How to get the most out of therapy sessions

This column is an opinion by Dr. Heather Keizer, a clinical psychiatrist and faculty member with the Department of Psychiatry at Dalhousie University. For more information about CBC's Opinion section, please see the FAQ.

There is more public openness about mental health issues these days and more people are actively seeking professional support.

But going to therapy doesn't automatically mean success.

Success in therapy depends upon a good match between you and your chosen therapist, the information shared during therapy, and what happens between therapy sessions.

Here are some ways to get the most out of it.

Be prepared for your first meeting

• Prepare a clear outline of your story. This should include when your current concerns began, and what helped or made things worse. Expect to share details about your childhood, your family and your relationships as well as your sources of stress and strength.
• Prepare a list of all your current medications and supplements, including your daily dosage, the prescriber, how long you have been taking the medication, and any benefits or ill effects you have noticed.

• Prepare to share your current and past medical history. Include any allergies, surgeries, and admissions to hospital, including admissions to addictions facilities.
• Know your family history. Family has an impact on mental health and illness both genetically and psychologically. 

Be curious and open to suggestions

• When selecting a psychotherapist, give it at least three visits. Trust and safety are very important to successful psychotherapy. Give the relationship a little time.
• Your relationship with a therapist will feel unusual at first. The therapist's role is to work to understand you and your history, but not to be your friend.
• Do not be offended if your therapist challenges you. The purpose of therapy is to assist you to grow emotionally, with new insights and coping strategies. This growth is often uncomfortable.

• Be ready to do emotional work. It requires considerable energy to focus on thoughts and experiences that are uncomfortable. But without some discomfort, you will see little change. 
• Do not expect your therapist to fix you. This is your work. The role of the therapist is like a coach who observes, assesses and guides the exercises, but the athlete must do the work.

Get unstuck if things are not progressing

• Set goals with your therapist. These should be specific and measurable.
• Create a plan of action to reach the goals you have set, with expected dates at which they will be fulfilled.

• Take time to reflect. Are you listening to the advice of your therapist? Has anything interfered with your progress? Are you distracted by new drama that interferes with your focus on deeper issues? 
• Do research on your symptoms and diagnosis. Are there innovative therapy techniques or workbooks that could help you move ahead? Request that your therapist incorporate these into your work together.

What will not work

• Threats and aggression will not help your therapy. You may feel that all emotions should be welcome in therapy. Not so. Aggressive behaviour is not therapeutic. Expression of emotion reinforces that emotion. Expressing anger only intensifies that anger. This is helpful neither for you nor your therapist. If your session causes you to lose control, excuse yourself from the session, leave and cool down. 
• Seeking a friendship with your therapist outside office hours may seem natural but it is not. Therapy is designed for you to gain insight and skills so that you may move on. Learning to respect healthy boundaries between yourself and your therapist is a primary goal.  

• Coasting in therapy will not give you the success you need. If your engagement remains superficial, your understanding and healing will be superficial, as well.
• Never ending therapy may provide a sense of security but denies you significant benefit. One of the most challenging aspects of effective therapy is saying goodbye. Ending therapy teaches that you can suffer real loss without losing your well-being or identity. It teaches healthy separation and independence.

When to end therapy

• If the relationship with your therapist is causing you harm, or threatens your personal boundaries, it is time to end therapy.
• If after four to six sessions you just don't click and you feel your therapist doesn't get you, it is time to end therapy. The fear of not finding another therapist is not a good reason to stay.

• If you have met your goals and are translating what you have learned into healthier behaviours and a positive self-image, it is time to end therapy.
• To effectively end therapy with a given therapist, write out your thoughts about your time together. If you can, balance your positive and negative experiences. Meet with your therapist face to face to share your thoughts. It is important for you to be heard and it is mature not to avoid a difficult final interview in order to honour your feelings.

A highly individualized process

Selecting an appropriate therapist and specific therapy is a highly individualized process and varies depending upon your symptoms and the seriousness of your diagnosis, yet these principles generally apply.

Note that serious drug or alcohol addiction requires medically supervised detoxification before psychotherapy can be effective.

Similarly, people living with severe psychiatric illness such as psychosis, bipolar disorder or clinical depression will require intensive medical stabilization in hospital before they are responsive to psychotherapy.

Some personality types and cognitively compromising conditions respond only minimally to therapy of any kind.

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