What to Expect in Psychotherapy

The cornerstone of psychotherapy is the relationship between the therapist and the person seeking help. But the therapy relationship is different from all other close relationships. On the one hand, the therapist–client relationship is characterized by intimacy and the disclosure of very private, personal experiences. On the other hand, there are distinct boundaries to the therapist–client relationship. To a therapy client, especially one who is undertaking psychotherapy for the first time, the therapy relationship may sometimes seem confusing and contradictory.

The following guidelines should help you understand the special nature of the therapy relationship and develop realistic expectations about the process of psychotherapy.

1. Find a competent, qualified psychotherapist.

Where should you go for help? Most colleges have a student counseling center or medical clinic where you can ask to see a counselor or request a referral to a qualified therapist. You can also ask family members, friends, your family doctor, or a religious leader for suggestions.

If possible, learn more about the therapist before your first visit (APA Help Center, 2012a). What are her qualifications? What approach does she take to treatment? Does she have experience with treating problems like yours?

Along with professional background, personal qualities are also important. When psychotherapists were asked how they chose their own therapists, openness, warmth, and caring were among the top criteria (Nordal, 2010).

Perhaps most importantly, you should feel comfortable with your therapist. Many psychotherapists offer a free initial consultation. So if you don’t feel comfortable with the first psychotherapist you meet, don’t hesitate to try out a couple of therapists before making your decision (Amada, 2011).

2. Strengthen your commitment to change.

Therapy is not about maintaining the status quo. It is about making changes in terms of how you think, feel, act, and respond. For many people, the idea of change produces mixed feelings. You can increase the likelihood of achieving your goals in therapy by thinking about the reasons you want to change and reminding yourself of your commitment to change (Hettema & others, 2005; Miller & Rose, 2009).

3. Therapy is a collaborative effort.

Don’t expect your therapist to do all the work for you. Therapy is a two-way street (APA Help Center, 2012b). If you are going to benefit from psychotherapy, you must actively participate in the therapeutic process. Often, therapy requires effort not only during the therapy sessions but also outside them. Many therapists assign “homework” to be completed between sessions. You may be asked to keep a diary of your thoughts and behaviors, read assigned material, rehearse skills that you’ve learned in therapy, and so forth. Such exercises are important components of the overall therapy process.

4. Don’t confuse catharsis with change.

In the chapter Prologue, Marcia mentions the cathartic effect of therapy. Catharsis refers to the emotional release that people experience from the simple act of talking about their problems. Although it usually produces short-term emotional relief, catharsis in itself does not resolve the problem. Even so, catharsis is an important element of psychotherapy. Discussing emotionally charged issues with a therapist can lessen your sense of psychological tension and urgency, and can help you explore the problem more rationally and objectively.

5. Don’t confuse insight with change.

Despite what you’ve seen in the movies, developing insight into the sources or nature of your psychological problems does not magically resolve them. Nor does insight automatically translate into healthier thoughts and behaviors. Instead, insight allows you to look at and understand your problems in a new light. The opportunity for change occurs when your therapist helps you use these insights to redefine past experiences, resolve psychological conflicts, and explore more adaptive forms of behavior. Even with the benefit of insight, it takes effort to change how you think, behave, and react to other people.

6. Don’t expect your therapist to make decisions for you.

One of the most common misunderstandings about psychotherapy is that your therapist is going to tell you how to run your life. Not so. Virtually all forms of therapy are designed to increase a person’s sense of responsibility, confi-dence, and mastery in dealing with life’s problems. Your therapist won’t make your decisions for you, but he or she will help you explore your feelings about important decisions—including ambivalence or fear. Some people find this frustrating because they want the therapist to tell them what to do. But if your therapist made decisions for you, it would only foster dependency and undermine your ability to be responsible for your own life (Amada, 2011).

7. Expect therapy to challenge how you think and act.

As you confront issues that you’ve never discussed before or even admitted to yourself, you may find therapy very anxiety-provoking. Moments of psychological discomfort are a normal, even expected, part of the therapy process.

Think of therapy as a psychological magnifying glass. Therapy tends to magnify both your strengths and your weaknesses. Such intense self-scrutiny is not always flattering. Examining how you habitually deal with failure and success, conflict and resolution, and disappointment and joy can be disturbing. You may become aware of the psychological games you play or of how you use ego defense mechanisms to distort reality. You may have to acknowledge your own immature, maladaptive, or destructive behavior patterns. Although it can be painful, becoming aware that changes are needed is a necessary step toward developing healthier forms of thinking and behavior.

8. Your therapist is not a substitute friend.

Unlike friendship, which is characterized by a mutual give-and-take, psychotherapy is focused solely on you. Rather than thinking of your therapist as a friend, think of him or her as an expert consultant—someone you’ve hired to help you deal better with your problems. The fact that your therapist is not socially or personally involved with you allows him or her to respond objectively and honestly. Part of what allows you to trust your therapist and “open up” emotionally is the knowledge that your therapist is ethically and legally bound to safeguard the confidentiality of what you say.

9. Therapeutic intimacy does not include sexual intimacy.

It’s very common for clients to have strong feelings of affection, love, and even sexual attraction toward their therapists (Martin & others, 2011; Pope & Tabachnick, 1993). After all, the most effective therapists tend to be warm, empathic people who are genuinely caring and supportive (Beutler & others, 2004). However, it is never ethical or appropriate for a therapist to have any form of sexual contact with a client. There are no exceptions to that statement. Sexual contact between a therapist and a client violates the ethical standards of all mental health professionals. A psychotherapist who engages in sexual behavior with a client risks losing his or her license to practice psychotherapy.

How often does sexual contact occur? About 9 percent of male therapists and 3 percent of female therapists admit that they have had sexual contact with clients (Pope & others, 2006).

Sexual involvement between client and therapist can be enormously damaging (Norris & others, 2003; Pope & others, 2006). Not only does it destroy the therapist’s professional objectivity, but it also destroys the trust the client has invested in the therapist. When a therapist becomes sexually involved with a client, regardless of who initiated the sexual contact, the client is being exploited.

Rather than exploiting a client’s feelings of sexual attraction, an ethical therapist will help the client understand and work through such feelings. Therapy should ultimately help you develop closer, more loving relationships with other people—but not with your therapist.

10. Don’t expect change to happen overnight.

Change occurs in psychotherapy at different rates for different people. How quickly change occurs depends on many factors, such as the seriousness of your problems, the degree to which you are psychologically ready to make needed changes, and the therapist’s skill in helping you implement those changes. As a general rule, most people make significant progress in a few months of weekly therapy sessions (Harnett & others, 2010). You can help create the climate for change by choosing a therapist you feel comfortable working with and by genuinely investing yourself in the therapy process.