How do I get the most out of therapy?

January 20, 2016 7:18 AM

OK, AskMe, around these parts we know and love the advice to get therapy. It's great advice! But what about the 201-level advice? Once you get yourself into therapy, how do you get the most out of it? I'm curious to hear some MeFite wisdom. What has made your experience with therapy richer and more helpful? Give me your practical tips, and tell me about mindsets and attitudes that you have found to be helpful (or not helpful).

I'm starting to see a therapist (hooray!) to deal with a few important but not crisis-level issues - mild depression, some career/work stuff, some issues around making major life choices.

Here's what I've already done/am doing:
- I found a therapist I like and feel comfortable around.
- I've identified specific things I want to work on and communicated them to her.
- I am happy to be in therapy and am looking forward to working on this stuff.

I'm sure it will be fine no matter what, and I don't feel any anxiety about whether I'm doing it "right." I am just feeling enthusiastic about it, and I'm curious to hear others' insights about how to get the most out of this experience.

Let's hear it!

posted by aka burlap to Health & Fitness (24 answers total)

I am the world's best therapy patient. That's because I see the therapist the same way I'd see a plumber or mechanic or a well-made instructables video.

I have X issue/goal, and only A/B/C tools to work with, so I've hired them to help me reach that goal using tools they know about and know how to use. They teach me the tools and how to use them, and I pay them for that service.

My time and money are valuable and I don't want to waste them. A little bit of "family-of-origin" background is fine for reference, but I'm not interested in an ongoing relationship, I want this to be transactional and short-lived, so I do the homework and read the proffered articles and git'r'done. (I also can't be bothered with a fluffy spa massage. If I'm paying you to work on my muscles, you need to be using elbows and body weight.)
posted by headnsouth at 7:43 AM on January 20, 2016 [8 favorites]

Be open with your therapist. Don't hold anything back. Unless you tell the whole story, the therapist won't know everything, and their advice will be compromised accordingly.

Listen to your therapist. If they tell you to do something, do it, even if you think it's stupid and you know it won't work.

Give feedback. If they ask you to do something, and it doesn't help you, tell them. If they're asking you about things you think are tangential, let them know. Therapy isn't an exact science, and it takes some trial and error at first.

That said, don't presume you know more than your therapist. Self-diagnosis via WebMD is a joke for a reason. Your therapist is a trained professional with a graduate degree. They know more about your condition than Wikipedia.

If you go through several sessions, though, and you don't feel anything, it's OK to change therapists. Different strokes... It won't hurt your first therapist's feelings. It might actually relieve them. A bad therapeutic relationship is just as frustrating for the therapist as for the patient.
posted by kevinbelt at 7:44 AM on January 20, 2016 [3 favorites]

Between sessions, write down things you want to discuss or work on in your next appointment. I did a little bit of running in circles because I'd show up to therapy having basically forgotten about all the stuff that had been bothering me over the last week.
posted by Metroid Baby at 7:47 AM on January 20, 2016 [12 favorites]

I think you need transparency and full disclosure (from you) coupled with focus for it to be productive in as short a time as is appropriate.
posted by AugustWest at 8:02 AM on January 20, 2016

I find that homework is really helpful. (I "graduated" from therapy last year, but I was in for many years and would go back in a hot minute if I need it.) Asking my therapist to give me things to work on between sessions that I can report on and reflect on when I'm not in the office is really helpful.
posted by xingcat at 8:09 AM on January 20, 2016 [4 favorites]

What worked for me:

Homework
Structured sessions (first we'd set the agenda for that day based on stuff that came up in the previous session, stuff we'd already decided to talk about this session, etc; review homework; dive into other items on the agenda; finish with next week's homework)
Total honesty
Box of tissues for crying.
posted by feckless fecal fear mongering at 8:23 AM on January 20, 2016 [1 favorite]

Keep in mind that the first few sessions will be a little less structured as you are still getting to know each other, once you show commitment by not flaking out (like many people do) and being on top of things, things will get more productive.

Check with yourself periodically to confirm that things are going in the right direction. You can put a reminder on your calendar and keep a file with monthly updates on every specific issue you are supposed to be tackling.

Towards the end of every session, take 10 minutes to discuss how you can apply what you have talked about in a practical way. That can be your homework until the next session.

In my experience, every patient sort of trains their therapist on how to approach things. If you do not communicate your expectations and do your part to show that you are interested, the therapist might switch to a not so engaged role (perfunctory acknowledgments, cliché, general advice - not to the point of not being unprofessional, but definitely not as involved as they could be). Even for the most committed person it can be hard to keep at it when the other party isn't that involved, so make sure you show your enthusiasm and come back with feedback. If you feel like things are stalling, say so.

Even though therapists are meant to be compassionate and kind and understanding, beware of those who tend to always justify your behavior, or who are irrationally on your side. A good therapist can respectfully and kindly guide you in realizing that you did not behave well in a specific point in time. After all, you are there because there are some behaviors and mental processes you want to change. You don't want to pay someone to tell you that you are perfect and everyone around you is wrong.
posted by Tarumba at 8:46 AM on January 20, 2016 [2 favorites]

I've been in lots of therapy and I can honestly say that the only therapy I've ever done that had long-term, positive results was extraordinarily goal oriented. It happened to be CBT for anxiety, but I think any tightly focused, goal oriented therapeutic approach is infinitely more useful than endless nattering about the mean thing mommy said when I was 10. That sort of thing is great for emotional catharsis (which everyone needs, don't get me wrong) but the relief I felt after those sessions was short-lived and did nothing to alleviate the symptoms of the illnesses I was in therapy for. Each session should start with a progress report/review, identification of current and new goals/issues, and then end with a discussion of tools/approaches. With homework.

I've also become much more aggressive about certain behaviors I've encountered in therapists (and myself, as a patient) that I nip in the bud when I'm in treatment.

1. I don't let therapists talk about themselves anymore. I've paid for many sessions over the years that ended with me knowing more about them than they learned about me. If it happens once or twice, fine, but if I notice a trend I end the relationship.

2. Unless it is directly relevant to me, I avoid discussing current events, politics, media, religion, etc. It's fine to talk about how political disagreements affect my relationship to my family, for example, but not ok to spend even ten seconds on the content of those disagreements.

3. If the therapist doesn't seem to keep notes during the session, I end the relationship. Part of this has to do with requiring documentation of my disability for the government, but I've also had far too many therapists who seem to have forgotten everything about me between this week and last week.

4. If the therapist needs to be reminded too many times of what we were working on from last week, I consider them chronically unprepared and end the relationship.

5. If a therapist makes a promise to do something (like make a phone call, get a referral, provide notes to my lawyer, etc.) and doesn't follow through, I end the relationship.

6. If a therapist seems to be getting too "close" to me, I end the relationship. Therapists who cry during *my* sessions put me in the awkward position of comforting *them*, which is not what I am there for.

Shockingly, I am not in therapy now because most of the therapists I've seen have been of this disorganized, chronically unprepared, distracted/emotional type, and I have wasted years and thousands of dollars letting these inappropriate and useless behaviors go on. To be perfectly honest, the best therapist I ever saw was kind of an asshole. He'd redirect me when I got distracted or wandered off topic, ended exactly on time even as I snotted into tissues, had a concerned but distant manner, and would ask pointed questions about my intentions and seriousness if I hadn't done my homework. At the time I hated him, but on reflection he was actually one of the most therapeutically effective providers I've seen over the years.
posted by xyzzy at 8:50 AM on January 20, 2016 [27 favorites]

I agree with xyzzy that a lot of therapists seem to have gotten into the business because they're touchy feely people, but I absolutely needed someone really smart and no-nonsense to make real headway. I was surprised that it worked for me to lie on a couch, too. There are pretty good reasons for it, and if I were to get back into therapy, I would actually look for a therapist who uses a couch (not making eye contact with the therapist allows for greater freedom of association and makes the patient less apt to take visual cues from the therapist).

One thing I would add to xyzzy's list is: I one hundred percent refuse to discuss my insurance coverage or the trouble my therapist has with my insurance company during my therapy hour.

The one place I diverge from xyzzy is that it does help me to understand the root of a continuing problem. While I agree that directionless whining isn't helpful, for me it does make a difference to know why I keep repeating the same mistakes and I've been able to stop some of them by realizing in therapy where the problem began.

I also completely agree with kevinbelt. Very good advice there!
posted by janey47 at 8:58 AM on January 20, 2016 [2 favorites]

Be clear with the therapist that you see this as a means to an end -- and that you expect an end -- meaning that you will either eventually move on to someone more effective, or together you will meet the needs that prompted you into therapy. Don't make it an ultimatum (You have only three months to help me!), but be clear that you are not interested in a lifetime of therapy (unless of course, you are). This doesn't mean you can't be flexible, but don't get sucked into an ominous unstructured relationship where it just goes in circles because hey, who's keeping track of how long this has been going on and the same issues popping up.

My therapist was a nut case and I ignored the warning signs until we got into a heated squabble over, well insurance coverage! She changed our arrangement regarding payment and didn't include me in the conversation and then handed me a bill for $1500 at the end of our second-to-last session (and I went only one more time to tell her it was over).

Pay attention to any warning signs that the therapist is not going to be good for you. I ignored one big one and payed for it in the end -- my therapist was ALWAYS 10-15 minutes late for our appointment. Then one day I was 5 minutes late (thinking it didn't matter because she was always 15 minutes late) and I spent the first 10 minutes of that session listening to how I was abusing the relationship by being late for the appointment. I wish my old self was a stronger person to have told her to fuck off and never return, but I was in therapy for a reason in those days. :o)
posted by archimago at 9:11 AM on January 20, 2016 [1 favorite]

My current therapist is great for me. I talked to him about a former therapist whose feelings I felt responsible for protecting. The new guy told me that everything a therapist does or says in session should be intended to help the client. I fully agree with xyzzy that they shouldn't be talking about themselves unless the anecdote has therapeutic value.

When your therapist says/does something that makes you uncomfortable in any way, or there's anything you feel bad about in the relationship -- find a way to talk about it. These conversations can be VERY therapeutic if they're handled right by the therapist, especially if you're someone who's conflict-averse or overly inclined to please other people. If the conversation goes badly because they're defensive, angry, or otherwise bringing their bad feelings into it, that's a very bad sign.

You don't need the therapist's approval or permission to end the relationship. If you don't trust them enough to discuss it, you don't even need to talk to them about it; in that case, just leave a message saying you're not going to be coming in any more.
posted by wryly at 9:31 AM on January 20, 2016

Some people will tell you that having something prepared is useful when going in to a new appointment, but I've always found that i get a TON more out of a session when I don't have a plan about what I will talk about (and also do not spend very much time recapping my week).
posted by softlord at 9:31 AM on January 20, 2016 [1 favorite]

Tell the painful, cruel truth. If you catch yourself telling a little white lie, tell your therapist you just told a white lie and clarify. If you realize something you said was not accurate, clear it up later. Sometimes the things we tell ourselves (little white lies, inaccuracies, quick answers to hard questions) are pointing in big neon signs to where our problems lie.
posted by Sophie1 at 9:36 AM on January 20, 2016 [13 favorites]

Talk about money with your therapist. It’s a great shortcut for getting at a lot of unexamined feelings, social fears, practical steps to address life, balancing relationships--all those good goals of therapy. I heard a Freudian analyst say (paraphrasing here) that discussing dreams is a pretty good path for getting to the psyche but that discussing money is a superhighway to it. The times I’ve talked directly with a therapist about money have both hard and productive.

I do agree with janey47--don’t spend your hour bogged down with insurance reimbursement logistics--but if you are having problem with the fee, definitely bring that up. Like everyone else, therapists can be awkward & cagey about money, & in my experience discussing fees has been a fruitful way to figure out the patient-therapist relationship itself.
posted by miles per flower at 9:37 AM on January 20, 2016 [2 favorites]

I had a great therapist that I was very.comfortable with. I wasn't hesitant to bring up the things I was ready to bring up.

But there were days when I just did not want to go to therapy. I skipped sessions a couple of times, but finally learned that the days I did not want to go were the days when I most needed to go, and the days when I learned the most. I always started my session with "I don't want to be here today, but I'm not sure why" and then we would just go with it and it worked out. So my advice is don't skip sessions, and be really honest, even if that means saying I have no idea of what to talk about today.
posted by vignettist at 11:07 AM on January 20, 2016 [2 favorites]

My second time around: I kept a journal and dealt with a lot of stuff on my own between sessions. My therapist said something positive about my willingness to work. Newbs often think the therapist is there to fix them. I knew I needed to fix myself, he was just there to help me do that. He thought that approach was comment worthy as a good thing. He said something like "I can tell you have done therapy before because..."
posted by Michele in California at 11:48 AM on January 20, 2016 [3 favorites]

I finally have a therapist I feel comfortable with, and I look forward to my appointments now. I occasionally make notes during the week about things I want to bring up when I see her, I hate getting to the last 5 minutes and then remembering something that I wanted her help with.
I also make sure she knows about what my p-doc and GP have prescribed for me, or what meds have changed. She's the one who realized Abilify caused a hypomanic episode for me and got me help (before the credit cards were completely maxed out!) because we meet every week.
posted by notaninja at 12:06 PM on January 20, 2016

When you turn up to a session and regret that haven't done any planning, can't think of what to say, there's no structure or goals, you think it's going badly or you're doing it wrong, or you start talking about fees or insurance, or you doubt the skill level of your therapist, and a million other blockages on the way to efficient enlightenment - that's the therapy right there.
posted by colie at 12:17 PM on January 20, 2016 [3 favorites]

I'd say keeping notes during the week and perhaps giving myself at least 30 minutes prior to a session to really think about the stuff I want to talk about and kind of summarize it to myself. It leaves me feeling less lost in a session.

I guess no therapist is absolutely perfect. But it is important to have someone who you feel is competent to discuss whatever you're dealing with. I went to my first therapist for coming out/sexuality issues. I asked her if she had ever had patients with that issue, and she said no I was her first. That absolutely terrified me. I ended up finding a new therapist through a recommendation from a friend (who was actually a therapist himself). The new therapist was gay herself, and I felt SO much more comfortable in there.

So yeah, don't be afraid to demand that your needs be covered competently, and don't be afraid to be honest and open with your therapist. They've probably heard MUCH worse/crazier things than what you're telling them anyway.
posted by christiehawk at 12:19 PM on January 20, 2016

Be willing to give your therapist's ideas a thorough try, but also be aware of what definitely won't work for you. I did a fair amount of reading homework that didn't speak to me before I started pushing back on it, and wish I'd said something sooner. And I never did try Weight Watchers, and am still proud of that decision. I also found looking back through my history to see how I kept repeating patterns was very helpful. So, as with most advice, know when to ignore your therapist (and/or metafilter)!
posted by ldthomps at 1:50 PM on January 20, 2016

Don't waste time over-narrating everything someone else did/does and get to what you feel and had evoked in that situation. It's too easy to try to get back up for an argument you're having with your partner/friend/parent rather than process what's happening to you via that argument.

Give yourself some alone time after therapy sessions to decompress. I used to go dashing back to work or take calls straight away, now I sit and have a tea somewhere alone, have a think and mentally pat myself on the back for going to therapy.
posted by honey-barbara at 3:02 PM on January 20, 2016 [1 favorite]

One of the most important things I've done on my end is to have a "no lying" policy. I make sure that every word that comes out of my mouth is true and free of omissions. If I'm feeling the need to lie about something, I confess that and explain the issue.

The other big thing is to take notes. A few sentences after every session can be very useful to refer back to later.

I am one of those people for whom traditional psychotherapy has been tremendously helpful, so I disagree with the CBT-only advice, but I suspect this is a very personal decision that you'll have to make on your own.
posted by zug at 8:45 PM on January 20, 2016

Be alert for ALL your significant feelings. Bring them to therapy. Especially the bad or "unworthy" ones. That thing your therapist does that really annoys or disappoints you, that thing you wish they'd do or not do, that thing that for whatever reason you're not saying because it seems too rude or too trivial or incidental, that thing in your therapy you complain to your best friend and the internet about -- tell that to your therapist. If they are worth their salt they will be able to have a calm and productive discussion about it with you, and it will reveal a lot about what you bring to important relationships. Too many people quit therapy because of an issue that it would have been really useful to air with the therapist. If your therapist reacts by being defensive or blaming, find a more robust therapist.

(The above advice applies more to therapists who work with the transference/relationship, like psychodynamic, humanistic or relational. Not sure it would fly well with a behaviorist.)

Seconding what has been said about talking about money -- it's as uncomfortable for therapists as it is for other humans, and if they can endure a difficult emotional conversation with you about money, they can hack it. Ditto sex, your feelings about them and the therapeutic boundaries (time limits of sessions, communication outside therapy etc.). All these topics can be super revealing. My current therapist won major respect from me the day she sat through my "Going to therapy feels like visiting a prostitute" rant.

Make notes/journal along with therapy. Not thinking about therapy outside therapy is about as helpful as having a personal trainer but not exercising when they're not there.

When you get so fed up you start thinking about quitting -- that's when things get interesting and productive. Work with that stuff right there.
posted by stuck on an island at 9:40 AM on January 21, 2016

Response by poster: All awesome answers! Thank you, everyone!
posted by aka burlap at 11:49 AM on January 23, 2016