Therapy, counseling, or talk therapy, can feel like a mysterious thing especially if you haven't done it before. The question of, "what exactly happens in the therapy hour?" is a common one. So is the question, "how does therapy actually work?"
By the end of this post you will know 1) what happens in session and 2) what factors contribute to a successful therapy experience.
What Happens in Therapy
Let's start with what happens in therapy sessions. Therapy is dedicated, carved-out time just for you. It often starts with a check-in on your mood, current functioning, sleep, energy, and other facets of your day-to-day experience.
Then, the focus shifts to what brought you to therapy in the first place. These issues will take priority in your work together. and be discussed during the course of therapy.
Of course, life also happens and sometimes therapy needs to focus on an immediate event or upcoming stressor. That's more than fine! Therapy will just pivot back to the original issue, at the appropriate time.
Getting Clear on Your Values
You and your therapist will explore and define your values -- what makes you tick and what gives your life meaning. You and your therapist will talk about your values and where you sense that your life falls short, at the moment, with regard to your values. This happens because life is complicated and often very difficult.
With therapy, you can learn to give yourself grace when this happens, notice barriers that arise, identify old patterns that no longer work, and take steps to make new choices. Choices that give you a deep, felt sense, that in that moment you are living your life in a purposeful way.
A Life with Greater Purpose
And that's the point of therapy, truly -- to help you notice what is and isn't working in your life, who you truly are and how you want to be in this world. More often than not, it is the discrepancies, or differences in our lives, that bring us to therapy.
These discrepancies can look like, "I want to be a good mom but I just feel so tired and numb", "I know I am supposed to care about my job, it pays well, but it doesn't make me happy", and "I have all these dreams for myself but I am too depressed to make them happen". Therapy helps you to see these discrepancies with kindness and guide you as you make challenging but ultimately rewarding choices.
Psychological Flexibility
Overall, therapy aims to increase your Psychological Flexibility. What's that, you say? Will we be doing yoga in session? Not exactly!
Psychological Flexibility is the helpful and expansive "thing" that happens as a result of therapy. According to Steve Hayes, Ph.D., originator of Acceptance and Commitment Therapy (ACT, said as one word), Psychological Flexibility is the "ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends."
But, more on Psychological Flexibility later...!
In order to achieve a greater Psychological Flexibility, your therapist will guide the conversations and work that you do based on: 1) your presenting issues and preferences, 2) what the data from scientific psychological studies recommend as the best possible treatment (aka evidence-based treatment), and 3) the therapist's own clinical expertise.
Very often the therapist will recommend work be completed by the client outside of session time, this is known as therapy homework.
Therapy Homework for Between Session Growth
A course of therapy almost always includes homework and that's because therapy is just one hour of your life. Yes, it's a deep and often powerful hour but an hour nonetheless. A whole lot of life is lived outside of your therapy session!
Homework helps you to practice and expand your skills in the other 167 hours that week. Homework can be behavioral-based (such as, "find a new walking trail and go for a 10 min walk), cognitive-based (such as, "notice what thoughts and emotions show up for you at the start of your morning") or, very often, a combination of the two!
When you return to therapy for your next session, you and your therapist will discuss not only what occurred the week prior but also how the homework assignment went. Conversations and in-session exercises (think: thinking techniques and small behavioral challenges) will continue and evolve the more work you do in and outside of the session. Therapy is successful, in part, because of the work you will do outside of the therapy session. That's great news because it means that you, the client, have a tremendous amount of control over the overall success of the therapy!
That brings me to other factors that contribute to a successful therapy experience.
Predictors of Therapy Success
#1 Predictor
Let's start with the biggest predictor of therapy success: the therapeutic alliance. The therapeutic alliance refers to the relationship you have with your therapist, or, your bond. A client and a therapist work collaboratively toward helping the client achieve their goals.
This is done with acceptance, a mindful awareness, compassion, shared experiencing, and at times a good dose of humor.
Other Important Predictors
Other predictors of therapy success include the client's Willingness and Openness. Let's define those briefly:
Willingness is the voluntary and value-driven choice to begin or continue contact with private experiences (i.e., thoughts, feelings, sensations, etc.) or the events in which they occur.
Said another way, willingness, is a choice, based upon what you hold nearest and dearest, to show up and sit with discomfort. In therapy, that looks like showing up to session, sitting with the sadness or worry that you may be feeling instead of shutting it down or escaping. While difficult in the moment and likely highly evocative, willingness is such a major factor in being able to heal.
Openness is a stance and a perspective; an approach. Openness invites and allows curiosity, creativity, imagination and overall open-mindedness to be present.
Therapy Demystified and Destigmatized
There you have it -- answers to 1) what happens in session and 2) what factors contribute to a successful therapy experience.
Knowing what to generally expect from therapy sessions and the overall therapy experience helps to make it feel more approachable and understandable. In turn, that familiarity will allow you more easily to gain tractions in therapy once you find an appropriate therapist.
If you are wondering whether the work that I do and the approach that I take may be an appropriate fit for you, I invite you to contact me.