How to Get the Most Out of Therapy
IN 2013, SUSAN* and her husband Scott were at a remote cottage near Victoria Beach, Manitoba, when the unthinkable happened: Susan’s daughter entered the bedroom to find Scott lying on the ground, unconscious after suffering a massive heart attack. While her daughter called 911, Susan leapt into action. “I tried to save him with CPR,” she says, but it was no use. By the time the first responders arrived, he was already dead.
The shock of sudden widowhood at the age of 61 was hard enough, but Susan’s grief was complicated by her feeling that if she had just done something a little bit different—performed CPR better, or not asked Scott to lift some heavy stones earlier that day—he might still be alive. “I couldn’t get out of the trauma,” she says. “I was stuck.”
Finally, a year later, her family doctor referred her to a therapist who specialized in grief, a relationship that helped her begin healing.
For many people—not just those suffering a loss—psychotherapy can be a safe harbour during a difficult time, or an invaluable part of treating an ongoing mental health problem. And as the stigma once associated with seeing a “shrink” is fading in this era of self-care and wellness, people who never considered therapy before in order to address problems old or new may be curious enough now to take the plunge. The question is: where do you begin?
Finding a Therapist
When seeking mental health support, some people may get a referral to a therapist from their physician. The bereaved may consult hospices and grief support organizations. And many people may simply ask around and find a professional by word-of-mouth. If none of those options are available, Google will certainly provide names and directories in your area. But no matter how you find a therapist, a little research before committing to a consultation can save a lot of time.
The first thing potential clients should do, says Pat Rayman, a Torontobased registered psychotherapist, is check for credentials. In provinces where psychotherapy is regulated— Ontario, Quebec, Nova Scotia and New Brunswick—the therapist should be registered. For therapists in other provinces, Rayman suggests making sure they are at least part of an association, such as the Canadian Association of Psychodynamic Therapy.
After that, it’s useful to look into the therapist’s area of expertise, which many advertise on their websites. Finding someone who can help you with your particular issue—whether it be related to death and bereavement, trauma and PTSD, aging, family conflicts, sexual identity or addiction—is also a good beginning.
Therapists use a variety of techniques based on a number of different theories. Psychoanalysis, sometimes called “the talking cure,” was pioneered by Sigmund Freud in the 19th century, and even now most therapists still encourage clients to speak expansively about what’s on their mind. However, some clients may prefer a more short-term treatment focused less on excavating the past and more on changing harmful thoughts and self-talk; cognitive behavioural therapy (CBT) is a popular option along these lines.
Dr. Jo Hoffman, clinical assistant professor of psychiatry at the University of British Columbia and a psychoanalyst, suggests keeping in mind the kinds of resources—financial, emotional and time—you have available. “If you’re going to do the deep-dive type of work, you need to have stability in your regular, everyday life,” she says. Someone in immediate danger—for instance, an abusive relationship—may instead require targeted crisis support in the short term. Whatever your situation, try to be realistic about how often you can meet and what you can afford.
During the initial appointment, the therapist will be looking to get a sense of what brings you in, and you should learn how they work, asking questions about any aspect of therapy you don’t understand. The two of you may have a conversation about treatment goals, and also discuss things such as frequency of appointments, fees and cancellation policies. But most importantly, this first consultation—which is not a commitment—is a chance for both of you to gauge compatibility.
As renowned therapist Irvin Yalom once said, “It’s the relationship that heals.” Indeed, studies have shown that across all types of therapy a good rapport between client and therapist is essential for effective treatment.
To suss out whether it’s a good match, Hoffman suggests being as forthcoming as you can be about your life and problems. “But also, be open and honest with yourself about how you feel about the therapist,” she says.
Dr. Ingrid Söchting, clinical associate professor in the department of psychiatry at the University of British Columbia and a CBT therapist, says she encourages people to shop around. “Some clients find it off-putting if a therapist is too ‘touchy feely’ and overly expressive, so they may prefer—at least initially— more distance and personal space,”
It’s important to pay attention to, and share, feelings you have during sessions—including those about the therapist.
she says. “On the other hand, some therapists display a surprising lack of warmth and empathy.”
Söchting suggests giving it two to three sessions, and if you have a lot of negative feelings, then just say “thank you” and move on.
Useful Homework and Building Rapport
After several sessions with your new therapist, you’ll find yourself observing your feelings and behaviour in a new light. For some clients, simply showing up week after week will be enough to spark a healing process, but there are ways to deepen the work.
Rayman suggests it can be useful to keep a journal. Mostly, she says, “you’re training yourself to be aware of what you’re feeling and what’s happening for you by writing it down.” The journal can also be good for describing dreams, since anxieties blocked from our conscious minds during the day can bubble up at night—and are good discussion starters in therapy.
Behavioural therapists may give clients worksheets to fill out, which help reframe obsessive, depressive or anxious thoughts. They might be asked to record outcomes of exercises meant to challenge fears, or to keep track of how their behaviours are linked to their moods. A binge eater, for instance, may record what they eat, and note their feelings and thoughts before and after.
But no matter what type of therapy you’re doing, you can aid the process by paying attention to, and sharing, feelings that you’re having during the sessions themselves—including those about the therapist.
“The more the client can be open— if they are bothered by something the therapist does and can tell them—it will work to their benefit,” says Rayman. A quiet therapist may have no idea that their client wants more verbal input, or a client may need to make it known they’re being pushed too hard to reveal vulnerable feelings.
For someone who isn’t used to being assertive, challenging a therapist may feel out of their comfort zone—which is exactly the point. The therapy office is a useful place to test out new ways of being in a relationship, which can carry over into the world outside.
Even if a psychotherapist does not practice in a province where the profession is regulated, they should be a member of an association with a clear code of ethics. These groups’ rules typically prohibit blatant boundary violations such as sexual relationships or unrelated business dealings between therapists and their clients.
Some bad practices, however, are subtler. For example, since a therapist can be a strong, influential presence in a client’s life, it’s important that the
client’s well-being and agency are prioritized. Rayman suggests being aware of that power dynamic: “Whose agenda is being followed—the client’s or the therapist’s?” For instance, she says the therapist should not be deciding the topics of conversation for the session or pressuring the client to have particular emotional reactions.
Where the treatment period is openended, Söchting suggests therapist and client should evaluate together how things are going at the three-month mark. If no progress has occurred, the effectiveness of the relationship should be reconsidered.
At any point, switching therapists is an option. A successful therapy relationship can continue as long as the client wishes—some people may decide to see the same therapist for many years, while others may decide after a while to try someone with different strengths.
IN THERAPY, Susan found herself able to talk about things she had never told a soul before—not just about the trauma of her husband’s death, but events from her more distant past. Having suffered from depression on and off her whole adult life, she credits her new-found emotional resilience to the therapeutic work she did. “When you get the strength to talk about deep-seated issues, that’s a huge thing,” she says. “Therapy was really very healing for me.”