What Do People Want From Therapy? (8 minute read)

When I used to work at The Children’s Hospital of Philadelphia, Center for Family Intervention Science, we would talk about some of the most important factors that determine a successful therapy session.  I am guessing that there are thousands of articles that aim to figure out how people change, when they express the most vulnerable memories and feelings, and what techniques are the “best” when helping couples and families resolve conflict.  As an intervention team that provided family therapy for teens who expressed suicidal ideation, we wanted to know the magic answer for how to get kids engaged “enough” in the therapeutic process to share their feelings, which takes me to the word ALLIANCE. 

“Alliance” is the working relationship between the therapist and the client.  More importantly, this word is divided into three parts:

1)      Trust and Rapport- This refers to the type of bond that you have with your therapist.  You may be able to evaluate your rapport with your therapist by asking the following questions.  Do they really care about my needs?  Do they “know” me?  Do they see me?  Can they connect with me in meaningful ways?  Do they “get” my experience? 

2)      Agreement on Goals- we need #1 to get to #2.  If a client feels that the agenda is solely based on the therapist’s need to “fix” and “control,” sessions can’t get to #2 in a meaningful way.  Trust is the most important variable in any relationship; just look at attachment research.  One of the first questions that a therapist asks a potential new client is, “what are your goals for our work together?”  When working with more than one client at a time (couples and family work), individuals’ goals may differ- and that’s ok.  A skilled couple and family therapist (someone who has actual training with these populations over the course of their career) can handle varied goals carefully and effectively.

3)      Agreement on Tasks in order to reach goals.  This work is handled as a team between the therapist and the client.  What therapeutic methods or activities help to increase bonds and trust and are successful with alleviating negative symptoms?  Could it be breathwork, self-care, communication skills, exposure or equine therapy, journaling, challenging distorted thoughts, increasing connection through insight and vulnerability, etc?  The sky is the limit; it just takes some creativity and bravery to try new things.

Without divulging too much personal or professional information, I can tell the difference between a seasoned clinician and someone who may simply be “trying to help” a client because I have been the client in individual, couple, and family settings.  The personal information that a therapist shares with a client is called “self-disclosure”.  I have been trained to only share personal information if it is helpful to the client and to use it sparingly. No one wants to go to therapy to listen to their therapist talk more than they have time to speak themselves. Therefore, the notes below are not going to be super detailed, and note that I only have experience working with some therapists, with specific training.  There are a TON of providers out there who enter the field, and I am limited in knowing all the ways in which people feel “healed”, which includes some Eastern Medicine. 

So, here we go with the self-disclosure part.  I tried meeting with a therapist in college.  As it turned out, we only met two to three times because I didn’t have an ALLIANCE with her.  Her eyes bugged me out and it felt as if she was looking at me so intensely, hanging on each word I shared.  She seemed many decades older than me and I felt like I couldn’t relate to her.  Perhaps, I wasn’t ready for this new relationship in many ways. 

Then, during the next transition in my life after college, I was in a new city and got a therapist recommendation from a friend.  I experienced some anxiety moving from the safety bubble of a college nest to working in a large city without my core people (except for my boyfriend, who is now my husband).  That work was helpful because the therapist sat with me and watched me grow slowly, over time.  She was patient with me, I didn’t feel judged, she challenged me and she remembered the details of my life.  Therefore, I trusted her (or had an ALLIANCE with her).

I could keep writing about my experience with therapists, but blogs are supposed to be short.  So, I will just catch you up to age twenty-six.  At this juncture, I thought it was important to seek pre-marital counseling to ensure that my fiancé and I were aligned on many topics in my attempts to ensure that we would “work out”.  That particular therapist was good at balancing both of our individual needs and agendas. She challenged us to hear one another and perspective take.  I trusted the process with her because I knew her training was from one of the most premier couple and family therapy training centers in the city, she seemed confident in her ability to support us, she “knew” our personalities and our life together as a couple, and she was kind. 

Now I will take you to the part of the blog that may help you when discerning if you want to seek counseling and if your current therapist is a good fit.  Below is a list of 7 things I am thinking about when considering my own therapy journey, while trying to help you in yours.  

1)      Throughout the course of my choices in securing a therapist in my “older years (ages 32-present), I have chosen people whose racial and cultural identities do not match mine because their educational and training experience was appealing and because I desire to work with people who may have different “world views” than my own limited version.  I have worked with a therapist originally from Trinidad, a first-generation clinician whose family is from Jamaica (in couples therapy around COVID), and a counselor who was born and raised in South Korea. The point is, you don’t have to choose therapists who have gone through every experience that you have.  In some cases, that’s a good thing- the therapy can move you to grander epiphanies and out of a place where you feel stuck by shifting perspectives that may be outside your frame of reference. 

2)      Conversely, perhaps it is good to have a therapist who has “walked the walk” and personally knows what you have endured.  For instance, much of the recovery from addiction treatment is led by counselors who have battled addiction and know the realities of relapse, shame, and families being shattered by this devastating disease.  It may be helpful for you to know that your therapist has gone through similar experiences, such as divorce, parenting, specific losses, etc…

3)      Try a therapist or a new therapy model three times to give it a fair chance.  So often, people want to jump out of their chair and find an exit door when they feel uncomfortable about sharing their feelings.  Welcome to vulnerability.  P.S. Perhaps I should have been reminded of this when I was in college. 

4)      On the other hand, if the clinician is abrasive, rude, unprofessional, or insensitive, there is no need to stick with that therapist.  There are a million other therapists out there, and you can start over with your story.  It may be even helpful to repeat your story several times (that’s called Narrative Therapy).  I have heard countless stories of bad therapy.  Sometimes it can do more damage than good- especially around divorce. 

5)      You may want to pick a therapist who has been trained in a variety of treatment methods.  These therapists are called “eclectic” (it’s not as strange as it sounds), meaning that they pick from a variety of healing and relational strategies when one may not be working as well, or doesn’t fit a client’s new issue.  We all go through transitions in life, and sometimes we need new ways to tackle problems.  I personally want to know that my therapist can choose from a variety of options to help me when I am feeling stuck, frustrated, or grief filled. 

6)      Speaking of transitions- this is a perfect time to seek counseling!!!  Whether it is after college, engagement, new job, marriage, postpartum stress, parenting at different ages, empty nesting, divorce, or the death of a loved one- we all need extra support during these times.  Treat yourself to therapy, we treat ourselves to tons of other things- why not treat yourself to deep reflection and a safe place to cast your burdens, sorrows, and problems?

7)      Just because you may want therapy, it doesn’t mean you need to commit to it weekly.  A reasonable clinician will understand your financial and time constraints and be open to seeing you when it suits you best.  Although, not attending sessions more than on a once-a-month cadence will be less helpful if you are going through an acute situation.  If you are enduring divorce, postpartum stress, eating disorders, addiction, affairs, or more intense couples and family issues, I would not recommend spacing out your sessions.  Always consult with your own therapist to understand what is most helpful for you and your situation during this time.

That’s all for now, Friends.  I hope that this information gives you permission to normalize wanting and needing therapy during trying times and transitions in your life.  If anything, it’s humanizing to address our own longings and pain and to allow ourselves to be “held” in therapy, even if it is just for 50 minutes at a time.

LoveWell,

Kim