Psyching Yourself Up for Psychotherapy

You have taken an enormous step toward expanding your understanding of why you think and do what you do. Most people don’t stop to think about their operating systems until things go badly. It’s often when life gets acutely unbearable that they call a counselor. These words capture the essentials for successful outcomes in psychotherapy: trust, rapport, and connection. The relationship with a therapist is a two-way street. At the beginning and end of a flight, an attendant will thank you for choosing his or her airline: “On behalf of the captain and crew, we thank you for flying with us.” This is more than a polite gesture. It reinforces the message that there are many choices of carriers when you fly. They want your business and are striving to serve you well.

You have tremendous choice when selecting a psychotherapist. There are many levels of licensure to choose from (MDs, psychologists, licensed clinical social workers, marriage and family therapists, licensed mental health counselors, etc.) and considerable variation in psychotherapeutic approaches (psychodynamic, behavioral, cognitive, humanistic, etc.). The myriad models, subsets, and eclectic combinations of these approaches can be confusing. Sifting through and making an educated decision about which ones may be a good fit for you can overwhelm people who are already overwhelmed.

I am a clinical social worker in private practice (LICSW). It gives me great pleasure to help people learn more about themselves. Here are my suggestions for maximizing your counseling experience:

Choose a Therapist Who Is a Fit for You

I really appreciate when people call and tell me that they are interviewing several therapists, hoping to find the best fit. I love what I do and welcome the opportunity to show it. Years ago, a young woman telephoned, saying that she was interviewing four therapists. She explained that, at 38 years old, she had been depressed for most of her life and tried counseling many times. This time, she wanted to know more about the therapist’s approach to treating depression before telling her story one more time.

In my experience, it is rare for people to have enough confidence in themselves, especially when they are emotionally depleted, to presume to interview a therapist in advance of the work. I applaud it. When I receive calls inquiring about my methodology, I try hard to return them within 24 hours. I eagerly provide answers to questions and use that call to establish a connection. I tell people, “I am pretty good at what I do but I am not going to be a fit with everyone. The work is too important. You owe it to yourself to find someone whom you feel cares and with whom you feel comfortable.”

Counseling, by definition, is a process in which vulnerability is high. Before inviting a clinician into your circle of support and taking him or her into your confidence, tell the clinician what you want from the process. Ask questions about the therapist’s training and process for working with people in therapy. Asking questions is a great way to present uncertainties and begin a verbal exchange that will let you know how your therapist plans to support you and whether you have confidence in his or her capacity to make a difference. I remind people that I rely heavily on their reporting to assess and determine a therapeutic plan. The first thing I say is, “I work for you. No one will ever be more of an expert on you than you.” This surprises many people who have previously worked with another therapist and have negative assumptions about the psychotherapeutic process. Neutralizing the power differential is important, especially for people who doubt their worth and ability. Years ago, a man in his twenties proclaimed, “I’ve had six therapists before you and I’ve lied to all of them!” I responded, “OK.” He leaned forward, “You mean, you want me to lie to you?” I simply listed the three popular reasons that people lie: to fit in, to avoid conflict, and for privacy. I asked him, “Have you ever met me?” He replied, “No.” I told him that my preference was for him to “take a pass” rather than lie, but that if he felt he had to lie, then so be it. “You must have a reason or you wouldn’t do it,” I said. This engaged him in a profound and trusting way. He disclosed that he had been sexually abused as a child. It was the first time he had told anyone about his trauma.

Choose a Therapist Whose Office Environment Is a Fit for You

Environment plays a hugely underreported role in the healing process. Upon arrival, stop at the door of the location where your therapist works. Notice your comfort level. If the essence of the place says “you matter,” then stay. If not, then acting on this awareness is essential. I recommend that you leave.

At our location, our specific focus was to change the look and feel of therapy. We carefully chose colors, seating, lighting, and decor with visitors’ well-being in mind. Greetings are an integral part of making a positive first impression. Again, you matter. If you are greeted in a manner that conveys this message, then stay. Feeling comfortable is a cornerstone of building rapport. If you are not, seriously question the clinician’s capacity to assist you in feeling better about yourself. At our location, we invite people to help themselves to a refreshment area where they may feel at home to help themselves to snacks and beverages. It’s all part of a greeting that conveys a welcoming message. Our therapists and life coaches warmly acknowledge all visitors, not just their own.

Safety is a fundamental, environmental, and emotional necessity. Confidentiality and a judgment-free space are minimal requirements for establishing trust and fostering openness. Sound minimization and privacy are essential elements of office design.

Be Open to Reflection and Connection

Most adults are heavily conditioned to bypass the influence from others when pondering the negative aspects of their lives. Developmentally, however, it is essential to consider these role models and the beliefs they took part in installing. “Do I have to look back at my childhood? It was a long time ago and I put it behind me. My parents did the best they could. I don’t want to blame them for how I turned out and what’s going on now!” These are frequently asked questions and statements when a person begins working with a counselor. They convey commonly held beliefs, worries about using other people’s behaviors as excuses.

I hasten to tell people, “Parents raise their children in their own image to fit into a world the way they see it. Children have no voice, no choice, and no mobility without a grown-up’s permission.” Young children have no way to sort out the information they receive or to consider the source. The early programming of a child’s mind is something I liken to filling an empty vessel without a filter. Everything gets in. Deciding what beliefs we keep is a selective process, available later when the brain is more developed.

In my work, I let people know that I will become biased about them. The trade-off, when neutrality is forfeited, is that they will feel completely supported by the connection.In 2005, I attended a three-day conference for mental health clinicians sponsored by a prestigious medical school. We couldn’t wait until the third day to hear a renowned physician speak about the diagnostic similarities and differences betweenand differences between bipolar and borderline personality. His first words were, “Love your clients!” He stopped and stared. Audience members poured out of their seats and dashed to the six microphones that were scattered throughout the ballroom. The first of these enthusiasts commented, “Wow! Those words are so unusual to hear in our field!” Then she asked, “Can you tell us more?” He cleared his throat and in a booming voice responded, “My dear, if you have to ask, what in the hell are you doing in this profession?”

Be optimistic about exploring your innermost thoughts with a trained counselor who cares. Remember the three words that are essential for success: trust, rapport, and connection.