Psyching Yourself Up for Psychotherapy

Portrait of a womanYou 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 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.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Pandora L. MacLean-Hoover, LICSW, therapist in Blue Hill, Maine

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 24 comments
  • Leave a Comment
  • donna b.

    donna b.

    January 29th, 2015 at 10:26 AM

    For me it was all about whether this woman and I had a rapport. It is one thing to be polite, but it is another for her to make me feel like I could bare my soul to her. But she did it and made me feel comfortable and I am forever grateful.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:19 AM

    Great outcome Donna!

  • Geneva

    Geneva

    January 29th, 2015 at 1:47 PM

    Choose someone who has a clear idea of what it is that you would like to achieve with therapy as well as a clear idea for the things that the two of you will work on together to get you there.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:20 AM

    Geneva,
    Yes. It is important that you feel heard about what you hope to achieve in the process.

  • Jan H

    Jan H

    January 29th, 2015 at 3:59 PM

    It has been the absolute and unwavering love that my therapist continues to offer that has allowed me to risk emerging from my self imposed ice chamber. Her gentle love has coaxed me to peek out, withdraw, test and become more transparent. Absolute safety I’ve never experienced.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:21 AM

    Jan,
    Safety is essential! So happy you found this with your therapist.

  • Renee

    Renee

    March 25th, 2019 at 7:54 AM

    When therapy is terminated abruptly, patients often experience abandonment and
    even devastation, much like a parent abandoning a child or a spouse abandoning a partner
    (Curtis, 2002). Patients are left feeling alone in a world that suddenly seems unsafe and
    unprotected (Sherby, 2004). Smith (1982-1983) describes the effect of forced termination
    on the patient: “It is as if suddenly the ‘treater’ has been unmasked as a thoroughly
    unreliable, faithless person” (p. 339). It is common for patients to interpret therapistinitiated
    termination as an indication that the therapist has put his or her needs ahead of
    the patient’s. The reaction to this realization is intense and often impedes achieving
    satisfactory termination. Therefore, abrupt therapist-initiated termination should be
    avoided (Joyce, Piper, Ogrodniczuk, & Klein, 2006).
    Saad (1983) interviewed a group of adults who underwent planned termination
    from therapy as well as a group of adults who underwent forced termination; significant
    differences among the groups were found. The adults who experienced forced
    termination showed evidence of mourning and mild mood disturbance. Conversely, the
    group of adults with planned termination did not. Results also demonstrated patients in
    longer more intensive therapies, such as psychodynamic therapy, experienced greater
    turmoil and mood disturbance in the months after forced termination than their
    counterparts. Simply stated, leaving is painful for patients, and many have difficulty
    separating from their therapists (Weiss, 1972).
    9
    Numerous researchers have shown a therapist’s negative countertransference
    feelings such as guilt, shame, anxiety, and depression are more likely to occur in forced
    termination than in planned termination. Furthermore, these feelings are likely to disrupt
    the already difficult termination process (Fair & Bressler, 1992; see also Dewald, 1980;
    Langs, 1974; Weddington & Cavenar, 1979). Scher (1970) describes the effect of forced
    termination on the therapist, stating:
    In many ways the position of the departing therapist resembles that of his patient.
    He, too, sustains a loss. He, too, experiences the anxiety of separation. Perhaps,
    for him, it is harder to claim abandonment and desertion, but he may feel equally
    adrift in the therapeutic world, wondering who, if anyone, will fill the void left by
    his patient. (p. 281)
    The common feelings associated with therapist premature termination are often
    misperceived as inappropriate and typically ignored. The therapist must acknowledge and
    work through these feelings rather than act them out in the therapeutic relationship (Fair
    & Bressler, 1992).
    Although termination and separation issues are present from the beginning of
    treatment, they are experienced more personally for therapists during termination
    (Edelsen, 1963). Edelsen posits this may be a factor in therapists’ avoidance of the issue.
    In order to defend against the impending loss, therapists may deny the approaching
    termination. As a result, it is introduced too late in the therapy and the patient has
    insufficient time to work through the loss (Keith, 1966).

  • Wendall

    Wendall

    January 30th, 2015 at 10:09 AM

    I was one of those people excited to be starting therapy when I did. I liked the person that I was going to and I liked the idea of feeling like I was working on the healing journey. That was a great move for me, the best thing that I have ever done for myself, so really, when you know that this is something that will make your life better, be excited about it and get everything out of the experience that you can.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:24 AM

    Wendall,
    The relationship between client and therapist is dynamic and simbiotic, what a terrific attitude you have brought to the process.

  • Turnz

    Turnz

    January 31st, 2015 at 7:25 AM

    I have so many layers of who I am I think it will take more than one head doctor to begin to understand me enough to help me understand who I am and why I am who I am…or whatever.
    I will not have a problem with being honest about opening up. I want to. I remember being told as a very young age that I had gifts.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:27 AM

    Turnz,
    It is wonderful to be validated. How nice that you were told that you had gifts.
    I highly recommend exploring the therapeutic benefits of IFS (Internal Family Systems), if you haven’t already done this.

  • tripp

    tripp

    January 31st, 2015 at 8:22 AM

    But there are also those of us for whom this feels like a failure to have to go to someone else to help resolve our problems. I know that it is not really a failure, but you have to understand that there are bound to be some people who feel that way and so for them it becomes a little more challenging to feel psyched up about going to therapy. There are all kinds of issues that heave to be resolved before many of us can feel that way.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:34 AM

    tripp,
    You have a valuable point about the negativity that is perpetuated in a culture built on a message of “pull yourself up by your bootstraps.” The strong implication is one of weakness if one seeks help instead of solving a problem by oneself.
    It is a great thinking exercise to pause and give careful consideration about the source(s) of this message. I really like Timothy Bulter’s body of work, Getting Unstuck, as a means for appreciating the stakeholders who influenced these beliefs.

  • Flynn

    Flynn

    February 4th, 2015 at 2:15 PM

    Go on… do it… you won’t regret the decision

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:35 AM

    Flynn,
    These are encouraging words. Thank you.

  • Bonney

    Bonney

    February 5th, 2015 at 3:25 PM

    I work in community mental health and the author’s second premise concerns me. Some people don’t have access to a lot of choice in their treatment options. For many of the people at our clinic we are pretty much the only resource they can access. We try to make the most out of the location and building but we are on a limited budget as a nonprofit. I’d hate for people to walk away from treatment because the building was not nice enough.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:41 AM

    Bonney,
    Thank you for writing this comment. You raise some of the legitimate concerns and questions that discussions about environment and well-being activate. Hopefully, you will be an initiator for change. I’d be happy to discuss many innovative ideas we have developed about doing more with less to positively impact one’s space.

  • Jotham

    Jotham

    February 12th, 2015 at 4:16 PM

    Bonney, your concern for potential client’s walking away is understandable. I think the look, feel, and comfort of a therapeutic environment says a lot to clients, including a general message of “you matter.” Non-profits do often have tight budgets, but it is my belief that more funding should go into making the environment supportive for clinicians and clients from a design perspective. Additionally, design mindfulness does not have to be expensive, as there are many free and low-cost solutions to creating a space that could assist in supporting client retention and minimizing clinician burnout.

  • Pandora MacLean-Hoover

    Pandora MacLean-Hoover

    February 17th, 2015 at 5:45 AM

    Jotham,
    Thank you for your comment and for bringing light to an often-overlooked reality, clinician burnout.
    The work is very challenging. We owe it to the hard working professionals in our field to help raise moral. Environmental improvements directly correlate with a look good, work better model for efficacy.

  • Lisa

    Lisa

    September 25th, 2015 at 10:30 PM

    I completely agree with you on all aspects of this article. I especially agree with being able to shop around for a therapist and being able to interview and select who you think is an appropriate fit. I attempted this for my son when he was around 9, he needed to talk to someone, as we are a military family and have gone through many transitions in our home with deployments. I did not receive any of the responses that you share with potential clients. I even expressed that I would like to be able to know about the therapist to assure that he would have a compatible relationship, because that is what you build with your client a professional relationship. I was very discouraged with the process, so I commend you for being open minded and also that your agency also allows this practice. I am 6 months from receiving my masters in social work and I hope to be an exceptional SW. I have no issues with allowing clients to meet with me or talk with me via the phone to see if there is a connection to continue services or if they feel the need to look elsewhere. I can acknowledge that I am not going to be a fit for everyone.

  • I don't matter

    I don't matter

    February 22nd, 2019 at 9:51 AM

    Psychotherapists have numerous obligations to our clients that exist with the intent of ensuring that our clients’ best interests are paramount in our thinking and resulting actions, One important area of practice where this fiduciary responsibility very clearly exists is that of termination and abandonment. As emphasized above, clients entrust their well-being to their psychotherapist, trusting that the psychotherapist will act with due consideration of the client’s ongoing needs and best interests. my therapist did not follow this example and has left me feeling heart broken and abandonment of me by her unexpected termination, It took almost three years for me to believe I mattered and was worth something, only to have three years’ worth of work to reset back to that feeling of having no worth and I no longer I mattered, She terminated without any notice, I thought things were going great, I was starting to feel excited about stuff. Having suicide idealizations in the past, abandonment and attachment issues, I am totally crushed, she left me with no back up or professional help, it was left for me to find the help I needed to get through this and I am having no success. I have reached out to her many times and pleaded for her help and my cry for help goes unanswered, this has destroyed me inside, how can you tell someone you care and you matter, when in reality you DON’T. I sent her a text asking her if I mattered after her termination of me and it went unanswered!!!

  • I don't matter

    I don't matter

    February 26th, 2019 at 10:29 AM

    Telling clients what they “really need” and that they should just “let go” of what they can never have, and that their inner child is “willful” when it comes to “life-and-death issues” (who isn’t?) are just 3 statements (among many) that give me some concern about your general stance towards your clients. Bowlby’s Attachment Theory (now updated for adults and vast amounts of validating research) suggests it is insufficient to simply “resolve” emotions or unmet needs by accepting & grieving the loss and “moving on”. What does the adult move on with? They need a therapist who can attach to them sufficiently in order to help them internalise a compassionate “Working Model”, and that will teach them (theoretically and practically) how to meet their own basic needs and how to appropriately seek some needs in healthy functional attachments to other adults (preferably also how to identify and relate to other healthy adults and not other dysfunctional traumatised adult children – i.e. repetition compulsion). A therapist who isn’t trained in developmental trauma therapy nor attachment theory nor in managing strong emotions has no business in advertising their services to traumatised clients, as they will do more harm than good. Catharsis is not only insufficient, it can be re-traumatising (overwhelming) to this client group as they never had a primary attachment figure who could help them learn to regulate their own emotions, self soothe, regulate physical and mental arousal levels, mentalize, nor (often) empathise and relate in a healthy way with others, etc. Clients seek to have their need met by others (waiting for them to “come along”) because they are INCAPABLE of getting their legitimate needs met by themselves – NO-ONE TAUGHT THEM HOW.

    Harlow noted that baby monkeys would rather starve themselves to death than to not be cuddled by a terry towelling wire mother – we all need to learn to internalise that terry toweling mother before we can “move on” and thrive. In the last decade or so, research in trauma-related symptoms points to the fact that most, if not all, mental illnesses have a direct causal link to abuse in childhood (whether psychological, emotional, physical, sexual, neglect). A frightening condemnation of our humanity. A therapist who cannot actively help a client develop an internal working model (by using the Therapeutic Relationship) before seeking to “resolve” their emotions regarding loss, abandonment, abuse etc should not be practicing with this client group. At best it will result in a client who cannot maintain change nor improvement, who is still unable to have a healthy adult attachment relationship, who struggles with their own parenting skills, AND, at worse will do real harm to the client they care about.

    Telling a client to “accept” that they were never loved and to mourn this loss can be profoundly painful and somewhat equivalent to a heart surgeon ripping the patients heart out and telling them to “accept” the loss while not giving them a new transplanted heart to keep them alive. In each case, death is a real issue (whether physical, psychological, emotional, existential, relational).

    Finally, Professional Boundaries are important but a therapist should be aware that a client who has been abused in childhood will experience the therapist as emotionally withholding/abandoning, inauthentic/dishonest and even neglecting, untrustworthy & cold. Fully explaining each boundary rule and the reasons behind it, and empathically attuning to, and discussing openly the clients responses is VITAL to a trusting and successful therapy.
    Please be careful about the words you use when referring to clients. They betray your real thoughts and feelings about your clients.

  • I don't matter

    I don't matter

    February 27th, 2019 at 3:55 AM

    I am not sure what to do, I feel like I don’t matter and have no worth, this took along time for me to finally feel I did only for her to take it all away, is this a normal process for termination? Sh has hurt me really bad, she told me I was a sick individual, how do you say that to someone you say you care about and matters. I know she will never thing she did anything wrong. This verbal attack has wreaked me and I just giving up on life, how can someone in this field, who has been working with a client about three times week for 3 years, who knows all the trigger then uses them against the client to terminate. I have been destroyed by this. I cherish her connection

  • Renee

    Renee

    March 25th, 2019 at 7:55 AM

    When therapy is terminated abruptly, patients often experience abandonment and
    even devastation, much like a parent abandoning a child or a spouse abandoning a partner
    (Curtis, 2002). Patients are left feeling alone in a world that suddenly seems unsafe and
    unprotected (Sherby, 2004). Smith (1982-1983) describes the effect of forced termination
    on the patient: “It is as if suddenly the ‘treater’ has been unmasked as a thoroughly
    unreliable, faithless person” (p. 339). It is common for patients to interpret therapistinitiated
    termination as an indication that the therapist has put his or her needs ahead of
    the patient’s. The reaction to this realization is intense and often impedes achieving
    satisfactory termination. Therefore, abrupt therapist-initiated termination should be
    avoided (Joyce, Piper, Ogrodniczuk, & Klein, 2006).
    Saad (1983) interviewed a group of adults who underwent planned termination
    from therapy as well as a group of adults who underwent forced termination; significant
    differences among the groups were found. The adults who experienced forced
    termination showed evidence of mourning and mild mood disturbance. Conversely, the
    group of adults with planned termination did not. Results also demonstrated patients in
    longer more intensive therapies, such as psychodynamic therapy, experienced greater
    turmoil and mood disturbance in the months after forced termination than their
    counterparts. Simply stated, leaving is painful for patients, and many have difficulty
    separating from their therapists (Weiss, 1972).
    9
    Numerous researchers have shown a therapist’s negative countertransference
    feelings such as guilt, shame, anxiety, and depression are more likely to occur in forced
    termination than in planned termination. Furthermore, these feelings are likely to disrupt
    the already difficult termination process (Fair & Bressler, 1992; see also Dewald, 1980;
    Langs, 1974; Weddington & Cavenar, 1979). Scher (1970) describes the effect of forced
    termination on the therapist, stating:
    In many ways the position of the departing therapist resembles that of his patient.
    He, too, sustains a loss. He, too, experiences the anxiety of separation. Perhaps,
    for him, it is harder to claim abandonment and desertion, but he may feel equally
    adrift in the therapeutic world, wondering who, if anyone, will fill the void left by
    his patient. (p. 281)
    The common feelings associated with therapist premature termination are often
    misperceived as inappropriate and typically ignored. The therapist must acknowledge and
    work through these feelings rather than act them out in the therapeutic relationship (Fair
    & Bressler, 1992).
    Although termination and separation issues are present from the beginning of
    treatment, they are experienced more personally for therapists during termination
    (Edelsen, 1963). Edelsen posits this may be a factor in therapists’ avoidance of the issue.
    In order to defend against the impending loss, therapists may deny the approaching
    termination. As a result, it is introduced too late in the therapy and the patient has
    insufficient time to work through the loss (Keith, 1966).

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