A psychotherapist thinks out loud about Being Human, and stuff…

Because psychotherapy can involve a major investment in time and money, I’ve been writing about what you can do to get the most bang for your therapeutic buck starting, last week,with choosing the right therapist. There are two more things I’d like to suggest you keep in mind, once the therapy has started: goals and feedback.

Generally speaking (not to annoy my psychoanalytic colleagues), psychotherapy has changed a great deal since the days of unlimited, five-day-a-week, free association on the chaise. The cost of what is now called classic psychoanalysis meant that only well to do people could indulge in the process. That’s still true. Over the last four or five decades, though, especially starting in the early 70’s, therapy evolved into something more acceptable to much of the middle class, and this group of therapy seekers wanted to know two things: how long is this going to take, and how much is it going to cost?

The only honest answer that any therapist can give to these questions is, “It depends on what we’re trying to accomplish”, and that’s where goals come in. Sometime within the first two or three sessions, you and your therapist should be establishing goals for the therapy. I usually ask, “How will we know when the therapy has succeeded?”, and I’ll hold out for a positive, active answer. You’re hurting for a reason; what do you need to do that will reduce (not eliminate; we need some pain) the pain in your life? In the first few sessions, you may not have a clear answer to that question, and when you have set a goal, it may evolve with time. The point is, you need one. That’s what you’re steering toward. If your therapist doesn’t bring the subject up early in the therapy, do it yourself. Insist on it. Your therapy will be more focused, and you’ll have a sense of accomplishment as you near the goal you set.

Which leads me to my final suggestion: feedback.

In an earlier blog entry, I wrote about how difficult it can be to know how well (or badly) the therapy is going. This applies to both the therapist and the client. You’ve set goals, so you know what you’re working toward, but how are you doing on a session-by-session basis? You and your therapist may have an opinion about that, at any given time, but it’s good if your opinions agree with one another. The thing is, all this interesting stuff is happening inside your head (that’s where we think it happens, anyway), but your therapist, your guide on this journey, can only see what she sees. Some regular communication has to happen, about the stuff that’s less visible. Your therapist should be asking regularly for your experience: how did you feel about the last session? How do you think the therapy is going? Is anything we’re doing working particularly well? Anything feel like a waste of time? Anything you’ve thought of that you’d like to try? Believe me, your therapist really wants to know. Back in the selection process, you picked a therapist who listens and doesn’t presume to know what you need; that’s your job and- listen to me, now- the act of getting clear about, and asking for what you need may be the most important thing you can do in therapy. As I’ve said before, your therapist is your toolbox. The way you learn to use tools is by picking them up and applying them, and the safest place to do that is in the therapy room. That’s your job.

For now, that’s what I have to say about getting the most from your therapeutic experience: pick the right person, set achievable goals and give your therapist feedback, as often as you can. As always, I’ll appreciate any comments you may offer. I love to hear what you think; it’s that feedback thing.

Happy trails……


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