Like the first day of school, therapy (aka, the first time you introduce yourself to a complete stranger and confide in them your deepest, most abhorrent flaws in the hope of becoming a slightly better-adjusted human being) can be nerve-racking. In fact, for men especially, who — and sorry to get morbid here, but it’s just facts — commit suicide at three times the rate of women, but attend therapy at a far lower rate, the mere idea of getting “analyzed” can feel utterly alien.
But hey, if you’re reading this, it’s probably because you’ve already scheduled your first therapy appointment (or you’re thinking about it), which means you’re pot-committed and that’s a really great thing, even if you’re already a mostly good person with just a few mommy (or daddy) issues you want to iron out.
I appreciate the encouragement. But how can I be sure I’m getting the type of therapy I need?
An understandable question, considering there are more than 50 different types of therapy. To make things more simple, according to the American Psychological Association, there are four major types of psychotherapy:
- Psychoanalysis and psychodynamic therapies. If you’re looking to adjust the motivations behind problematic behaviors, feelings and thoughts.
- Behavior therapy. Think Pavlov’s famous dogs, who began drooling when they heard their dinner bell because they associated the sound with food. In other words, therapy that “focuses on learning’s role in developing both normal and abnormal behaviors,” per the APA.
- Cognitive therapy. This is the mindfulness therapy that you’ve heard so much about, which focuses on identifying negative patterns of thought in order to alter unwanted behavior patterns.
- Humanistic therapy. “This approach emphasizes people’s capacity to make rational choices and develop to their maximum potential,” per the APA. “Concern and respect for others are also important themes.”
If that made you more confused, consider this U.S. News report, which explains that there are two primary philosophical models of psychotherapy: Psychodynamic and cognitive/behavioral. “Psychodynamic therapies focus on a patient’s unconscious process by having that person talk freely about his or her thoughts or feelings, and it aims to delve into past memories that might yield understanding of present problems,” reports Kirstin Fawcett. “Cognitive/behavioral therapies, on the other hand, are based on understanding one’s thought process or behaviors in the present and identifying how dysfunctional patterns in these areas may contribute to a larger life problem.”
Psychodynamic is probably the cliched image you might have of a therapist — lying on a couch in a fancy office, rambling about your mother. If you’re first starting out, it’s probably best to give cognitive/behavioral therapy a shot, because this tends to be “more structured than psychodynamic therapies and tend to be shorter in duration, depending on the person’s needs,” per the same report.
What if I don’t connect with my therapist from the get-go?
That’s totally fine and normal. Just don’t let your initial disdain for the person asking you “how that makes you feel” discourage you from really committing to your self-care. According to John M. Grohol’s article on Psych Central, you should determine whether or not you actually want to work with the professional within the first three sessions. “If, after the first three sessions, you feel you have issues with the therapist that haven’t been resolved, it may be time to cut your losses,” writes Grohol. “It is unrealistic to believe that every therapist can work with every client, and vice versa.”
In fact, per Grohol’s same article, you can even ask your soon to be ex-therapist to refer you to a colleague (if you need a referral). “Most therapists will respond in a professional manner, and ensure that if you need a referral, they help with that,” writes Grohol. “Some therapists may ask why you’re leaving, and you’re welcomed to answer them honestly or say you prefer not to say. It is up to you — it is your therapy and your choice in how much of that reason you want to share.”
Also, don’t feel guilty setting up appointments with a few different therapists to start. Some even offer short phone interviews to help you decide if you like them or not. “I routinely offer a prospective client a free 15-minute phone consultation to help them see if I am a good fit for what they are needing,” Gary Brown, a prominent therapist in L.A. who works with individuals and couples, told Bustle.
To that end, it’s also a good idea to be clear with your therapist from the beginning about what you hope to achieve through therapy. Ryan Howes, a psychologist in Pasadena, told MEL last year that it’s common for a first-time patient to set out the goals they want to achieve through therapy, and agree on some kind of end date for resolving their issues. “Ultimately, it isn’t a relationship that’s supposed to go on forever,” writes Adam Elder.
That seems fair. Do I have to bring anything with me?
No. Although according to an article in Wholefully, you should bring anything with you that will make you feel more comfortable spilling your guts. “Always cold? Bring a sweater. Have a tickle in your throat? Pack some cough drops,” writes Cassie Johnston. “The more comfortable you are, the more willing you will be to open up into a candid conversation. I always bring water and cough drops … because my throat gets so tickly when I talk for long periods of time. You probably don’t need to bring tissues — most therapists have those covered.”
I’m not going to cry. Wait, am I going to cry?
You may. But it’s important to know that most therapists will treat the first session as a sort of default session, Jeannie Bertoli, a relationship expert and counselor, told the Huffington Post. “Some therapists do a first session by getting an assessment of the current problem,” she says. “Some will do background, so they’ll understand your childhood and any medical issues. Some will just listen and say, ‘Uh huh’ a lot, and will be a more passive therapist, and some will really engage with you about what’s going on right now, and get to the depth of it.”
Let’s assume that it’s taken me years to acknowledge that I even need therapy, and a few more years to make the room in my life to do it. Therefore, I want to get to the deep stuff right away. Is there a way to cut through all the crap in a polite fashion, and without missing anything important?
Of course — again, this is your therapy session. In other words, it’s up to you to decide what you want to talk about, how you want to talk about it and when you want to bring it up. “You’re the co-creator of this relationship,” Bertolli tells HuffPo in the same article. “If you go in saying, ‘Here are my goals, here are my expectations, my preferences for how to proceed, what matters to me the most,’ — if you go in prepared and not looking to take a backseat, you will have the most success.”
Just be prepared to go more than once. “If you’re dealing with a specific issue, you may want to go for a certain amount of sessions — 10 sessions, six months, etc,” writes Lea Rose Emery for Bustle. “Some people like to stay in therapy for maintenance, and that’s okay too. Remember that you can adjust the experience to find something that works for you.”
Basically, per the same MEL article from last year, Howes says that if you think you’re ready to walk away from therapy, you’ll have to ask yourself this question: Do I want to leave because therapy is no longer working, or do I still have things to work on but no longer wish to do the work? The question is an important one, since there are an infinite number of problems with a variety of different resolutions. For example, getting over an irrational fear of finding scorpions in your shoe (yes, that one’s mine) is likely going to have a more concrete and obvious end goal than, say, trying to overcome some sort of less readily accessible issues like childhood abuse. My point is, not all problems are created equal, so every patient is going to have a different therapeutic journey.
Surely after a few sessions, my therapist will be able to tell me exactly what I need to do? They’re professional advice-givers, right?
Well, actually, no, they’re not. In fact, it’s not their job to give you advice at all. “Actually, the role of a therapist is to present clients with a better comprehension of what motivates or causes them to act or think in the way that they do,” reports Accelerated Resolution. “Instead of being used to give advice, psychotherapy should be a tool that guides people in making their own decisions.”
But aren’t I paying this professional to tell me what to do so I can resolve my issues?
No, you’re paying a professional to help equip you with the necessary tools to make your own decisions. “Therapy is a place to explore your feelings and learn about yourself,” writes Keely Holmes, a psychologist in California. “It’s a place of self-discovery. It’s a place to find out how you have become tangled up and a place to learn how to untangle yourself. It’s a place to gain a better understanding of your inner world and your relationships. This process is what people come into therapy to learn.”
Otherwise, Holmes says, if a therapist was to tell you exactly what you should do, they’re essentially handicapping you from handling situations in the future. “Some people want others to tell them what to do because it means not having to take responsibility if things don’t work out,” writes Holmes.
Okay, fine, last question: I don’t really have to lay down on a couch, right?
No. The couch is mainly used during psychotherapy, which is different from therapy since it doesn’t also include seeing a psychiatrist (Fun fact: Psychiatrists and therapists aren’t the same thing — the former are medical doctors whose job is to diagnose illnesses and probably prescribe medication.) But in case you’re still worried, according to the American Psychoanalytic Association, “the couch is used when the patient feels ready for it; there is no pressure,” per a report in Psychology Today.
As with everything else to do with therapy, where and how you sit is really all in your hands.