How does therapy work?

If there is one thing therapists don’t do very well, it’s explaining how therapy works. 

In this article, I will tell you exactly how therapy works.  I’ll talk about what happens in a therapy session, what to expect when you attend your first appointment, and how to measure whether it’s helping.

By the end of this article; you’ll have a clear picture of what a therapist does so you can decide if it’s something you want to do.

What happens in the first session?

The first appointment can be one of the most nerve-racking sessions.  If you’ve not been to see a therapist before, you don’t know what to expect.  Will I have to talk about my childhood?  Will it make me cry?  What if my therapist thinks I am being silly and wasting their time?

If these questions pop into your mind, rest assured many other people have had the same worries.  When you don’t know what to expect, your mind naturally thinks of the things you’d be most concerned about. 

When you meet with one of our therapists for the first time, they’ll focus on making you feel welcome and comfortable.  It’s our job to put you at ease so you can begin to talk about your struggles. 

The first appointment is a consultation to help you identify what’s happening and tell you how we can help.  Your therapist will ask you questions about the issue, e.g., when and where it happens most often, how long it has impacted you, and whether it has improved or gotten worse.     

Getting to know you

They’ll also want to know more about you, e.g., what you do to occupy yourself, how you socialise or have fun, and what life is like at home.  It’s important to get a sense of you as a whole person, not just what’s bothering you.  We want to find out what makes you tick and learn about your current context because everyone is different. 

And finally, your therapist will ask you about your hopes and goals.  As well as understanding what’s bothering you, knowing where you want to get to is helpful.  For example, what you want to change, what you want for your life and how you want to be different. 

If you’re not sure, that’s OK.  Your therapist will help you clarify what you want to accomplish.  Many people want to feel better, less anxious or stressed, and more confident.  We’ll help you turn these feeling-type goals into ‘actionable’ ones.  That way, we can establish more tangible forms of measuring your improvements.  What you do influences how you feel, so therapy is about learning to do things differently so you can improve your mental health, relationships and lifestyle. 

You don’t have to tell your therapist everything.

Just because you’re sitting down with a therapist doesn’t mean you need to tell them everything.  You get to choose.  Sure, it’s helpful to share relevant information that will help them help you, and you can take your time.  You don’t need to share every painful detail as soon as you meet them.  In fact, it’s wise to take your time and see how you feel talking to them before you get into the more complex topics.

What else happens in the first appointment?

Your therapist will happily answer any questions about their knowledge and experience, how they intend to help you and what happens to your information. 

I recommend researching beforehand to see if a therapist is a good fit.  You can read about our therapists on our website, or we’d be happy to schedule a call so you can ask them some questions.

However, you may think of some other questions in your consultation, and it’s OK to ask.  All information is confidential unless the law requires us to share your information, which we discuss in another article. 

At the end of the consultation, you can decide if you want to schedule further sessions.  Typically, people need 10-20 sessions.  Some need less, and others need more; it really depends on several factors, which we discuss in another article about how therapy works.

Is it just talking?

While television gives you the impression you’ll lie on a couch and talk about your childhood, therapy is very different in reality.  You’ll sit opposite your therapist, and you make a plan each session to change something important.  For example, to tackle your anxiety so you can travel or practice what to say in a difficult conversation. 

Good therapy is more doing than talking.  In other words, you and your therapist focus on doing something that gives you a new way strategy.  You learn it first in the session and practice it outside the session to get better at it.

Jim Lucas

How are therapy and counselling different?

To be honest, there isn’t much that’s different.  Counsellors and therapists learn different systems and procedures for easing suffering.  Some focus more on your relationship, listening and allowing you to reflect on your experiences.  Others spend more time teaching you skills.  And some do both.  

The most important thing to consider is ensuring you feel listened to, supported, and challenged where appropriate.  Skilled therapists know when to listen, sit silently, or speak up to take the lead. 

What coping strategies will I learn?

Your therapist will describe how they work and what interventions they think will help.  This will depend on the type of problem and what you want to achieve.  It might include one or some of the following skills:

• Mindfulness skills to reduce over-thinking.
• Perspective-taking skills to improve self-care.
• Acceptance skills to manage your emotions.
• Self-compassion to reduce self-criticism.
• Cognitive skills to take the power out of troubling thoughts.
• Values exploration exercises to identify what you want from life.
• Planning and problem-solving skills to overcome procrastination.
• Assertiveness to improve communication.

You’ll learn some of these skills as you move through your sessions.  You may already be good at some of these skills, so we needn’t spend too much time on it. 

How do you measure improvements?

Great question.  You want to know if your investment of time and money has been worth it. 

We like to take our time identifying specific goals you want to achieve.  For example, improve communication in your relationship so you can be closer.  How do you measure that?

The better your goals, the more likely you’ll get what you want.  It helps to set approach goals rather than avoid ones.  To be less anxious is an avoid goal.  So, we’d explore what being less anxious would allow you to do.  For example, you might say, “If I were less anxious, then I’d go more places on my own.”  Now, there is something you can measure. 

Similarly, you might say, “If I were more secure, I’d be honest with my partner.”  Again, there is something you can measure. 

“That what you measure, you can improve.” 

Peter Drucker

You can measure actions, but tracking your feelings is much more complicated.  Emotions move and shift, thoughts roll into one another, and physical discomfort comes and goes.  Plus, measuring things you can’t control is not very helpful.  In reality, the only thing you can control is what you do, so that’s how you can measure improvements in therapy.

So, hopefully, that gives you a better understanding of what happens in therapy.  It’s both talking and doing.  It’s working together to tackle the problems you care about so you can commit to leading a life that matters to you and your loved ones.

If you have any other questions about how therapy works, please get in touch.