Therapy usually starts with one or two sessions of gathering information.
Therapists will need to get the diagnosis right and learn more about you, your family, medical history, drug and alcohol use, your strengths, and a few other topics before therapeutic work actually starts. It’s an uncomfortable process, because you’re giving very private information to a stranger. That information will help the therapist get the diagnosis right, understand where your problems are coming from, and find the right skills and techniques to help you.
Most clients hold some information back, either because they don’t know the therapist very well yet, or out of embarrassment or shame. It’s understandable that there are things you don’t want to talk about yet. Try to give the therapist the basics.
Every once in a while, new client will tell me: ‘There’s a lot more there, but I’m not ready to talk about it.’ Knowing that is really helpful to the therapist.
In therapy, new information sometimes changes the diagnosis or the way they want to work on your presenting problem. That’s a normal part of the process, but that time of uncertainty gets a lot shorter if we have all the information as soon as you feel comfortable giving it to us.
You’ll probably need to do skills training outside the session.
The balance of talking and skills-building varies by the therapist’s style and by the diagnosis. Most therapists will ask you to do some work outside of session. It might be reading, videos, podcasts, journaling, or (most commonly) skills practice. It’s often called ‘therapy homework’, but I prefer to call it skills practice because that phrase emphasises your personal growth, not your obedience to your therapist.
Skills training is a lot like learning a sport or a musical instrument. You may not be very good at your new skills right away, which is fine. You don’t expect to be great at baseball or piano when you first start. Mental health skills are the same. They take a little practice before you’ll even know if this skill will work for you.
Your therapist will probably recommend the amount of time you should practice. Twenty minutes per day is a common recommendation for learning meditation. Make an effort to do that. If it’s completely unrealistic for you, though, talk about a more reasonable expectation with your therapist. The best practice schedule is the one that you’ll stick to long enough to create real change for yourself. Five minutes a day, over a long period of time, is better than 20 minutes a day for three days, after which you give up because that isn’t realistic for you.
The ‘therapy hangover’ is real.
A lot of people experience what I call ‘therapy hangover‘, which means that you have a reaction to the hard work you did in your session. To use exercise as a metaphor again, this is the muscle soreness of therapy. You worked very hard, and your mind and body are telling you it’s time to rest.
Just like with exercise, therapy hangover will have you feeling a little emotionally or physically tired after sessions, but it shouldn’t leave you feeling mentally injured. Feeling irritable, tense or emotional after a session is normal as long as it’s manageable. Plan something fun and relaxing after therapy. Maybe use some of your new skills to calm the feelings and release tension.
Talk to your therapist about how you feel after sessions. Let them know if you need to pace therapy a little more slowly and carefully. If your therapy hangover lasts more than a few hours at the most, or is unmanageable enough to make you want to stop therapy, this is something your therapist should know about.
There are a lot of different types of therapy.
Each type of therapy (CBT, DBT, interpersonal, psychoanalytic, humanist, and so on) is based on a different belief about where mental health or relationship problems come from, and what will help. Cognitive-behavioural, for example, is based on the belief ‘It isn’t events that make us unhappy, it’s our beliefs about those events.’ Dialectical behaviour therapy works with that idea, but also with the idea of seeking better mental health through acceptance and mindfulness. There are also tech-based therapies like biofeedback and neurofeedback that treat mental health as a brain health problem. These therapies work to correct things like relaxation levels, stress and trauma responses, or the patterns of electrical activity in the brain.
There’s also no rule that you have to choose just one. Some people get better results from a treatment plan that pulls from different styles, for example CBT and biofeedback. If you have a therapist who’s trained in more than one therapy style, you can customize your treatment a little more.
It’s normal to give your therapist some feedback.
We’re going to get things wrong sometimes. We aren’t psychic. It’s completely OK to let a therapist know that you’ve tried your best with a technique, and it just isn’t working. There are always multiple ways to work on a treatment goal. Sometimes your therapist might push in a direction you’re not ready for yet, and you should definitely bring that up.
Therapy hangover is a great example. It’s normal to feel tired after a session, not completely wrecked. Let your therapist know if your work together is too intense, and you need to slow it down a bit.
It can also be normal to be mad at your therapist about something. They should be willing to hear that. If they genuinely did something wrong, they should be willing to own it. If you had an outburst that really wasn’t their fault, but some anger got directed at them, that’s part of our job! Your therapist should be willing to help you work through that and understand what happened.
If your therapist seems closed to feedback, talk to them about it but then maybe consider exploring other options for therapy if it’s hurting your ability to make progress.
Aimee Daramus, PsyD is a psychologist based in Chicago, Illinois.