How to get the most out of your therapy sessions

There are many different kinds of therapy (and it's important to find out which one is right for you), but they can all present the same challenge of learning how to candidly talk through an issue and implement feedback in a limited amount of time. While the therapist is naturally the expert, therapy sessions are a two way street, and it's crucial that the patient also brings their best to the table, to make it a fruitful endeavour for both parties. We reached out registered psychotherapist and success coach Hina Khan, and Demian Brown, a Toronto/Oakville-based psychotherapist and clinical social worker, to find out what we should do before, during and after sitting on the couch.

Do you need to go in with a plan?

Having a clear plan of what you want to talk about before a session might be helpful, but it's not essential. "Therapy is very layered and complex, you may walk into a session not knowing what you want to talk about," says Khan, "and that is OK. Don't feel 'pressure' to come up with something. It is one of the only spaces where you DON'T have to come up with things to talk about, you can simply be and see what emerges." Brown echoes this, saying that not having a plan might even prove to be an effective strategy. "I tell my clients to 'go talk' wherever they even whimsically want to go with topics," says Brown, "because what people decide to say and how they organize it themselves starts to reveal themes and issues that are prime for preliminary exploration discussion and even treatment planning."

Prioritizing issues

You may initially be going to a therapist to work on a particular issue, but smaller or more current issues may arise. So, before you go to a session, how do you know which to address in that limited amount of time? "People generally come to therapy with something they want to work through," says Khan, "but in therapy, we want to work with the emergent as well." For example, if an issue comes up right before therapy, Khan says "it is important to talk about those things. Those situations can be very illuminating and helpful for a client to explore." Brown also agrees, noting that starting with short-term goals can be a good way "to get some success under your belt," while working toward larger ones. However, Brown says, "Sometimes, some short-term issues might not be worth prioritizing," if they run in conflict to the overall treatment plan. To avoid this, Brown puts emphasis on a strong initial assessment period, where your therapist draws up that overall plan. Ultimately, since each therapist can have different areas of expertise, it's best to largely focus on what they can help you with most.

Roadblocks

There may be an idea that you're not "ready" enough to see your therapist, but even that is all part of the process. Brown says that sometimes his clients have "issues with being afraid to be direct with an authority figure", or a fear of "opening up with underlying shame, issues of self-esteem, self-worth or issues involving self-efficacy", but getting in and dealing with those roadblocks can be a gateway to tackling the other concerns. "Therapeutic goals arise from these fears and difficulties," Brown says, explaining that "underlying issues could become a topic for therapy itself and often are related to why the client attended and what they want to fix in the first instance. Clients approach therapists not with their whole selves fully revealed and ready to work collaboratively, but rather in a guarded way hoping for acceptance with a critical view of the treatment and shame."

In that sense, it's not so much about "being ready" before therapy, but using therapy to become ready, and Brown outlines an exercise to illustrate this. "I help my client write an ideal version of themselves that they have complete confidence in, and then to select a goal that will help them to reach, thus starting the process of them becoming their ideal self," says Brown, before identifying their strengths and weaknesses in getting there, naturally sorting out what needs to be worked on. Working this way with "the whole person", says Brown, keeps perspective and addresses hurdles.

Goal setting

Goals do provide a great guideline, but stay flexible. Brown believes goals "should always be negotiated on an ongoing basis", and they can be reevaluated when they're met or no longer productive. Goals are there to create a marker for change, so, instead of rigidly locking into them, they can always be changed, evolved or refined to better suit your progress.

Effective language

When describing thoughts and feelings to your therapist, you should use the language that suits you best. "Be as honest as you can be," says Khan, "you should feel it is a safe space." Brown believes "You should be comfortable being yourself, perhaps even if that involves swearing" and that, despite your own reservations, you should expect "radical acceptance" from your therapist. Brown says good therapists are also educators, being able to "teach the concepts and language" of their field, so they can think out loud and discuss assessments with you. So, while you should stick with words you're more comfortable with, over time you should be able to expand your therapy vocabulary and effectively meet your therapist more head-on.

Keeping on topic

You may feel the pressure to stay on the topic at hand, but don't. "It's not your job to monitor the session," says Khan, "the therapist will be aware of the time and, at times, interjecting and asking specific questions to draw something from you." This is a delicate art, as Brown admits, waiting for the best time to interrupt a client without disrupting the natural flow of thought. If you do feel that your therapist can do more to keep you on track — speak up. Brown suggests asking your therapist to keep notes to go back to rather than interrupting you, keeping your own post-session journal and taking a moment at the end of each session to discuss what you from your therapist in the future.

Time management

For efficiency during the session, it's best to be assertive and prepared with everything else (having done homework from the previous session, etc.) so you can fully devote your time to what matters. Brown also recommends either taking notes during your sessions or tape recording them, so you can better retain and reflect on important points.  

It's also wise, where possible, to schedule your sessions at the right days and times for you to get the most out of yourself. In addition, Khan suggests "you may want to buffer some time (post-session) so you don't have to interact with others immediately." Brown advises it may be a good idea to "Ask for longer times between sessions (such as bi-weekly instead of weekly)," in order to better process, work on feedback and get more out of fewer sessions.

When it's time to move on

Invariably, despite the efforts of both you and your therapist, you may get the urge to stop therapy or seek other help, and that's perfectly normal. Brown believes there's "No such thing as loyalty to a therapist," and that therapists should encourage a variety of treatment options from the outset to keep you from developing an unproductive dependency. It's a good idea to check in with yourself regularly, asking if your needs are being met and if you're seeing personal growth in the areas you desired. If you journal, Brown suggests "meta-journaling", a monthly entry looking back to assess and analyze your previous progress. Also realize that wanting to stop or change therapy isn't necessarily a sign that things are going badly. "Sometimes, the feeling of stopping, taking a break or extending time between sessions is a result of the deep work," says Khan, and knowing that true growth ebbs and flows can keep you from getting in a rut. 

Do you have tips for better therapy? Have questions about it for our experts? Sit on the couch and tell us below.