If you’ve never gone to therapy, you might not have much idea what happens in a therapy session. This is fairly common, since much of what people know about therapy comes from (often inaccurate) media portrayals.

In the past decade, awareness around mental health issues has increased significantly. Greater awareness has helped reduce mental health stigma by supporting therapy as a beneficial, normal method of getting help. Accordingly, the shroud of secrecy around therapy has started to fall away. Your friends, family members, even your coworkers may be perfectly willing to open up about their experience in therapy and how talking to a mental health professional has helped them.

But if you’re still unsure about therapy, or don’t know anyone who’s gone to therapy, you might hesitate before booking your first session. Maybe you feel nervous about what a therapist will do, or you don’t think your distress actually merits therapy.

You don’t need to experience any significant mental health issues or emotional distress for therapy to work.

Before exploring how therapy works to help people who are struggling, let’s bust that myth right now. You don’t need to experience any significant mental health issues or emotional distress for therapy to work. If you’re struggling, confused, feel like you want to sort out a problem or your life and don’t know where to start—therapy can help.

Therapy Is Personalized

The process of therapy can differ somewhat based on what you’re experiencing.

For one, the length of therapy can vary based on the issue you want help with. If you’re struggling with depression after a breakup or job loss, for example, therapy often helps you work through the problem within a few months. You might not be completely “cured,” but you’ll generally be able to resolve lingering distress on your own. That’s a key goal of therapy.

Serious or longer-lasting concerns, like trauma from abuse or chronic depression, may require more therapy sessions and a more intensive approach.

In most cases, you’ll spend just an hour each week in therapy. But your therapist might also recommend specialized types of therapy to meet your needs. Dialectical behavior therapy, for example, generally involves an hour of therapy, an hour of skills training, and an additional hour of group therapy each week.

Therapy doesn’t operate as a blanket remedy or one-size-fits-all approach. Therapy for intrusive thoughts (a component of OCD) will likely look much different than therapy for a phobia of dogs.

But even two people with generalized anxiety might see treatment proceed in different ways, based on the type of treatment the therapist specializes in and their individual needs.

If you’ve tried various coping strategies and still struggle with severe anxiety, for example, you might want to try medication, a perfectly valid (and helpful) treatment option. Your therapist should support your decision and work with you to find the right drug.

If you know you don’t want to take medication at all, unless absolutely necessary, you might look for a therapist who specializes in alternative treatments, like yoga or nature therapy.

Therapy Helps People Reach Goals

You might consider going to therapy (or want to avoid therapy entirely) with the idea that your therapist will give you advice, tell you what to do, or ask how every little thing makes you feel.

But therapy doesn’t work like that. Rather, therapy offers a safe, nonjudgmental space for you to talk about problems and anything that’s overwhelming you or even just making life a little tough. Your therapist listens to what you have to say and then works with you to develop a plan to confront challenges and achieve an improved quality of life.

You can also go to therapy if you aren’t experiencing significant distress. Therapy can be beneficial in the pursuit of any goal, no matter what that goal is.

Maybe you want to date but feel you lack the skills to approach someone or make a relationship work. Perhaps you want to work on being closer with your teenage children. Or maybe you just want to break a lifelong nail-biting habit.

Whatever your goal, your therapist will help you explore potential changes you can make to arrive at the outcome you desire. But you come to therapy with your goals (or spend time identifying them in session). You also have an opportunity to share solutions that don’t work, which can help you and your therapist work together to find something that will have benefit.

Say you’ve been feeling low because you no longer have time to create art. Your therapist asks what a typical day looks like for you. After you explain your schedule, they point out you’re spending all your time doing things for others, something you never stopped to consider.

In short, therapy can help you work to identify and break concerning patterns or habits on your own. Therapists don’t give you all the answers. They help you find the right tools to help yourself.

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud.

Therapy Puts You in Control

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud. But your therapist doesn’t decide where you go or how you get there. You do that work yourself.

That’s why finding a therapist you can work well with is so important. You can often help personalize your own therapy experience by choosing your own therapist, so look for someone you feel comfortable with.

Therapists aren’t machines. Their unique personalities, mannerisms, and styles of interaction will likely show through in the therapy process. Their personality can help attract you to the work you’re doing together, or put you off it.

Finding a therapist who will encourage you to keep pushing through difficulties, even when it’s unpleasant, is also essential. Therapy often feels uncomfortable, even unpleasant. That’s a normal part of the process. But when you and your therapist have a strong working relationship, you trust them to support you through the discomfort and arrive at a place where you feel ready to make change.

If you don’t believe your therapist will continue offering compassion and support, regardless of the thoughts you share or challenges you face, you’ll have a harder time opening up and sharing your vulnerabilities. As a result, therapy may have less effect.

You pay for therapy. It’s your space to create change. Your therapist offers guidance during the process, but you work toward what you need.

Conclusion

If you go into therapy looking for a quick, easy solution, or with the hope your therapist will solve all your problems, you won’t get much out of the process.

Therapy can be hard work, and going into therapy with this in mind can help prepare you for the occasional tough session. But when you work with the right therapist, therapy can be productive and healing, and most of your sessions will probably feel rewarding, even when they’re a little difficult.

Ready to find a compassionate therapist? GoodTherapy is the best place to start. Start your search here.

References:

1. Frey, E. (2017, April 27). How therapy actually works and 5 myths about therapy debunked. Retrieved from https://medium.com/kip-blog/5-myths-about-therapy-debunked-17e7fdd8b8a5
2. Going to a therapist. (2018). TeensHealth. Retrieved from https://kidshealth.org/en/teens/therapist.html
3. Understanding psychotherapy and how it works. (n.d.). American Psychological Association. https://www.apa.org/helpcenter/understanding-psychotherapy
4. What is psychotherapy? (2019). American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/psychotherapy

Neurotransmitters are chemical messengers that carry electrical signals between neurons in the brain. Dopamine and serotonin are two important neurotransmitters for mental health. They affect your mood, memory, sleep, libido, appetite, and more. Imbalances can contribute to addictions, mood conditions, memory issues, and attention difficulties.

Over the past several decades, the world has seen an increase in medications for serotonin and dopamine imbalances. These prescriptions can treat symptoms of many mental health conditions. Yet they have a long list of potential side effects, from dizziness to insomnia. Also, their effectiveness varies from person to person.

[fat_widget_right]

Some people want to try some non-drug treatments before committing to medication. Others take medication but want to supplement it with other strategies. Below are 10 ways to increase dopamine and serotonin that don’t require a pill:

1. Exercise

Regular exercise for at least 30 minutes each day improves one’s overall mood. Research has revealed that long-term cardiovascular exercise boosts serotonin levels in the brain. Serotonin can lower hostility and symptoms of depression. It also encourages agreeableness.

(More: Move for Your Mood: The Power of Exercise to Help Lift Depression)

2. Spend Time in Nature

In previous generations, humans spent most of their time outdoors. These days, many people work indoors, sitting at a desk under artificial lighting. Researchers have found as little as five minutes outdoors in a natural setting can improve mood, increase motivation, and boost self-esteem. The amount of time spent in sunlight correlates with serotonin and dopamine synthesis. Even a brief walk in the park can improve your well-being.

(More: 5 Ways Nature Can Help You Feel Better)

3. Nutrition

Diet can also influence one’s mental health. Coffee increases your serotonin and dopamine levels … for as long as you take it. Once you stop drinking coffee, you will go into withdrawal. Your brain, used to the high levels of neurotransmitters, will act as if there is a deficiency. It can take up to 12 days of caffeine-free diet for the brain to return to its normal state.

Omega-3 fatty acids boost serotonin levels without the withdrawal. They help serotonin trigger nerve cell receptors, making transport easier. Many studies have shown that omega-3s help reduce depressive symptoms. You can find omega-3s in cold-water fish like salmon.

Contrary to internet rumors, eating turkey does not raise your brain’s serotonin levels. Many people think foods rich in tryptophan can boost mood, since the brain uses tryptophan to produce serotonin. However, tryptophan competes with several other amino acids for transportation to the brain. Since it is low on the body’s priority list, it usually loses.

That said, having some tryptophan in your diet is important. If you don’t have enough, your serotonin levels will drop. If you need more tryptophan, you can get it by eating starchy foods like whole wheat bread, potatoes, and corn.

(More: Good Mood Foods to Help Fight Depression, Stress, and More)

4. Meditation

Meditation is the practice of relaxed and focused contemplation. It is often accompanied by breathing exercises. Evidence has shown that meditation increases the release of dopamine. It can relieve stress and create feelings of inner peace.

(More: Stress Reduction: Mindfulness Meditation for Beginners)

5. Gratitude

Scientific research has shown gratitude affects the brain’s reward system. It correlates with the release of dopamine and serotonin. Gratitude has been directly linked to increased happiness.

There have been many studies on a practice called the “three blessings exercise.” Every night for a week, you write down three things you are thankful for. People who complete this exercise tend to report more happiness and less depressive symptoms. Their improved mood can last up to six months.

(More: How a Simple Mason Jar Can Bring More Gratitude to Your Life)

6. Essential Oils

All essential oils come from plants. These oils often have medicinal properties. One study found that bergamot, lavender, and lemon essential oils are particularly therapeutic. Using your sense of smell, they prompt your brain to release serotonin and dopamine.

Note: Always follow the instructions on the bottle’s label. Although essential oils are “natural,” some can be dangerous when misused. Do not let young children play with essential oils.

(More: How Aromatherapy Can Boost Psychological and Physical Health)

7. Goal Achievement

When we achieve one of our goals, our brain releases dopamine. The brain finds this dopamine rush very rewarding. It seeks out more dopamine by working toward another goal.

Larger goals typically come with increased dopamine. However, it’s best to start with small goals to improve your chances of success. Short-term goals can add up to achieve a long-term goal (and a bigger reward). This pattern keeps a steady release of dopamine in your brain.

(More: How Positive Affirmations Can Help You Achieve Your Goals)

8. Happy Memories

Researchers have examined the interaction between mood and memory. They focused on the anterior cingulate cortex, the region of the brain associated with attention. People reliving sad memories produced less serotonin in that region. People dwelling on happy memories produced more serotonin.

(More: Can We Purposefully Make Memories Last Forever?)

9. Novelty

The brain reacts to novel experiences by releasing dopamine. You can naturally increase your dopamine by seeking out new experiences. Any kind of experience will work. You can do something simple like a new hobby or recipe. Or you can try something grand like skydiving. The less familiar you are with the activity, the more likely your brain will reward you with dopamine.

(More: 5 Things on My New Year’s Bucket List for My Kids)

10. Therapy

Research indicates if you change your mood, you can affect serotonin synthesis in your brain. This implies mood and serotonin synthesis have a mutual influence on each other. Psychotherapy often helps people improve their mood. It is possible therapy can help raise one’s serotonin levels as well.

(More: Benefits of Therapy)

While these 10 methods can boost your neurotransmitters, they are not a substitute for medical care. If you have mental health concerns, you should always seek a doctor’s or therapist’s advice. A mental health professional can tell you which approaches are best for your unique situation. There is no shame in taking medication or attending counseling. They are common treatment options among many.

References:

1. Coffee and hormones: Here’s how coffee really affects your health. (n.d.) Precision Nutrition. Retrieved from https://www.precisionnutrition.com/coffee-and-hormones
2. Do you need a nature prescription? (2013, June 19). Retrieved from http://www.webmd.com/balance/features/nature-therapy-ecotherapy
3. Essential oils: Poisonous when misused. (2014). National Capital Poison Center. Retrieved from https://www.poison.org/articles/2014-jun/essential-oils
4. How Do I Increase Serotonin and Dopamine Levels? (2017, August 14). LIVESTRONG Foundation. Retrieved from http://www.livestrong.com/article/301434-how-do-i-increase-serotonin-dopamine-levels/
5. Jenkins, T.A., Nguyen, J.C.D., Polglaze, K.E., & Bertrand, P.P. (2016, January 20). Nutrients, 8(1), 56. Retrieved from http://www.mdpi.com/2072-6643/8/1/56/htm
6. Lv, X.N., Liu, Z.J., Zhang H.J., & Tzeng C.M. (2014). Aromatherapy and the central nerve system (CNS): Therapeutic mechanism and its associated genes. Current Drug Targets, 8(14), 872-879. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23531112#
7. Novelty and the brain: Why new things make us feel so good. (2013, May 21). Retrieved from https://lifehacker.com/novelty-and-the-brain-why-new-things-make-us-feel-so-g-508983802
8. Omega-3 Fatty Acids and Mood Disorders. (2012). Today’s Dietitian, 14(1), 22. Retrieved from http://www.todaysdietitian.com/newarchives/011012p22.shtml
9. Thankfulness linked to positive changes in brain and body. (2011, November 23). ABC News. Retrieved from http://abcnews.go.com/Health/science-thankfulness/story?id=15008148
10. This is how your brain becomes addicted to caffeine. (2013, August 9). Retrieved from https://www.smithsonianmag.com/science-nature/this-is-how-your-brain-becomes-addicted-to-caffeine-26861037/
11. Why our brains like short-term goals. (2013, January 3). Retrieved from https://www.entrepreneur.com/article/225356
12. Young, S.N. (2007). How to increase serotonin in the human brain without drugs. Journal of Psychiatry and Neuroscience, 32(6), 394-399. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/

In day-to-day life, we often spend a lot of time holding in the feelings and thoughts we have about others. These thoughts may be about people we love, someone we’re in relationship with, those we work with, or even just people we dislike but need to interact with regularly.

Life is about relationships; the quality of those relationships can contribute to how fully alive and happy we get to be. The authenticity and honesty in our closest relationships are strong markers for a healthy life—but we still hold back.

Why Do We Hold Back?

Part of the reason for this is maturity. Many of us know what it’s like to be with a child who doesn’t have a filter. They might tell a stranger that they’re ugly or let Great-Aunt Abigail know that her birthday gift was the same as last year’s—and it wasn’t appreciated then! This child hasn’t yet learned that little white lies can be okay and that there are times we aren’t blatantly honest in order to protect the feelings of others.

Another contributing factor is that we can get so used to holding in our thoughts and feelings that we lose awareness of them. And when they do make it awareness, we often say, “Bah! It’s not that big of a deal. Forget it.”

There goes another repressed feeling.

When Repressed Thoughts and Feelings Surface

Maybe we unload into a journal or speak with a friend or partner (not about them, but about each other.) Perhaps those feelings get displaced onto others, or even somatized into physical symptoms. Suddenly, all the little things we didn’t think were important are coming out in unexpected, unhelpful, and unhealthy ways.

We must learn to bring into consciousness the small cuts that build up in our lives and hold us back from more intimate relationships.

We think, “Okay. Let’s head to therapy! That will help with my anger, anxiety, or depression.”

In a counseling session, we may talk about Great-Aunt Abigail’s cheapness and how it seems to show how little she’s cared for us all along. Maybe we talk about a demeaning boss with whom we can never express our full frustration. Perhaps we get to share about all our friends who willingly take and take but never seem to return all we do for them.

Realizing Your Therapist Is Human

We should talk about all of these issues with our counselor. But over time, something else often becomes apparent: we discover our therapist is also a human being. We begin holding back the same kinds of thoughts and feelings from them.

A few examples of these thoughts include:

• “They looked at the clock a few more times than they usually do, but maybe they’re just hungry and looking forward to lunch. Never mind that it made me feel expendable.”
• “Okay, they stumbled when remembering my child’s name—I’ve only been talking about the little brat for 8 months now. But they must have so many clients, right?”
• “That was definitely a yawn. A yawn! How dare they. Oh, come on, it’s 8 p.m. It’s not a big deal. Stop thinking about it.”

Why Should I Share These Thoughts With My Therapist?

We often censor feelings and thoughts about our therapists because we know that’s the mature thing to do. We certainly won’t make too many friends if we’re constantly telling the people in our lives how they’ve let us down. But we’re not in our “daily lives” in therapy. We’re in therapy. We’re in this experimental petri dish to get to know ourselves better, something we can only do in relationship to someone else. We must learn to bring into consciousness the small cuts that build up in our lives and hold us back from more intimate relationships.

Talking with your therapist about any of the thoughts listed above may not get them to change or apologize, although that may happen. The main purpose of verbalizing these feelings is to give you the experience of exploring how these slights, which are most likely replicated in real life and often in bigger ways, affect you and your relationships with others. Discussing these thoughts in a trusting therapeutic relationship can help you work toward spending less energy holding them in on a regular basis. It can help to find a trusted therapist near you with whom you can explore these feelings.

Over time, you may find you are not holding grudges for as long as you used to or that your expressions of anger are not as strong as they’ve been in the past. This may mean you’ve begun to release yourself from the grasp of those slights and the repressed thoughts that often accompany them.

The decision to initiate any interpersonal relationship is anxiety-provoking, and the decision to talk with a therapist might be uniquely so. When we decide to meet with a therapist, we are faced with numerous challenges: allowing ourselves to depend on someone else for help and support; revealing our problems; risking trust in a stranger; facing what we have avoided; and relinquishing long-held, sometimes beloved habits, to name a few.

When we refer someone to therapy, it is important to keep this in mind. Though the statement “I recommend you talk to a therapist” sounds simple and benevolent enough, we cannot lose sight of the fact our caring act is simultaneously an anxiety-provoking challenge to the would-be person in therapy. So how can we go about this in a way that doesn’t provoke any additional, unnecessary worries or fears?

The following is a list of principles one can consider when making a referral to a therapist. While these ideas do not guarantee a certain outcome, they may reduce the chances of triggering anxiety that could promote avoidance.

[fat_widget_right]

1. Make it about their needs and goals.

Therapy is much more likely to succeed if the person is there of their own free will, motivated by their own goals, trying to meet their own needs. External pressures to be there and pressures to work on problems that other people see, but that we do not see, can lead therapies to get stuck. The last thing we want to do is refer someone to therapy because we want them to change or conform to some goal that we have for them. That’s usually a recipe for someone either avoiding therapy or showing up but hating it.

Good therapy involves difficult, anxiety-provoking work, so most people will want to do that only if it is their only option for reaching specific goals. That is why it can be important for your referral proposal to include a reference to those goals, and to the way their emotional difficulties hold them back. An example could be: “Seems like the headaches you are getting are really hassling you at work, and it seems like they get worse with stress. Therapy can help with that and it might make you less miserable at work and home.” In this example, it is clear the referral is in the service of the person’s feelings and interests, done out of care and concern for them and not out of some demand or expectation by the referral source.

2. Make it optional.

I encourage you to make your recommendation optional, with liberal use of comments such as, “It’s really up to you,” “I’m not sure if I’m right, but it’s something you can decide for yourself,” and, “It’s not a requirement, just a thought.” I encourage you to phrase your referral as optional because going to therapy is optional. Therapy is anxiety-provoking enough to begin with, and we only add anxiety if we make the person feel like it’s an expectation, a demand, or a requirement.

When we approach therapy as a demand or requirement instead of an option, we can trigger a few responses that decrease the effectiveness of our referral. If the person we are hoping to refer has submissive tendencies, they may comply with our wish that they be in therapy. That will get them as far as a therapist’s office, but because they are not there of their own free will, they may not get the full benefits of the therapy. Other people may respond to our demand that they seek therapy with defiance or stubbornness. Rather than consider the option, they may say no just to spite you and to stymie your efforts to control them, even if they feel therapy could help.

Therapy has the highest likelihood of helping if the person is there of their own volition, not out of compliance, so be sure to remind yourself and the person you want to refer that the referral is optional.

If we’re clear about the reality of therapy—that the length of treatment and the level of commitment is up to them—they may find it less threatening and be more likely to try it.

3. Make it conditional.

What do we commit to when we commit to meeting with a therapist? Many people fear that by meeting with a therapist, they are committing to a long-term relationship. They sometimes also fear the therapist will decide how long the therapy lasts. These are anxiety-provoking preconceptions, and they are incorrect. When we try to refer people to therapy, it is important that we remind them of the truth—they are agreeing to one session at a time, and the length of the treatment is their choice, based on their goals and preferences.

It may help to be frank about what an initial therapy session is: a test drive. You can say, “You can meet with Maury and decide if you’d like to meet with him again. The first session or sessions can help you decide if you think he might help. You may know right away you’d like to meet with him more, but sometimes it can take a few sessions to decide if it’s worth continuing to invest in the therapy. Either way, it’s up to you how many sessions you go for. A therapist is an employee whom you can hire and fire.”

When we present the idea of therapy as a test drive, something the person can continue for as long as it meets certain conditions for them, we take away anxieties that therapy will be more of a commitment than the person may want. If we’re clear about the reality of therapy—that the length of treatment and the level of commitment is up to them—they may find it less threatening and be more likely to try it.

4. Do not make promises.

Ethically speaking, even a therapist cannot make promises, predictions, or guarantees about what they can do. We do not have a crystal ball with which to see the future. Often, my initial phone call with a new referral includes a difficult conversation along these lines:

Person: “So, do you think you can help me?”

Me: “Well, for better or worse I can’t know that just yet. We’d have to meet for you to form an opinion about that.”

Even if it’s a bit disillusioning, this is the truth. Like physicians or personal trainers, therapists can’t know whether their efforts will turn out to be helpful—only time and a careful, continuous, collaborative assessment will tell. We find out if our treatment plan is helpful once it helps.

There is great danger when a referral source makes promises about therapy or a therapist. Any expectations you give to the person you’re trying to refer can give them false hope or make them unnecessarily anxious and avoidant.

Every therapy session is, like every day of life, an experiment—we assess the problem that’s going on, pick an intervention or style of intervention we think might help, try it out, see what result we get, and adjust our treatment plan according to what works and what doesn’t. There is no magic to it, just a workaday process of trial and error, where we work hard to tailor a unique therapy to the unique person and their unique goals. In that sense, any preconceived expectations about therapy, just like in any other relationship, will be false.

For these reasons, there is great danger when a referral source makes promises about therapy or a therapist. Any expectations you give to the person you’re trying to refer can give them false hope or make them unnecessarily anxious and avoidant.

For example, a referral source could say, “He specializes in depression—he gets great outcomes.” Even if that is true, no two depressions are the same because no two people are the same. Likewise, no two treatments are the same because no two therapy teams are the same. Making promises or suggestions regarding a particular outcome can promote misleading or false hope. It may also distract from the fact it’s the work of the person in therapy, not the work of the so-called “expert in depression,” that makes or breaks the therapy.

Referral sources sometimes also make claims about a therapist’s technique when making a referral. For example: “He’s a very confrontative therapist—he’ll bust right through your defenses!” While it may be true that a therapist is capable of being confrontative, and while that kind of therapy may be appropriate for some people’s needs, presenting a referral in this way can be problematic. Good therapists base their technique on a careful assessment of the unique needs of the person in therapy, not based on what the therapist is good at or known for. Because of that, there is no guarantee the person you’re referring will ever have their defenses “confronted”—it all depends on the therapist’s assessment of what might help in the moment. Making such claims about a therapist can set up false expectations or give a person something to fear. Imagine already being nervous about letting go of certain defense mechanisms and then hearing a therapist is going to “bust right through” them.

For these reasons, when I refer someone to a therapist, I say something like, “There’s no way of knowing how it will go in advance, so the best way to find out whether the therapist can help is to go and check them out, assess how you feel with them, and make the best decision you can about whether to keep investing in the therapy. Hopefully they’ll be flexible and you two can make a therapy together that meets your needs.”

5. Let go of your desires!

If you haven’t caught it yet, my main thesis here is that while we can suggest that someone goes to therapy, or reveal our desire that they go, it is up to them. Pressuring people into doing something that is anxiety-provoking will usually lead to avoidance, submissive compliance, or stubborn defiance.

It is hard, but we must accept that we all have the right to avoid therapy and the anxieties that are built into it. No matter how badly we want to see a friend, loved one, or other person get help, our wanting it cannot make them want it. Only their inner desires can do that. So, while we can feel free to make suggestions to people about going to therapy, we must remember that they can do it only for them, not for us. Our desires for them can play only a very limited role in someone else’s therapy journey.

Example of Referring Someone to Therapy

Here is an example, based on the principles above, of what I might say to refer someone to a therapist:

“You seem to be suffering a lot and you’ve been clear that you’re not liking that, so I’ve been thinking that therapy might be useful to you. Obviously, it’s up to you if you want to go, but I do have the name of a person who I think might be able to help. Of course, that’s no guarantee, and you may have to shop around a bit to find someone who is a good fit. Either way, if you want to check this person out, they could be helpful. Do you want me to pass their contact info along?”

You can phrase this any way you like, but I think the key points for any referral are here:

1. Seems like you’re hurting, so therapy might be worth a shot.
2. It’s up to you.
3. You’re not committing to a lifetime on the couch, just one initial session.
4. There’s no guarantee it’ll be worthwhile, but the only way to find out is by trying.

Of course, this approach does not guarantee a specific outcome, but I believe it gives the best possible chance that the person will feel cared about by you, make the decision for themselves, and have the most realistic expectations possible going into therapy. Let me know if this helps!

Advice is cheap.

Advice puts the onus on the listener and not the speaker.

Advice is often a quick fix—a mere Band-Aid on a wound that needs more persistent care.

I can usually detect someone’s frustration when, as their therapist, I pointedly do not offer advice. One of the skills therapists learn early in their training is one of the hardest, for both the therapist and the person in therapy: sitting in silence. But drawing out more information from people is a psychotherapist’s most useful tool. After all, your therapist is a trained listener, not advice-giver.

That does not mean your therapist is merely looking at you and listening while you talk. Any skilled therapist will be listening acutely for specific signals, which they then use to guide the direction of the conversation over time.

In general, your therapist is listening for three things:

[fat_widget_right]

1. What You Really Want

Nobody knows you better than you. That is why advice so often fails to help you move in the direction you want to go. Ultimately, you have the answers to your questions, though they may be buried under the expectations, hopes, and dreams of others.

It is actually pretty rare that people ask us what we really, truly want. We spend so much of our energy and efforts trying to meet the needs and desires of others. This is true for concerns large and small. It has to do with how we spend our weekends, what we eat for dinner, the career paths we choose, whom we marry and when, whether or not we have children.

In a variety of ways, your therapist is asking you, “What do you really want?”

Answering that question can bring about changes you may never have expected—some joyful, some scary. But in the end, the answer comes from you and nobody else. The essence of your answers are what will guide you closer to the life you want.

2. Change Talk

Speaking of changes, I am rarely surprised when I hear someone hint at something in their lives they wish would change. When I reflect that desire back to them, people often respond as if it is the first time they had thought about it.

Your therapist is listening for your change talk. It usually starts with a tentative, “Maybe I could …” or “I wonder what would happen if …” or “I’ve always thought it would be interesting to …”

Your therapist is listening for your change talk. It usually starts with a tentative, “Maybe I could …” or “I wonder what would happen if …” or “I’ve always thought it would be interesting to …”

When I dive deeper upon hearing something like that, usually those sorts of statements are brushed off as a pipe dream. Your therapist intervening to examine change-talk statements may require you to face some of your deepest fears. This could be a fear of failure, fear that it is too late to try something new, fear that you are lacking in the talent, charm, or financial means necessary to follow this line of thinking. The reasons I hear why people cannot take even the smallest steps toward their dreams are usually more creative, varied, and unpredictable than I could imagine.

That is the point of intervention for you and your therapist. Change talk is where the work of therapy begins.

3. Your Self-Regard

Many people are shocked when they finally recognize how hard they are on themselves. Over time, we develop core negative beliefs about ourselves which we mistakenly believe to be the truth.

Your therapist is listening for those types of statements. Don’t be surprised if your therapist picks up on a core negative belief about yourself and challenges it. Such beliefs, that we are not “enough” in some way, seep into our subconscious so much that we do not even realize how critically we speak to ourselves.

Confronting those beliefs are some of the most demanding aspects of therapy. But it is possible, even likely, that if you think you are not enough, your therapist does not think of you the way you do, and they will reflect that belief to help you develop a more positive (and realistic) self-regard.

So while your therapist may guide your conversation in certain directions, it is not to offer you advice. It is so you can both learn more about what you truly want. And, eventually, so you can both learn what steps you think are most appropriate to take.

Shall we get started?

It’s one of the most important questions in therapy. It’s stereotypical. Sometimes, it’s disruptive. It can lead to anxiety and self-examination.

And it’s not going away.

Your therapist asking you what you’re feeling is a staple of most forms of counseling, and for good reason.

What you do with the question can begin to free you.

Yes, we all know therapy is about feelings. Before any of us stepped into a therapist’s office, we probably saw a cartoon, TV show, or movie in which a therapist asked the person sitting across from them: “How does that make you feel?”

[fat_widget_right]

The thing is, people come to therapy for a million different reasons. It could be to deal with depressive or anxious symptoms, trauma, or unhealthy expressions of anger. The list could go on and on.

Few people come to therapy with the stated goal: “I want to better understand and connect with my feelings.” For everyone else, it may not seem productive to be asked each week about what they’re feeling. All they know is they want to feel better!

A common response to the feelings question is frustration and annoyance. Especially if it occurs during a the telling of an event or a story from the past. If you’re focused on something from the weekend or from work, the feelings question may disrupt your flow.

Well-timed, the question can lead to breakthroughs regarding unhelpful patterns, difficult feelings, and negative interpersonal relationships.

Of course, it could be an ill-timed question by the therapist. Maybe it would be more helpful if they waited a bit longer to move you toward reflection. Maybe not, though. Perhaps the question is coming from the therapist’s sense that there are feelings you may be unaware of.

Well-timed, the question can lead to breakthroughs regarding unhelpful patterns, difficult feelings, and negative interpersonal relationships. It can reconnect you with any feelings you may be trying to avoid by overthinking the situation.

So, yes, the question may be an attempt to interrupt and go deeper. But if it’s making you angry, tell your counselor. That’s important information too.

This Is Not a Test

A common response to the feelings question is anxiety or, worse, a sense you’re doing something wrong if you’re not sure what the feeling is. Suddenly, it may feel like you’re being “quizzed” or tested.

This, too, is important information to bring up. The intention is (hopefully!) not to make you feel like a failure. You’re in therapy to learn about yourself and how to better understand your feelings. You’re not expected to know all the answers, let alone anticipate questions. Speak up if you sense pressure to perform or expectation from your counselor.

Remember that “I don’t know” is an acceptable answer. You may not be aware you’re having a feeling because you don’t tend to stop and check in with yourself. If the feelings question comes up, it’s a chance to do that.

And maybe you’re having zero feelings in that moment. Again, good information.

The Feelings Layer Isn’t the Only Layer

Becoming more aware of how you’re feeling at any given moment is not the only aspect of emotional well-being, but it’s an important layer to explore. Knowing your feelings may help you understand your actions better. It can inform your future choices.

Becoming aware of your feelings may help you feel less helpless. It may help you feel more in control.

Perhaps best of all, knowing your feelings gives them less control over you.

“My therapist was great! I learned a lot, but I’m not sure much changed.”

Does the above statement describe your experience with therapy? Maybe you’ve uttered a similar phrase to a friend.

Therapy shouldn’t just be interesting. It shouldn’t just feel like a good mental flossing that leaves you with a lot to think about. Effective therapy can be both of those things, yes. But it should also get you moving in a more positive direction, as quickly as possible.

The answer to “Why doesn’t therapy work?” has everything to do with the difference between insight and action. Lasting change may include insight—but it doesn’t have to. On the other hand, if you only have insight, you’re unlikely to make the kind of changes that translate into a more satisfying and fulfilling life.

Say your car dies and you have to start walking to work every day. After you do this for a couple of weeks, there’s a good chance you’ll start to experience the benefits of being more active, and you might feel better, physically and mentally, than you did before you started walking. Once you start feeling better, you may choose to keep walking—even after your car is fixed.

In this case, it was necessity—not insight—that forced you to take sustained action. You didn’t have an “Aha!”  moment and decide to start a walking program based on that flash of insight. Your car broke down, leaving you with no choice. You walked to work because you had to. The insight you gained as a result of walking every day was simply an unexpected positive outcome. [fat_widget_right]

Why Insight Isn’t Enough

So, why do people stay in therapy if they’re not making measurable progress? I think there are any number of reasons.

For one, people don’t always feel safe, comfortable, or clear-headed enough to talk to their partner, friends, or family about embarrassing, unflattering or critical feelings they might be having. Therapists know how to listen with soft ears and open hearts.

Therapy also provides people with a safe place to express difficult feelings, those they may be afraid to share with others, without the fear of rejection, harsh judgment, or attack.

Before you choose therapy, make sure you’re ready and willing to do what it takes to create real change in your life. Don’t settle for insight.

People might also stay in therapy when they aren’t progressing because they are mistaking their increased insight for progress. This can happen because our bodies love insight. You know the “Yes!” feeling you get when you find your keys after looking for them everywhere? That’s the same rewarding feeling we get when the clouds over our thoughts part and confusion gives way to clarity. Our bodies relax when we feel understood, and therapy is a place where many of us feel understood, sometimes for the first time.

What’s Holding You Back?

If you feel like you have experienced insight in therapy but aren’t making progress, it might be helpful to reflect on your current or past experiences in therapy. Have you taken time to consider your work in therapy outside of session and completed any homework your therapist assigned? What substantive changes have you made as a result of the insights you’ve gotten in therapy?

For example, say you have realized your efforts to protect your child and keep her safe have actually led her to feel less trusting, less confident, and more frightened in the world? What have you done with that insight? Have you changed or modified the protective behavior in any way?

If you have realized your busyness is a distraction keeping you from leaving a toxic relationship, what have you done with that new information? What steps have you taken to simplify your life and come up with an exit plan?

Before you choose therapy, make sure you’re ready and willing to do what it takes to create real change in your life. Don’t settle for insight. Insight can feel great, and it is helpful, but it’s really just a starting place. Real change takes time, focused attention, mindfulness, and discipline. Real change isn’t just “finding the time” to “do the work.” Real change occurs only when we identify the people, places, and activities that harm us and replace them with people, places, and activities that bring out our best qualities.

If your therapist isn’t helping you move toward your goals, remember that it’s always okay to search for a new therapist. Choose someone who does more than nod, smile, and “provide a safe, confidential space” for you to gain insight. Look for a therapist who is ready to work with you in that safe, confidential space, one who can help you explore your insights and turn them into concrete plans of action that lead to the lasting changes we are looking for.

Real change requires real change. If you settle for less, that’s all you’ll get.

Your next therapy appointment is approaching, and you’re wondering what you might talk about. Nothing “exciting” has happened recently. You’re not upset about anything in particular. There’s been no drama. You’re actually feeling pretty good.

You think to yourself, “There’s no point in going. I might as well cancel.”

Here are some reasons you shouldn’t.

Therapy isn’t helpful only in times of crises. It can serve the purpose of ensuring the maintenance of healthy coping strategies. It can be a place to investigate alternative ways of looking at situations that have the potential to be “bigger” so they don’t end up being seen as flash points, but rather as manageable moments to employ useful skills and tools. In addition, themes and patterns that emerge over time might be more easily acknowledged in a session not devoted to crises.

[fat_widget_right]

People I work with often mention they thought on the drive over they had nothing to talk about but were amazed to discover there was quite a bit to explore. Once more immediate challenges are dealt with, there are opportunities to dig beneath the surface and work on the core issues that underlie everyday struggles.

Sometimes, hesitating before a session signals you might be close to working on something of great importance. That hesitation might represent fear or apprehension. It’s helpful to share with your therapist that you considered canceling, as well as the feelings that came up for you.

Therapy is work; it’s not supposed to be easy. It requires being open to different perspectives, trying new things, making changes, being honest with yourself and with others, and doing things that are difficult or challenging.

You might not be aware of things your therapist is seeking to explore with you. A seemingly simple question might serve to elicit a lot of material—important content you hadn’t even realized was there.

If you believe your work in therapy is done and you’re thinking you’ll call in the future if things aren’t going well, communicate this intention in person. When contemplating terminating therapy, it’s important to discuss it in session with your counselor so it is carried out therapeutically. It is a wonderful chance to concretely take stock of the progress you’ve made and the strategies you will take with you. It’s imperative you review the supports you have set up as well as the plan you will be putting in place for how to handle stressors or triggers that may challenge you going forward. Allow for that closure. Otherwise, you may leave without full awareness of what you’ve accomplished and without being completely cognizant of the tools you have at your disposal, should you need them. It’s also the perfect opportunity to demonstrate communicating effectively something that might be difficult to express.

As a therapist, I am grateful when a person I work with feels comfortable enough to bring their uncertainty to me. It demonstrates the person is feeling strong enough to do so and is not avoiding the expression of their thoughts, often indicative of progress.

Saying goodbye is not always easy, but it is often best said in person, with the parameters for reengagement clearly mapped out. It’s possible your therapist will respectfully disagree with your assessment and encourage you to continue in therapy. It is important to hear that and consider that feedback in your decision-making process.

Wanting to cancel may be as much a part of the therapeutic process as attending your sessions regularly. It may signal it is time to review your original counseling goals to see whether they’ve been met, or whether in fact you and your therapist have gone in a different direction. Acknowledging your ambivalence can give you and your therapist an opening to get back on track with regard to the counseling goals, or the chance to create new objectives.

As a therapist, I am grateful when a person I work with feels comfortable enough to bring their uncertainty to me. It demonstrates the person is feeling strong enough to do so and is not avoiding the expression of their thoughts, often indicative of progress.

Showing up and then articulating your inclination to cancel can serve to strengthen the therapeutic alliance and deepen the work you do in counseling. It demonstrates you are acknowledging your thoughts and feelings rather than taming them into submission or sweeping them under the rug, and that you are willing to communicate directly rather than avoiding or ignoring.

If you’re thinking of canceling, show up instead, talk about it, and with your therapist, collaboratively navigate how best to handle those moments going forward.