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 Lexington, Massachusetts

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.

  • 19 comments
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  • 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.

  • 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.

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