What Is Therapy Anyway?

So you’ve heard about therapy. Perhaps a friend has gone and said it was helpful or you doctor recommended you see a therapist for the depression or anxiety you’ve been experiencing. But what actually happens in therapy? Do I have to lay on a couch? Tell some new-agey healer all of my childhood fears? Take a psychological test to find out what is wrong with me? Does the therapist tell me exactly what I need to do to cure myself for good within a specific timeline? Does it mean I am crazy or weak if I go to therapy?

I have been asked all of these questions and more, but there isn’t a simple, black-and-white answer. For the purposes of this description, I am taking about individual therapy. However, therapy can involve couples, families and groups as well. Generally speaking, therapy involves a therapist that is either a psychologist or someone with a master’s degree in counseling or clinical social work. Therapists do not prescribe medication. Psychiatrist are Medical Doctors with a speciality in psychiatric medicine that prescribe medication. A therapist provides psychotherapy and will refer the client to a psychiatrist if medication if needed (although it is also common to start with the client’s primary care or OBGYN). 

We refer to the time between a therapist and a client as a session, which typically last 45-60 minutes. Typically, sessions are weekly or bi-weekly depending on the needs of the client. Sessions are usually moved further apart as the client progresses (or schedule or finances change). Some clients may see a therapist for a few sessions and feel improvement, while others may be working on deeper for long-standing issues that actually take a year or more to work through. While my goal is for clients to feel better as soon as possible, there is no quick fix or magic wand. Long-term solutions to improving mood, relationships, self esteem, and thought and behavior patterns, don’t happen overnight. However, that doesn’t mean you won’t see improvements for a long time. We see slow and steady improvements as signs of sustainable progress.

What actually happens during the therapy session can vary widely depending on the therapist’s particular orientation and the needs of the client. Therapy can explore very pragmatic coping skills and problem solving, expand understanding of how past experiences are impacting your current thoughts and behaviors, involve more experiential interventions like meditation, art, and hypnosis, or include any combination of these and numerous other practices. 

However, regardless of what intervention is used, research has showed time and time again, that the most important aspect of therapy is actually the relationship between the therapist and the client. A therapist can be an expert in all types of fancy psychological theories and practices, but if you don’t feel comfortable with them or trust them, there is not great potential for progress. I will make notes about what happens in session, but everything remains confidential unless I believe your are in imminent danger of hurting yourself or someone else or there is suspicion of child or elder abuse. Otherwise, I am required by law to not disclose any information about you without your written permission.

I totally understand that sitting in a room with someone you just met and telling them some of your most personal information and feelings can be an odd and uncomfortable experience. I do my best to make it feel less like some sort of Fruedian psychoanalysis, and more like a regular conversation. With issues around postpartum depression and anxiety, there will be some educational components of what is going on and what to expect. With all of my clients, we spend time trying to understand how the way your are thinking is affecting your feelings and behaviors and work to reframe those negative thought patterns. We will also examine how relationships are impacting you.

We will develop treatment goals. I can write up goals with typical measures and interventions that satisfy insurance and professional standards, but what I really want to know is what YOU want to get out of therapy. Bottom line, you are the expert in you. Therapy is not so much me telling you what to do, but helping you figure out how you can change what is not working for you. You understand better than anyone how you think, experience emotions, and how you want your life to be different and better. I will be your guide and biggest supporter in getting there.