What you need to know about therapy and therapists (from a therapist)
Thinking about therapy? Read this first.
Perhaps you’ve been struggling with anxiety, depression, stress, or have otherwise been so overwhelmed by everything that you almost feel nothing.
Maybe you had previously sought help, and left feeling disappointed by a session that simply didn’t meet your expectations.
You’re not alone. As a clinical psychologist, I have met many clients (including people who chose, eventually, not to continue with therapy) who have entered the therapy room without a clue about what they might be getting into.
In my experience, being clear about what therapy is and the role of a therapist greatly helps someone make a decision about whether or not to start therapy, and set realistic expectations on outcomes. That’s what this article is about.
Table of Contents (clickable):
- What therapy is
- Why your therapist matters
- What therapists do (beginning, middle and end stages)In my experience, being clear about what therapy is and the role of a therapist greatly helps someone make a decision about whether or not to start therapy, and set realistic expectations on outcomes. That’s what this article is about.
What therapy is, according to a clinical psychologist
Therapy, also known as counselling or psychotherapy, is a practice intended to help people explore, understand and overcome mental health difficulties, relationship problems, life challenges, and major life decisions.
Therapy is a two-way effort by the therapist and client. The therapist gives structure to therapy, provides a safe space for the client to express themselves, and sometimes provides knowledge and relevant activities. The client works on their difficulties and themselves through “therapy work” outside of sessions (more on this later).
Why your therapist matters
The exact form of therapy can mean different things to different practitioners. To give some (albeit grossly simplified) examples:
- Cognitive behavioural therapists help people identify and evaluate their thoughts and beliefs, taking a more rational and practical approach.
- Schema therapists work by helping a client understand patterns in their actions and thoughts, explores their origins. They tend to use a broader range of activities including “rational talk” to imagery exercises in sessions.
- Therapists specialising in mindfulness may focus primarily on mindful awareness of thoughts and sensations as a means of healing.
As you can see, therapists can have very different specialisations and ideas about therapy (also known as “theoretical orientation”).
This is why I believe there is no “best therapist” — we are all different, and it’s a matter of finding a good fit.
So, if you gave up on seeking help because of a bad experience or two, I urge you not to give up. Look up therapists or counsellors near you, find out a little about their specialisations, and you may just find a good fit for yourself.
What therapists do (in and out of therapy) — in my experience
Throughout the process of therapy, a therapist is not supposed to be the “doctor” that cures the client. The therapist is more similar to a coach guiding an athlete who, ultimately, still runs the race himself.
Firstly, most therapists do not just learn one method of therapy and stick with it. The vast majority of therapists in this day and age are trained in cognitive-behaviour therapy, but also have some experience and training in other forms of therapy.
In my own training as a clinical psychologist in Singapore, I gained exposure to a wide variety of techniques in cognitive-behaviour therapy, acceptance and commitment therapy, schema therapy, dialectical behaviour therapy, and the list goes on, through hundreds of hours of sessions with clients. On top of that, I also read widely and attended training courses in other forms of therapy.
Regardless of theoretical orientation, a therapist’s job is to guide a client through the beginning, middle, and end of therapy, all of which look somewhat similar regardless of the type of therapy.
The beginning stage of therapy
Sometimes, a client meets us at the beginning stage of therapy expecting to do middle-stage things, like jumping into working on problems, only to be disappointed.
The beginning is where the important preparatory work happens.
This is when the client and therapist get to know each other. I ask clients about their struggles, their stories, and learn as much as I can about them that’s relevant to their therapy. I also give clients a brief idea of my style, how I work, and what is expected of them during therapy.
At this point, I also come up with a treatment plan tailored to my client’s needs. This requires a good amount (hours) of post-session work into considering my clients’ difficulties, and good clinical intuition on what they will find helpful.
Then, I always discuss this plan with clients and get their thoughts on it, checking what they want to focus on first, and so on. I proceed with a treatment plan only when we have both agreed to it and have a shared idea of where our therapy is going.
Sometimes, a client meets us at the beginning stage of therapy expecting to do middle-stage things, like jumping into working on problems, only to be disappointed. That’s why orienting a client at the first meeting is so important for both of us.
The middle stage
This is where the work of therapy happens, including processing thoughts, emotions, bodily reactions, and taking action. The middle stage of therapy is what people usually think of when they think about therapy.
At this point, clients and therapists often agree on some form of “client work”, be it mindfulness practice, thought diaries, or taking concrete action in a client’s chosen problem — and therapy effectiveness is often greatly influenced by the amount of effort a client puts in at this point.
Therapists ensure that clients stay on track on their chosen therapy goals, and initiate a re-discussion of priorities should a spanner get thrown into the works.
The end stage
Finally, in the ending stage of therapy, the therapist and client prepare for the client to continue life without therapy. This usually looks like preparing for re-occurrence of symptoms, what to do in emergencies, and when a client knows they need to seek help again. Clients may make notes or flashcards that they can refer to when required.
Throughout the process of therapy, a therapist is not supposed to be the “doctor” that cures the client. The therapist is more similar to a coach guiding an athlete who, ultimately, still runs the race himself.
Conclusion: Give Therapy A(nother) Chance
If you’re struggling with your mental health or facing challenges in your life and considering therapy, I hope this article helps in your decision-making. If you have been disappointed by previous therapy attempts, I hope this article gives you some insight on what you experienced, and urge you to give therapy another chance.
As a first step, find a mental health professional near you or speak to an online therapist, and start your journey to the life that you want.
If there are other things you would like to know about therapy, leave a comment or follow for more upcoming articles.
