Entering therapy is often a big deal. It can take a lot of time, money, and mental space, so of course you want it to work. But how does it actually work? What makes therapy effective? In this post, I am not going to talk about evidence-based practices and treatment approaches (e.g. EMDR, CBT etc) but will try to shed light on the dos and don’ts for getting the most out of your time in counseling.

Let me preface this post with something useful I learned in graduate school: Research has repeatedly shown that the two most important factors that contribute to change in counseling are 1) extra-therapeutic factors (i.e. client’s knowledge base, social support, life experiences, strengths, abilities, readiness to change, ego-strength etc, accounting for 40% of change) and 2) the therapeutic relationship (accounting for 30%). Model/techniques and hope/expectancy each contribute 15%. So the change you are looking for in counseling is mostly up to you and me (and our ability and willingness to accept other helpers).

As a therapist, I take my part in this seriously. What I bring to this, you can read more about elsewhere on this website. Let me here focus on what you can bring to make therapy work.

1. Be ready.

Ask yourself if you are ready to make a commitment to this work. Expect to spend at least twelve sessions, or four to six months on this. Test your readiness by meeting with a potential counselor. If you click with her or him, say yes and jump in. If you don’t, check in with yourself to see if you are up for meeting with another counselor. If you are not up for it, you may not be ready. Accept yourself for where you are at, and be kind to yourself.

2. Be curious.

So you are ready and have started therapy. Remember your first session? How curious you were about this endeavor, your counselor, what the office would look like, and how it would go? Yes, you had expectations, hopes (and maybe felt nervous); but amidst all this nestled an unassuming, innocent curiosity about it all. It said: Let us explore. Let us look around and not know. Let us be surprised.

Hold onto this curiosity as you go. It disarms judgment and criticism (two regular visitors in my office) and tills the ground of change. Change always has an element of surprise in it. Curiosity prepares the way.

3. Be honest.

Honesty is one of curiosity’s offsprings. Sometimes what you find is not what you want, and your curiosity lands you in the pit of shame or regret. Or you disagree with something your therapist just said. Shine a light on it. Give it voice and air. Honesty is the foundation of trust. When you are honest with yourself, you learn how to trust yourself. When you know how to trust yourself, change is on the way.

4. Ask for what you need.

This is part of #3. While we therapists are trained to put ourselves into our clients’ shoes, we are never 100% accurate in knowing what our clients need. (We may even be far off the mark.) I don’t always know or anticipate what you may need in a given moment. Do tell your therapist what is not working for you or what would be helpful. Don’t confuse commitment to therapy with compliance. Asking for what you need helps to strengthen the therapeutic relationship, i.e. you just made a 30% contribution to your factors of change!

5. Be patient.

A doctor once told me that bad things happen quickly, and good things take time. Therapy can be a good thing and so is intentional change. Neither happen quickly or in predictable ways. The psyche and soul don’t operate in digital time but they do operate. Trust this process and have faith. Saint Augustine said “Faith is to believe what you do not yet see; the reward for this faith is to see what you believe.” This doesn’t mean passive surrender. Patience and faith are action words. In fact, they are often difficult to practice, especially when the heart is heavy and another week has passed between sessions without a sense of change. If that is so, I feel for you and will, with your permission, keep faith on your behalf.

6. Get out of your way.

Life is complex, and so are our desires and needs. If you want to take the time, make a list of the top ten desires/needs you have. Here you can click on a helpful list to get started. When you have identified your top ten needs, eliminate all but one or two. Then compare the remaining one or two to the ones you came up with initially. Does your final selection conflict in any way with your initial needs (even in small ways)? For example, my need for solitude may conflict with my need for belonging, i.e. one may get in the way of the other. Know what is most important to you (while being aware that this is subject to change). Let this be your touchstone, your lighthouse, your way home.

6. Love yourself (more than therapy).

If you made it to this, you have come a long way. Actually, you may not need therapy anymore. This doesn’t mean that life won’t deal you any more challenges and hard times, but you have much of what it takes to weather them. One of my long term clients recently told me “I am finally starting to like myself.” She had a big smile on her face and we agreed that this was one of the best sessions we ever had. Make room for Love on the couch next to you, in fact, climb into her lap. She is waiting for you.