January 16th, 2019

I’ve Never Been to Therapy, What Should I Expect?

Psychotherapy is a bit of a mystery, for people who have never experienced it. Many of us are familiar with the pop culture cliche of a person laying on a couch, going on about something that is bothering them, only to have the expressionless therapist sitting across from them say something like “uh-huh… tell me about your mother.” And while your mother may be a fruitful topic for therapy, suffice it to say that this isn’t what therapy looks like in reality. Psychotherapy is a rich, collaborative exploration that varies widely across therapists, clients, and even between sessions for the same therapist and client.

A graduate school professor of mine once told me that there are over 300 recognized theoretical orientations in the psychotherapy profession (not to mention those approaches which aren’t recognized as valid)! There are also hundreds of thousands of people practicing therapy at any time, and we all bring our own individuality into our work. The wide variety of approaches, and therapists implementing them in unique ways, with unique clients, contributes to the mystery that many new clients enter into, when they decide to give therapy a try. It may sound counter-intuitive, but research analyzing the outcomes of therapy has repeatedly demonstrated that it’s not the particular modality of therapy that is important, but the relationship between the client and the therapist, and other common factors, including the authenticity of the therapist and their use of methods which they truly believe to be helpful.

One way that therapies can differ is in the amount of structure that is used in therapy sessions. Every therapist uses structure to some degree, and many will change the amount of structure to fit the particular client and the particular situation. Some therapists will introduce structure in the form of paper assessments (questionnaires) which they will ask you to fill out and perhaps discuss. Some therapists follow step-by-step protocols which they may or may not explain to you along the way. Another way that therapists can create structure is through how directive they are (e.g. giving you specific instructions in session, assigning homework regularly). On the other side of the spectrum are therapists who tend toward a more exploratory and organic approach; allowing the therapeutic process to be led by the client, the growing therapeutic relationship, and their own intuition. There are merits to using more and less structure in therapy.

When I meet with clients for the first time, I usually start by asking them something like “what would you like to get out of therapy?” What I do depends a great deal on how the person answers this question. In my work with clients, a lot of time in therapy is spent in a conversation in which I am striving to encourage a mutual exploration of the client’s experience and what is getting in the way of them having more of the life that they want. I often introduce more structure when it seems to me that the client is stuck in some way and/or overwhelmed. Sometimes, clients need a structured exercise because they are struggling to think or feel at all. In these circumstances, we will experiment together with different exercises, to see if we can get the client un-stuck and/or calm and centered.

People vary greatly in how much structure they need, in order to work through their difficulties, and the same person will have different needs for structure at different times. People also vary in the amount of knowledge that they have in regards to psychology, relationships, and their own inner experience. Some people come to therapy, knowing only that something in their life just doesn’t feel right, and they may  initially need their therapist to take the reins a bit more. Other people come in with a lot of things that they wish to work on and a desire for their therapist to act as more of a facilitator. Over time, clients may come to learn that they can benefit from an ability to seek helping in relationships that is sometimes more and sometimes less structured and directive.

Some people find it difficult, at first, to sit with a therapist without knowing what is going to happen. It’s quite normal to have anxiety, when you start going to therapy, because you’re meeting a complete stranger with whom you will at some point be exploring vulnerable parts of yourself. My best advice here would be to share whatever you feel comfortable sharing about why you are coming to therapy and if this therapist is a good fit for you, your trust in the therapist and understanding of what you need will grow naturally over time. If you have questions, ask them. If you don’t want to do something, let your therapist know. If you disagree with your therapist, share your disagreement. If you feel like you should be focussing on something else, say something. Regardless of how much structure a therapist is using, therapy is first and foremost a healing relationship. Above all else, learn to trust your gut and honor your experience; a good therapist will do the same.

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