There's plently of research evidence out there that shows that therapy can help people. But we also know that it helps some people more than others. Just why that's so is a complex question that I can't explore thoroughly here. But I can say that a lot of research indicates that two of the most significant factors in effective therapy are the quality of your connection with your therapist and your own contribution to the work. This isn't to say that therapists don't have their share of work to do -- they certainly have immense responsibility -- but they can't do it all for you.
That second factor -- the client's contribution -- isn't so clear or well understood. And it often raises another question: "How do I know whether I'm doing what I need to do so that I'm not wasting my time in therapy?"
Before I go on I should clarify that the sort of therapy I'm referring to isn't directed or based on a manual. It's called psychodynamic, psychoanalytic or depth psychotherapy. This is traditional talk therapy as opposed to cognitive and behavioral therapies, in which the client is given specific directions. While cognitive and behavioral models have their benefits, many people prefer depth therapy because it makes space for thoughts and feelings to rise up organically, because it aims to get to the root of problems, and because it aims to promote growth by working with the entire personality rather than focussing on the eradication of specific symptoms.
But there's a potential problem with depth therapy: while there's substantial evidence that it can be effective, if we aren't mindful we may wander, losing focus and diminishing efficacy. Yet most people going to therapy have little sense of what they need to do to keep it from wandering, of what they actually need to focus on. They know that therapy takes work -- but just what that work entails they'd be hard put to describe. As one man said to me "I tell my friends that I'm working on it in therapy, but to be honest, I have no bloody idea what that really means."
Therapists do try to explain what it means to work in therapy, but it's difficult to describe briefly how the process works, and delivering even a short discourse in session can be disruptive to the natural flow of the work.
The content of therapy -- the specifics of what clients talk about in sessions -- differs widely from person to person, and can't be prescribed. But the process of therapy -- the how -- includes essential practices that are helpful to be aware of, whether it's depression, anxiety, relationship issues, addictions, general well-being or other issues that bring you into therapy. These tools, as I call them, constitute the heart and soul of "working on it" in therapy. (I describe them in depth in my book, I'm Working On It In Therapy: How To Get The Most Out Of Psychotherapy. You can also find a sample chapter at this link.)
Learning to use these tools consciously helps clients who have engaged in depth psychotherapy continue to benefit from the process long after they've stopped seeing their therapist. These tools are no secret, yet they are not well known.
So here's my answer to how not to waste time in therapy: take an active role in making it work for you by using the following 10 tools in your sessions:
1. Get real: Take off the mask and show your many faces.
2. Channel the flow of feeling: Have your feelings without your feelings having you.
3. Enough about them: Look deeply within for the sources of change.
4. Don't hold back: Forge an authentic connection with your therapist.
5. Be curious, not judgmental: Observe yourself honestly without attacking yourself.
6. Carry your fair share, and only your fair share: Differentiate when to take responsibility and when not to.
7. What's your story? Identify the recurring themes and fundamental beliefs that guide your life.
8. It ain't necessarily so: Build a better narrative and choose your beliefs consciously.
9. Do something! Continue your psychological work outside of sessions.
10. Into the fire: Use the challenges of your life as opportunities for growth.
If you are using even a few of these tools, you are probably making good use of your time. But these short descriptions may raise more questions about whether you are using them, so I'll be describing some of them in more detail over the next five weeks.
I want to be clear that I'm not recommending that anyone rush through therapy; there is evidence that longer stays in therapy result in longer lasting change. However, I would like to help people to use their time in therapy more effectively.
And please don't take any of my suggestions as "should" or as rigid imperatives. You and your therapist may have your own way of approaching therapy; my intention is not to challenge that, but rather to deepen and complement the work you are doing. If there appear to be discrepancies between what I suggest and what's happening in your work with your therapist, speak with him or her about it. Discussing what's happening in your sessions can be some of the most valuable work you do there.
I'll be curious to hear what others have done to make therapy effective. Please leave a comment and let us know.
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