I've been reading Lori Gottlieb’s Maybe You Should Talk to Someone. In short, it’s a memoir from a therapist about everything she’s learned in therapy (ironic, right?).
It gives a raw look at her patients—how they move through loss, loneliness, and fraught relationships. It reminds us how delicate life is, the myriad of emotions we possess, and how we all want to feel a sense of belonging and often get lost along the way. It also reminds us that therapists are people, too. Ultimately, it got me thinking much more about what we do in therapy.
We hear a lot about how everyone needs therapy and how to access treatment. We seldom talk about those mysterious 45 minutes inside the room with a perfectly placed tissue box. Or, increasingly, during a Zoom session.
Yes, the therapist is the expert guiding the session. But you still have control. Gottlieb illustrates how, despite her expertise, she kept diverting her own therapy session to a rant. She wanted her therapist to agree and validate how awful she had it. It took her multiple sessions to make better use of her time. One of her patients similarly spent most of his sessions talking about how idiotic everyone is, from a cashier to his wife’s therapist, as a way to outsource the problem.
So, how much should we be ranting about our annoying co-worker versus waiting for the therapist to ask questions or give advice? Should we talk about the issue affecting us that day or week versus the more long-term mental blocks holding us back? Is there a magic flow to the perfect therapy call?
Once your session is on the books—squeezed in between work meetings or before you pick up your children—it’s time to reflect on what you want out of it.
Reflect on what you want (maybe using pen and paper)
For starters, there are different types of therapy and one might work better depending on the person and the issue. Cognitive behavioral therapy (CBT) is intended to be short-term and helps people untwine fears, expectations, and learned thought patterns. Psychodynamic therapy, on the other hand, is more free-form and considered longer-term, says Dr. Nina Vasan, clinical assistant professor of psychiatry at Stanford School of Medicine and founder and executive director of Brainstorm: The Stanford Lab for Mental Health Innovation. Before entering therapy, consider which type may be best for you.
In whatever time you have before your therapy session, “think about how you are feeling in the moment, and how you’ve been feeling, and what you want to bring to the session,” Vasan says.
She also recommends writing down notes about how you’ve been feeling that week and any feedback from your last session to ensure you leave having said what you needed to.
“Journaling is an exercise that not only has data by itself to be helpful from a mental health perspective in terms of improving stress and helping regulate one’s mood, but also when done in conjunction with therapy, can be a helpful tool to help you figure out what you want to focus your therapy session on,” Vasan says.
Know it takes time
For people beginning therapy for the first time, it’s easy to assume that your therapist is there to solve your problem and send you on your merry way.
“The optimal timeline for each patient is different depending on what they are dealing with and its urgency,” Vasan says.
Gottlieb writes about how many patients come to deal with a specific challenge—a breakup, job change, or loss—but end up reflecting and finding things out about themselves they didn’t expect initially. A therapist can help you reflect on your experiences, relationships, and struggles in a non-judgmental way.
“A therapist is not there to tell someone what to do,” Carla Felten, a child and family therapist and clinical program coordinator at Daybreak Health, tells Fortune. “They are here to help guide the person to see the problem or challenge for what it is, with knowing themselves well enough to address or handle the situation in a way that feels authentic and safe.”
Ask yourself why you’re even there
Felten outlines several questions you can ask yourself before jumping into your session:
- What do you want to get out of this time together? What will be useful to you?
- If you don’t know, will you be open to your therapist guiding the session in the way they think is helpful?
- Do you want to vent/rant/talk through things? Process difficult or hard information and figure out how to approach a challenging situation?
- Do you want to learn things about yourself and the way your body, brain, emotions, relationships work and impact each other?
- Do you want to learn ways of taking care of your mental health?
- How have you gotten through adversity and difficult situations in the past? How has your culture provided healing opportunities?
- How will you know that therapy is “working” for you?
“Therapy is also about helping you unlock your potential and identifying areas of support that are already in place to help get you through difficult times,” Felten says. “You often have the answers to your own questions—you just may need someone to help you uncover them or guide you to them.”
What to think about during a therapy session
There’s no golden rule for how much you should talk versus listen in a session.
“The reality is that this will vary based on what you’re dealing with at the moment, what type of therapy you’re doing, and the style of your personal therapist,” Vasan says. “I think what’s important here is being vocal with your therapist about your needs, wherever on the spectrum they are.”
Therefore, take stock of how you’re feeling during the session. It’s okay to call a timeout and switch gears.
“If you need to feel heard or if you need some feedback on how you’ve been thinking about a particular issue, ask for it,” Vasan says, noting the difference between someone who needs advice and problem-solving versus someone who wants a sounding board. “Better communication between the therapist and patient leads is always a good thing.”
What to think about after your therapy session
Don’t be afraid to reflect on your therapy session about what worked and what didn’t. Nothing is going to change overnight either, Felten says.
“Be willing to share what you really need in therapy, and know that it takes time to grow comfortable and to trust that the therapist will respond to them in a way that is helpful,” she says. “Be willing to try things that you had not heard of or practiced before. Everything suggested is to make something better, more helpful, or easier for you—sometimes things will work and sometimes they won’t.”
It’s also okay to consider whether or not your therapist is the right fit
Therapy is a time for you to grow—it’s important to advocate for yourself and ensure you get the most out of it.
“While there are boundaries that are in place to help balance and protect the relationship of therapist and client, you have a right to know how qualified your therapist is in helping you,” Felten says.
Ask yourself:
- Do they have experience in the things you’re coming to therapy for?
- How have they helped others who are similar to you?
- Do they acknowledge your culture and identities?
- How do they take in feedback that you give them?
- Do you feel like they really listen to you and remember what you tell them?
- Do you feel like they care about you and want to support you?
- What are things that are really important for others to know about you?
- Do you tell important things to your therapist directly or wait for them to ask?
When you have someone who ticks your boxes, patience is key.
“Sometimes it’s difficult to know if therapy is ‘working.’ It’s not just about talking about hard things and then you feel better – in order for it to ‘work,’ you have to ‘work.’” Felten says. “It takes effort to be vulnerable, to acknowledge and actually talk about trauma, to trust someone, to learn and practice. If these things do happen and eventually become a little easier, you are growing and healing.”
