How Therapy Works Part 3: The Client's Role

Intro

As has hopefully been established by now throughout this series, a positive therapy experience is dependent on multiple variables. Part 1 and Part 2 focused on finding a therapist who knows what they are doing and is a good fit for you, but this final post is to talk about the agency each client has in their own therapeutic experience.

Most therapy today is not some sort of expert consultation, but rather a cooperative and collaborative endeavor between the therapist and the client. As I commonly tell my clients, the therapist brings an understanding of psychology crucial to the therapeutic process, but equally important is the client’s own individual experience and knowledge of the self. Ultimately, the client is the only person in the room who can tell if therapy is working and is the only one who can truly know what has been effective. Invariably, the clients I work with who have the most success are the ones who take ownership of their own treatment. The following are what I believe to be the most effective ways clients can get the most of their time in the session.

Be Honest

I have had multiple clients ask me how I know when people are lying to me in session. My snarky response is usually, “I don’t, but I get paid the same if they do.” As a therapist, I only can work with what I know. If there are significant portions of your history, situation, thoughts, struggles, etc. that I am in the dark about, you can bet that these are not my priorities when I am session prepping. I speak as a repeat client in therapists’ offices when I say that one of the beautiful parts of the therapeutic relationship is having someone you can speak to that has no stake in your struggles. Your spouse, partner, friends, parents, boss, and children are all people that have emotional investment in what you are going through; therefore, it is more difficult (and might not be appropriate) to speak to them with unfiltered authenticity. A therapist is someone who has no skin in the game outside of the office, and is one of the few people who can adopt a purely objective and neutral stance. At the end of the day, you are only diminishing the treatment you are paying for if you are not honest in session.

Honesty does not extend simply to parts of your life that you choose to withhold. It is a key aspect of your experience in treatment as well. It is absolutely acceptable to tell your therapist if they are focusing on interventions, coping skills, or treatment modalities that you don’t find helpful (or that you do!). You are the expert on yourself, and you know more about your life and experiences than any therapist could possibly hope to learn in a single hour a week.

I do not want to diminish the difficulty of being honest with your therapist (I would be lying if I claimed I was always 100% honest with the ones I have worked with). It really is a vulnerable place, and it is your therapist’s responsibility to earn your trust before you decide to share. I only implore you that when you have made the decision, that you go all in.

Do Your Homework

I am a bit of an outlier in my field in that I actually enjoy math, and one of my favorite ways to force math into my job is by using the following illustration. Consider that there are 168 hours in a week. If you meet with your therapist once a week for an hour (probably a high estimate for most forms of outpatient therapy), you are only spending about 0.6% of your time in therapy. If that 0.6% of your week is the only time you focus on your mental health, you are unlikely to see a difference in the other 99.4% of your life.

This does not necessarily mean that your therapist will assign you specific homework assignments (personally, I am usually ambivalent about giving clients specific worksheets and telling them to bring them back in the next session), but all therapists encourage clients to focus on concepts discussed in therapy outside of session. This may take the form of practicing breathing exercises, communicating your needs to your partner, starting to exercise consistently, keeping a thought record, reaching out to a friend for support, journaling your emotions, or even just setting aside a half hour to take a bubble bath because, dang iit, you deserve it!

One of my old supervisors had a plaque in her office that read, “If you change nothing, nothing will change”. I suppose it’s the wordplay, but something about the phrase really speaks to me. If you are in therapy, odds are there is something about your life that you wish was different. We cannot count on the world or people around us to change; change must start with us. The act of sitting in a room talking with someone is not in and of itself a cure for mental illness. Think of it instead as a facilitation of treatment. The lasting work in therapy is often what occurs outside of the session.

Trust in the Process

I’m guessing that the reaction of many people reading this factor would be “well, duh!”, but a client’s belief that the therapeutic process can work has been identified as one of the most important factors towards the success of treatment. It is important to note that therapy can be different from other types of health treatment in that therapy is based on self-directed change that is persistent and consistent. When you consider it, medical treatment can frequently be a passive endeavor on the patient’s end. For example, broken bones that are set properly will heal naturally without conscious effort, many infections can be treated without any more consideration than taking an antibiotic as prescribed, and most of us will overcome colds even without medicine or a visit to the doctor. As long as you follow the doctor’s recommendations, many (no, not all) medical issues will sort themselves out without the need for significant lifestyle change.

Therapy is different. Effective therapy will bring to light behavioral and thought patterns that can range from unhelpful to downright detrimental. Therapy will help identify problems, but the challenge then is for the client to take the actions necessary to fix these problems (see: Do Your Homework). Since so much of the change is client-driven, the client’s belief that change is possible is crucial to success.

I want to be clear about what trust does not mean, which is namely blind obedience to your therapist. Within trust, there is room for skepticism, especially if you have had a poor experience in therapy before. There is room to ask for clarification about what your therapist is recommending, to look for a second opinion, and to be open if something your therapist is suggesting isn’t working for you (see: Be Honest). There is room to leave your therapist if the rapport simply is not there. Think critically, ask questions, find somewhere you can feel comfortably uncomfortable (because good therapy will be uncomfortable at times), but then believe (or at least proceed with the hope) that what you are doing can get you where you want to go.

Medication and Therapy

I want to take a minute to address the question of medication within the context of psychological treatment. Full disclaimer: I am a masters-level clinician without a medical background, and am not qualified to give advice or recommendation about the use of medication (no one without an “M.D.” after their name should ever do this). This is just a brief explanation of the role I have seen medication play in therapy.

Medication can be an excellent and critical part of a person’s mental health journey, and is worth discussing with your primary care doctor or a psychiatrist, particularly if you have symptoms that are not responding to therapy and/or lifestyle change. For some people, taking a medication like Prozac daily may be all they need to address mental health needs. However, research indicates that medication is most effective in conjunction with therapy.

I like to use a weeding allegory to explain this process. Imagine your mind as an overgrown garden. Taking medication can be like removing the foliage on the surface; it can address the chaos and establish order in the garden. However, medication taken in isolation often leaves the roots of the weeds intact, meaning that the problems will “regrow” and will need to be readdressed constantly. If there is neurochemical imbalance in your brain, this may be the result of factors that medication cannot change. For example, medication cannot remove your trauma or impact challenging circumstances in your life; it can only mitigate the effects of these factors. Therapy is the tool that can remove the roots of the problems for a more sustainable fix, while medication is the tool that makes the problem manageable enough to focus on the roots. In intense and/or persistent cases, both are a necessary part of the treatment.

In Conclusion

Thank you for sticking with this series through these three entries. We are happily seeing a reduction in the stigma surrounding mental health treatment, but the therapy is too often shrouded in uncertainty, especially based on the way it is portrayed in popular media. Choosing to enter therapy can be a challenge (I recently reentered myself and it was difficult for me even though therapy is my actual job), and I hope that this series demystified treatment at least a little for you. If you have further questions, or would like to give therapy a try, I would encourage you to request services on our website at timbercreekcounseling.com. If you would like to contact me directly to continue the conversation, please feel free to email me at connor@timbercreekcounseling.com. I truly believe that with the right attitude and right therapist, anyone can benefit from therapy, and I would genuinely encourage anyone who has never tried it to use this resource. It is Connor-tested and Connor-approved.