What you can and cannot expect from psychotherapy
In my experience consulting with patients who are considering whether or not to pursue psychotherapy to improve their mental health, the path to this decision is as varied as the people who travel down it.
Sometimes, it is the concern of a friend, partner, or family member that is the tipping point for an individual to seek help. In other cases, a teacher, school, colleague, or employer is insisting that mental health needs be prioritized above all else so that a person can return to school (or work) on better psychological footing.
Often, adults themselves are aware of ways in which they would like their relationships to be better, their mood or anxiety to feel more manageable, or of specific behaviors that they would like help to change; in these cases, people ‘self-refer’ in the interest of personal growth, symptom reduction, and overall improved quality of life.
Regardless of how you might arrive at the decision to try psychotherapy (or the type of talk therapy you choose), you will arrive at your first session with a set of expectations including some misconceptions about the psychotherapy process.
Why Are There Misconceptions About Psychotherapy?
If you are an outsider to the field of mental health, you may be among the general public who could benefit from help improving mental health literacy (i.e., knowledge about mental disorders). This certainly makes sense and is not unique to the field of mental health. After all, non-lawyers don’t typically know much about litigation. But it might make it hard for you to pinpoint the threshold for significant psychological distress in yourself or others (See this related post to distinguish ‘normal’ anxiety from generalized anxiety disorder). And it can add hurdles to successfully initiating psychotherapy or being willing to stick with it.
The most readily accessible information on psychotherapy comes from media portrayals. Research has shown that people do form conceptualizations and expectations of psychotherapy based on the illustrations they see in television and film. And whereas you might be able to balance out fictionalized, sometimes-damaging depictions of other professionals like physicians or teachers with your real-life experience receiving medical care or education, it may be more challenging to counter stereotypes of mental health clinicians, or the overall process of psychotherapy.
What Not to Expect from Psychotherapy
Understanding what not to expect from the experience can help you approach treatment as, as I like to think of it, an educated consumer with an open mind.
Here are some common but misguided expectations to try to leave at the door before you enter your session:
Don’t expect a quick fix.
There are a very limited number of problems for which one session of psychotherapy will be all the treatment that is required (Exceptions to this include single-session exposure therapy for some specific phobias in adults, teens, and children.).
Psychotherapy can be a short- or long-term commitment.
The first several appointments are typically used for you and your therapist to determine if (and what kind of) therapy can be helpful. You will be asked to talk about the specific concerns that led you to seek care, as well as elements of your broader medical, social, and family history that will help the therapist get to know you better.
For some people, it is quite uncomfortable to talk openly about their symptoms and history. For others, this is in and of itself a powerfully relieving experience. Regardless, it is highly unlikely that meaningful, lasting change or resolution for longstanding patterns of thinking, relating, or behaving can be adequately achieved in a handful of appointments.
That said, it is reasonable to expect structured, present-focused approaches like cognitive behavioral therapy, interpersonal psychotherapy, or acceptance and commitment therapy to be time-limited. Psychodynamic psychotherapy and psychoanalysis, on the other hand, which focus on the exploration of unconscious desires and processes are likely to require a greater time investment.
In most cases, the process will not be easy.
Psychotherapy is work. It will require you to take a hard look at yourself. You will not be alone in this; your therapist will be working hard too.
You will work together to (1) develop more awareness about exactly what is causing you a problem (for example, particular ways of thinking, avoidant behaviors, expressing or coping with various emotions, or communication style), (2) understand how your current patterns are serving you well and not so well, and (3) experiment with different ways of thinking, doing, relating, and coping.
Along the way, there are likely to be moments when you feel worse before you feel better. Talking about traumatic experiences, for example, might disrupt sleep. Confronting ways in which others have treated you poorly, or you have mistreated others, can lead to sadness and anger.
Facing something you are afraid of—be it a rollercoaster, raising your hand in class, or deciding to get a divorce—can create more anxiety in the short-term. In your ‘feeling worse moments’, remember that the old patterns felt bad too. Perhaps it’s worth giving it some time to see if this tough moment will give way to something better in the long run?
Talking with your therapist is not the same as talking to a friend.
The therapeutic relationship differs from other relationships. It is not reciprocal, not a "two-way street." You will likely share intimate details of yourself with your clinician, and he or she will not be responding in kind. The uni-directionality of sharing is not intended to be harsh or withholding, nor is it any kind of indicator of your trustworthiness or likability to the clinician.
Rather, your therapist sets limits around what and when they will share personal information in order to keep the focus where it needs to be—on you and your goals—and in some types of therapy, to help you makes sense of your assumptions (or projections) about him or her as another way to learn more about yourself. The boundaries set by a therapist in some instances can also model for you ways of limit-setting with others.
Your therapist will not usually tell you exactly what to do, what decision to make, or that you’ve made the ‘right’ choice.
Because your therapist will not be directly living out the consequences of your choices, he or she will typically refrain from overt instruction. There are certainly exceptions to this—namely, if there is a concern for your safety or anyone else’s—that might lead your therapist to be more candid and directive with you than usual.
Rather than telling you what to do, your therapist will ask you questions to help you determine what you want to do—and why.
He or she will reflect back what you’ve said to help you hear it with ‘fresh ears’ and facilitate a thorough examination. Your therapist may guide you to consider other options you had not imagined or to think through the positive, negative, and ‘somewhere in between’ consequences of taking a particular path.
If you work with the same therapist over an extended time frame, your therapist may be able to remind you about prior decisions (and their consequences) or flag repeated patterns. This may inform how you proceed with decision currently in front of you, or how you cope with its outcome.
Don’t expect to ‘click’ with the first therapist you see.
As unique as the therapeutic relationship is, it shares in common with other relationships that it involves two people coming together.
You are clearly the expert on you, and you arrive at your therapist’s office with particular temperament and personal style, a perception of the active problems, and an idea of your goals for therapy. Your therapist is the mental health expert, and he or she is greeting you with their own particular therapeutic style, areas of clinical experience (including the type of therapy practiced, age or diagnostic group(s) typically served, etc.), and temperament.
You may not "click" with the first therapist you see or it might take more than one appointment to decide if they're a good fit. You may need to see more than one clinician for multiple sessions before you find the right therapist.
Finding the Best Therapist for You
Best fit is different for different people, but you consider the following questions as a helpful start in evaluating goodness of fit for yourself:
- Has the therapist answered your questions to your satisfaction about your diagnosis, his/her clinical experience, and what treatment could involve?
- Does the therapist convey professionalism (in conversation, in the office environment, in his or her description of practice policies regarding cancellation, emergencies, etc.)?
- Is the therapist asking thoughtful questions?
- Given any challenges for you in beginning psychotherapy, how comfortable do you feel talking openly with the therapist?
- Do you like his or her style, including their extent of interaction with you, use of humor, ability to perceive and address your emotional state during a session?
To learn more, consult the American Psychological Association for additional information on what to expect and what not to expect from psychotherapy.
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