How to do therapy. A therapist’s take on a client’s role in therapy

| Caitlin Kline, LCSW

So, I’d like to start off by prefacing that what I’m presenting in this blog is from my own professional experience and what I have learned from other clinicians. It is likely slightly different for each therapist’s style and structure. 

Well, it seems easy- you Google search for a person who takes your insurance, has an office near your home or work, make the call, fill out the forms, and show up and talk. For some, even starting the Google search is a tough first step to make, but this blog isn’t about finding the courage to start the therapy process. That’s a whole different blog! What I’d like to focus on is how to be the most effective participant in your own wellness.

I come from this having been on “both sides of the couch” as I like to say (i.e. having been a client and a therapist). Setting appropriate expectations will be the first part of making the most of this experience. The first point I’d like to make regarding expectations is to be aware that this to be a challenging process in which things may get better before they get worse. I like to use the metaphor of a facial to describe this process. If you’ve never had a facial, the esthetician will clean and exfoliate the skin, do some extractions, and bring all of the toxins to the surface. Initially, your face won’t look ….as smooth and beautiful as you would like. However, in a few days, you’ll notice that the skin is healthier, not as congested, and glowing! This is similar to the therapeutic process at times, as it can expose the “toxins” before the glow starts to appear. 

Another expectation of this process is your involvement and participation being of vital importance. Coming to a therapist’s office, sitting on the couch, and talking for 50 minutes is not the only part of the work (sorry!). Another metaphor (because I like metaphors) that I like to use when talking about this is a coach meeting with his/her team in the locker room before the game. They have a strategy meeting, a pep talk, remind the players of what their roles are on the field, etc. Then, the players go out and play. The therapy room is the locker room in this example. A therapist is not going to solve the problems that you come in with, rather guide the process. You must go out on the field (life, in this example) and utilize the strategies discussed. 

Other than having appropriate expectations, it’s going to be important to know what is going to help the therapist help you! The first one being honesty and vulnerability (as scary as this sounds). We would like to think that we can just look at someone and read someone like a crystal ball, but we aren’t that good! The more data we have, the better we can assess the problem and work with you to address that problem.

The second being open to communication about the process- what’s working, what’s not working? As therapists, we are here to work ourselves out of a job! If you have completed your goals, great! This is what we want! If we can do something differently or we are going down the wrong track, let us know so that we can be more helpful to you. Lastly, finding a good therapeutic fit is not always easy. Not everyone likes everyone! We don’t like everyone- it’s ok! We would rather know what is going on and how we can be more helpful to you, even if that means referral to another clinician. 

Now, I may be different from other clinicians in this, but I do not come into the session with an agenda (after the first session, that is). I will often have clients come in and have nothing that they want to focus on, which leads me on a hunt and peck journey to find something that is helpful to discuss. I ask my clients to marinate on what they would like to focus on prior to their session so that the time is as useful as possible to them. 

Lastly, I want to address the fear of judgment from therapists that clients have. Now, I’ll admit it, we aren’t robots, we do have our own preferences and opinions, but our lens from which we look at the client is not one of judgment and critique. We may be working with a person with an unhealthy behavioral pattern and ask several questions about that behavior- What motivates this behavior? When does it seem to happen? What are the thoughts that they have prior to the behavior? Etc. I can see how talking in depth about a behavior that may be shameful feels like judgment. The lens from which the therapist is asking these questions is not coming from a place of judgment, rather from a place of investigation and problem-solving. 

Today's the day to make a change.