Psychotherapy is costly both in terms of time and money. Here are some ideas on how to make your investment in therapy as useful as possible. You don’t have to use all of these suggestions, and these are not rigid rules that you must follow. However, paying attention to these will improve your experience in therapy.
First off, make sure that you feel good about me and my approach. Therapy is most effective when you are completely open with me, so take your sense of safety with me seriously. If you are cautious to talk with me about certain things, the reason for your caution is something we should talk about.
I would like to earn your trust and become your closest confidant. This will take some time, but if you do not feel your trust in me building, please bring it up! I want to co-create a relationship where you can freely share almost anything (except for some things that are illegal, like murder, or suicide). That is a part of the special joy of a psychotherapy relationship. You can tell me anything you want about yourself, and I won’t judge, I won’t insult or berate, and I won’t just leave you unexpectedly (to the extent this is within my power). It’s such a valuable and unique relationship; please take advantage of it as much as possible.
A good therapeutic relationship is made rather than simply found. Be creative about helping me get to know you. The better I know you, the more effective our work together will be. Share photos of your family and loved ones, bring in your art work, share a favorite song, ask to meet at a special location, go for a walk or invite me to your home. Make use of methods that have worked for you to build other relationships You are paying me for my time, and we can be creative about how we spend that time. Don’t worry, if I am not comfortable with it, I will let you know.
To deepen the relationship, be direct with me. No therapist is perfect. What am I doing that works and doesn’t work? Am I leaving things out that you had hoped would be part of our work together? Do you find me cold? Intrusive? Not challenging enough? Too challenging? Do you worry that you like me too much or that you depend on me too much? Say so. This sort of direct communication not only helps me help you, it also helps you get comfortable with parts of yourself that you usually hide. A core principle of therapy is that it’s the relationship that heals. But you can’t just show up; you need to open up too.
It would not make much sense to go to your medical doctor and not be open about your symptoms – similarly, in therapy, please be open and direct with me about what is bothering you. If you are not comfortable telling me, please tell me that! “I want to talk about something, but I do not yet feel safe enough with you to be that vulnerable.”
I am a very good and experienced therapist. I can only be a great therapist for you with your active collaboration in designing our work together.
Schedule sessions at a good time for you. Make sure you have the mental space to really dive into your concerns and that you are not having to “hold yourself together” so you can handle your next commitment. Make some time after the session to journal a bit and reflect on what happened.
Keep your appointments, be on time and pay your bills. This is a very basic way of honoring the work we are trying to do together. Emotionally, I can only really invest in your healing to the extent that I feel you investing in it.
Define observable benchmarks for the changes you want, whether in terms of behavior, thought, or feeling. The work of each session will likely be different, but therapy should be getting you closer to your benchmarks. If not, we should talk about that.
A really great therapy session generally follows this pattern:
- Logistics first
- Check our relationship – clear and connected.
- Do the work of the day.
- Plan how to use today’s material in your outer life.
- Finish up with shared appreciation.
Here is little more on each of these:
Take care of the logistics first – it is almost always disruptive to have to handle these at the end, so do the money, scheduling, insurance and any questions first.
Centering in yourself. This might just take you a breath, but sometimes it can be very useful to take several breaths to clear a space from your day, deepen your mindfulness and focus on your goals for the session. You may already know how to do this, if not, I can offer you a variety of approaches.
Keep our relationship clear and connected. Please bring up any concerns you have in our relationship and talk about them. If there are no unresolved issues between us, check the quality of our connection and fine tune it – do you want to feel closer? Less close? Is our physical proximity comfortable?
A word on physical contact – I am cautious about physical contact because I do not want to invade your space or to create an ambiguous situation. At the same time, physical contact can be very helpful. Personally, because I can get so much information about another person through touch, touching the person I am with often helps me feel safer. I spent years doing massage, and these days I dance and do interactive martial arts; I am very comfortable being physically connected with others.
I believe that most people are touch-deprived and that this creates a malaise in the human organism. For these and other reasons, touch may be an important part of your healing work. It can also bring up issues around boundaries, affection and sexuality that are difficult (and extremely useful) to grapple with.
Do the work of the day. I will often ask you, “What would you like to work on today?” or “What would be most useful to go into today?” It is helpful if you have put some thought into these questions before the session.
Since our relationship is a co-creation, neither of us really know in advance what is going to happen next or what will be most healing for you. Here are some ways we might use our time:
Sharing about your week – there is no need for you to do this, although for some people this is a way for them to include me in their lives, to feel understood and known, to report on progress, and to bring out problem areas. You may be going through a particularly difficult period in your life and needing some quality support and validation.
Talking more deeply about our relationship and relationships in general. Ideally, we are co-creating an unusually open and trusting relationship. Talking about the process is important and talking abut how it is, and is not like your other relationships is part of that.
Being witnessed in the unfolding of your present experience. Most people have little experience being totally transparent with another. Therapy is a place where you can do that and at some point I encourage you to take advantage of that.
Clearing your past. Many people carry distress from their past or immature learnings that have never been updated. It is profoundly helpful to methodically clear this up. This requires focused work and the sooner in your life you do it, the better.
Developing new skills. So much of the quality of your life experience is based on your self management skills and your skills in interacting with others. Improving these skills -whether in terms of thinking, emotion, or behavior – is an essential part of your personal growth. Again, the sooner you do this in your life the longer you will enjoy the results.
Plan how to use today’s material in your outer life. Often it can be useful to co-design specific exercises or to plan out conversations to be had with important people. Follow through and accountability in taking your new tools and insights into your life is essential. If we agree on some “homework”, do it!
Finish up with shared appreciation. Ideally, we just co-created a powerfully caring and healing session together. Honoring the sacred space we entered, and are now leaving, is important.
In between sessions:
Journal about the process – taking the time to reflect on paper about our sessions will solidify your insights and strengthen your resolve to practice new skills.
Share about your experience in therapy with supportive others – this can be a great way to involve your supporters in your growth. But be selective; you do not need to share everything with anyone and sometimes tender areas of new growth benefit from privacy.
Put the gains you have been making in therapy into practice! If we made agreements around specific follow through, do your homework. When you find opportunities to practice new interpersonal skills or skills for self-management, put these to use. As with anything else new, be prepared to make some mistakes at first!
Prepare for your next session – think about topics you would like to address, problematic areas in your life or skills you would like to develop. Sometimes it can help to write these down and bring your notes to the next session. Not preparing for a therapy session or waiting until the last minute may inadvertently make it more difficult to talk about what is really important. As you know, preparation is key for anything worthwhile in life.
When it is time for us to complete…
It is natural to wonder about when our therapy relationship will be complete. Please talk about this with me when it is up for you. My investment in you and your wellbeing will mirror your investment in therapy. This is in the coin of time and money, but more importantly, in the coin of respect and care. When I invest in you, I make the agreement to show up with all of myself in each session, and to not break the relationship off without discussion. Please show me the same respect.
Sometimes it is appropriate for us to taper in our work together, having sessions once a month or as needed. We can talk about these specifics when the time comes.
If our work together has been effective, you will have made great strides towards your personal goals and we will also have developed a personally caring relationship. I know from experience that my caring for my clients endures beyond our professional relationship. We may choose to stay in touch for years…or not. We can decide together.