Three Important Things Your Therapist Won’t Tell You

three important things

One night in 8th grade, when I was already in my first or second episode of depression, the idea of going to school the next day was overwhelming. I was sleep deprived, stressed, despairing, and needed a break. I wrote a letter to my parents, telling them I couldn’t go to school the next day, that I was going to sleep in, and why. Whatever I wrote was alarming enough that a therapist was called.

In sessions, I would sit, staring down, anxious and mostly silent. If it ever did cross my mind to open up to the very kind, calm, and approachable woman across from me, I was held back by fears of what she would think, and what the consequences would be for telling her things. The only thing I did tell her was that I didn’t want to be there.

After a couple months I was allowed to stop, and that was the end of it.

This experience created a blueprint for how to interact with a therapist. I didn’t see another for seven years, and when I did, I didn’t use my appointment time well. I didn’t figure out how to do it properly for another thirteen years.

What Three Things?

I don’t know why these topics aren’t addressed at the beginning of a therapeutic relationship. It could be because the therapist is so well trained that it doesn’t occur to them, or maybe that they don’t want to influence your experience and behavior in sessions.

Whatever the reason is, you’ll get much more out of therapy, and things will make more sense to you after you understand these three things.

1) That Negative Feeling You Have Is Supposed to Happen

This is the big one.

Paul, a very good friend of mine, is a therapist by profession. I told him about something my therapist had said that really bothered me. I felt hurt and less trusting; I even wondered if it was worth seeing this therapist at all. To my total surprise, Paul said “that’s supposed to happen.” Our conversation went something like this:

Me: What do you mean that’s supposed to happen?
Paul: ...
Me: Why don’t you guys tell people this??
Paul: …

Martha Crawford, LCSW, who maintains a blog about her experiences as a therapist, has a whole post about conflict in therapy. She describes how anger comes up during therapy:

Some become angry because I can see the pathway in, I have gazed at a vulnerable and naked space in them – and they want to cast me out and drive me away. Some are secretly terrified that I will go and their anger helps them organize a pre-emptive strike. Sometimes anger helps people self-regulate, manage their dependency, separate.
Sometimes the anger that emerges in session, or is directed toward me is obviously displaced, patently unfair. A lashing out. And still, somehow, it is almost always understandable to me when I can hold, or uncover the subjective context that it is embedded in.
…whenever I have neglected to invite anger to enter into the process as a welcome guest, conflict barges in unannounced and unexpectedly, harming the therapeutic relationship – sometimes irreparably. Anger and conflict are experienced then, as definitive proof that something is wrong in the therapy, rather than as a vital component, a therapeutic mechanism of healing and connection.

As a patient, I agree that it is vitally important to bring up and address feelings of annoyance, abandonment, misunderstanding, and anger. It doesn’t help to avoid these negative feelings. Taking the leap to confront someone is significant, and so is achieving a better understanding of your emotions.

Don’t write off anger towards a therapist who is doing something worth being seriously angry about, though. That does not need to be “worked through.” I once had a therapist exclaim that she wanted to rip my eyeballs out. I walked out and never came back. Another time, I was diagnosed with ADHD by a therapist who ignored me when I said the diagnosis had been ruled out by exhaustive testing years ago. That wasn’t information to be brushed off, and anger, followed by finding another therapist right away, would have been the right reaction. If you need help finding a good therapist, start here.

2) Remember That You’re Paying Them to Listen to You

Nervousness or anxiety during a therapy session is very common. If you’re like me, you’ll have thoughts and concerns swimming around your head that you’re not sure you want to talk about. Should you mention the sporadic problem drinking? Will they think you’re an alcoholic; you know you’re not? What about the embarrassing sexual escapades during your last hypomanic episode? What will they think of you? If you have a concern about the way your treatment is going, will they be offended if you bring that up? If they’re offended, will it ruin the relationship? Will they still want to help you?

The only right thing to do is to voice these concerns to your therapist. You’re paying them to listen to you – holding back does nothing to serve your interests. Even if you are somehow getting free therapy, you’re still paying with your time and attention. While it might feel like they’re in control, you are.

When Worry Means More Than Worry

Those topics you’re so concerned about bringing up are likely the ones bothering you the most (and maybe not in the way you assume). The fear of judgement is also very much worth talking about. In the above example, the person could say “I don’t drink all the time, but when I do, it has this effect on me that concerns me. It’s also very hard for me to talk to you about this – I’m worried that you’ll judge me, and that you might tell my psychiatrist to not prescribe the anti-anxiety medicine that really helps me.”

When Worry Means Worry

If, however, the therapist has really proven themselves to be untrustworthy, remember – you’re paying them to listen to you. It’s time to find a new therapist, however much that sucks.

3) Don’t Go Into Your Therapy Session With Your Mind On Other Things

I’d bet that over half of the times I’ve walked into a therapist’s office, I have sat silently for a full minute, and then announced that I didn’t know what to talk about. Sometimes this was because of my mood state, like depression making it hard to concentrate. A lot of the time though, I had simply failed to prepare myself.

In school, did you ever frantically do your reading assignment right before class, skimming as quickly as possible and highlighting a passage or three so you could get through the discussion? Did it get you through the class, leaving the impression that you read and digested the whole assignment? Probably, but you didn’t get what you could have out of it.

In Therapy, Preparation Can’t Be Faked

When you race into your therapy appointment five minutes late and stressed out, or you spend your time in the waiting room playing a game on your phone, it will be uncomfortable when you are suddenly in a position where you need to be focused on and engaged with another human being. You will be talking about the most difficult aspects of your life. That’s an abrupt change. You may be able to take time in the therapy session gathering your thoughts, but you will waste time (that you’re paying for). More likely you’ll be scatterbrained and unsure of what to talk about.

Getting Ready

How do you prepare yourself? If your schedule allows it, plan to always show up 15 minutes early. If you get delayed leaving, hit traffic, your bus is late, you’ll still be on time. Once you get there – 5 or 15 minutes early, depending – just sit quietly and think for at least part of that time. Relax and don’t fiddle with anything. Consider what you want to talk about. Allow for the transition from your daily life to the therapy session. If you really, really, want to play a game on your smartphone, make it something that won’t frustrate you. Don’t go into therapy keyed up or frenzied, unless you’re hypomanic or your bike just got stolen, and you really can’t help it.

Pro tip for preparing yourself: in a notebook or on your smartphone, write down things you want to bring up in therapy. Do this throughout the week as things come to you, and/or the night before your appointment. Then you’ll really feel grounded, and will head into your appointment with a sense of purpose.


Can You Quickly Tell Me What I Need to Remember?

Sure:

  • You’re supposed to get mad at them.
  • You’re paying them to talk to you.
  • You need to focus on your appointments, and prepare if you can.

If you’re experiencing an acute episode of depression or hypomania, it could be impossible to really focus on psychotherapy. The worse the episode that you’re having is, the more true that will be. What that means is, if you’re interested in working through communication issues, talking through difficult events in your life, and so on, that will have to be put on hold. Working on those things might go to the back burner all on their own – you’ll be overwhelmed by your symptoms and dealing with them.

During these times, your therapy is still important. Your sessions will probably focus on how you’re doing – perhaps coping techniques, and your feelings about your experience with your mood disorder. Once you’re improving, you can pick up where you left off.


Photo by Kelly Sikkema on Unsplash

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