What to Expect in Therapy

By Beacon Care Services • 26 Oct 2018

  • Talk therapy increases self-knowledge and teaches healthy mental habits.
  • The focus should be on meeting a goal that you and your therapist have agreed upon.

What happens when you go into therapy? First, there’s the fact that it’s all about talk. As therapist and author Tamara L. Kaiser describes, it is “a conversation between therapists and their clients.” Along with this conversation, you may have some homework between sessions.

But how will this make you better? That’s your real concern. After all, people go into treatment because they have an emotional issue causing them real pain. In many cases, prescribed drugs such as antidepressants may ease the pain with little talk-therapy. How can therapy work as well, or even better, than these?

The answer is in your head, literally. Modern neuroscience found the circuitry of the human brain to be highly “plastic.” That is, the brain changes nerve connections and signal pathways as it takes in new experiences. All your life it is constantly learning and adapting. This means patterns of thought and emotion are not set in stone. They can be altered. Therapy targets the patterns that are harmful and essentially trains your brain to choose different ones.

In this way, therapy is simply another form of learning aimed to teach you about yourself as you replace bad mental habits with healthy ones.

A participant, not just a person seeking help

Therapy comes in many forms, and therapists have long-running debates about which methods work best. What’s clear, though, is the success of any method calls for effort and motivation by the person undergoing therapy. In cognitive-behavioral therapy (CBT), you can expect to get homework assignments. In all types of therapy, the goal is for the person to gain self-knowledge and to act on it. First you learn, with the therapist’s help, why you think and act the way you do. Then you do the work of changing. “The goal is to teach patients to become their own therapists,” says Judith S. Beck, Ph.D., President of the Beck Institute of Cognitive Behavior Therapy.

Research shows therapy works best with “extra-therapeutic” supports. These include motivation from family and friends, and from life events (such as changing jobs) which happen during therapy. Then there is the quality of the relationship between person and therapist, the choice of method, and the person’s own level of hopefulness. Therapy can involve just the therapist and you. Successful therapy often includes the support of family, friends, and community.

From intake to outcomes

Therapy often starts with an assessment followed by a diagnosis and treatment plan. Clients may fill out a health history questionnaire including questions about home, work, life, relationships, parents, partners, and other factors that affect their emotional life.

The therapist and client may decide on focused goals like: “Improve depressed mood by engaging in at least one pleasurable activity each day and sleeping no more than eight hours per day.” (Goals of this kind are typical of CBT.) Or they may be more wide-ranging, like learning how to have healthy relationships. In any case, both the therapist and person in therapy need to keep the goal visible and be able to reach it.

This “intake” process, as it’s sometimes called, is followed by scheduled sessions of 45 to 50 minutes.

What happens in and between those sessions will depend on the therapy method. The therapist may ask frequent questions to reveal issues and habits of thought the client had not noticed. This “Socratic questioning,” is important in CBT. In other forms of therapy, the therapist may mostly listen and let the person talk. This can include free association for which the therapist steps aside and lets the client say whatever comes into his mind.

Between sessions, especially in CBT, people can be given tasks which support the work they are doing with their therapist. An unhappy and anxious person who is out of work, for instance, might submit a job application as homework.

Time and progress

How long your therapy takes will depend greatly on the diagnosis. In CBT, says the Beck Institute, uncomplicated cases of anxiety or depression might need only six to 12 sessions. More deep-seated or long-term problems, such as bipolar disorders, can take many more. Some other methods take longer than CBT. Treatment for some complex problems, for instance, can go for many years. The major thing is to have realistic expectations from the start. And that comes when you and your therapist set the right goals in the right amount of time.