'What Actually Happens During a Therapy Session' And Six Other Common Questions About Psychotherapy

I'd like to address a few typical questions--and misconceptions--about what therapy is, and isn't, and how it works.
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Cape Town, South Africa
Cape Town, South Africa

When you take your car to the car mechanic, you know what's going to happen -- your car will get repaired.

When you break a bone and visit your doctor, you know what's going to happen -- your bone will be set in a splint or cast and eventually heal.

But when you make an appointment to see a therapist, what's going to happen?

Many people aren't quite certain. Will you talk? Will you be "hypnotized"? Will you have to discuss your childhood? What's the "point" of seeing a therapist, anyway? Why not just talk to a friend?

There is a great deal of uncertainty in our society about what actually happens during a therapy session, what types of issues and problems can be suitable for therapy, and the kinds of benefits that a therapy session can provide.

I'd like to address a few typical questions -- and misconceptions -- about what therapy is, and isn't, and how it works.

Q: Do I have to be "sick" or "disturbed" to go see a therapist?

A: No. While some therapists do specialize in severe emotional disturbances -- including schizophrenia or suicidal thoughts -- many therapists focus on helping clients work through far more "typical" or "everyday" challenges -- like mapping out a career change, or improving parenting skills, strengthening stress management tools, or navigating a divorce.

Thinking that one has to be "seriously disturbed" in order to see a therapist is a myth.

In fact, most of my clients are successful, high-achieving people who are quite healthy, overall, but who are challenged by a specific, personal goal -- like losing weight, creating more work-life balance, finding ways to parent their children more effectively, feeling anxious about dating again after a rough break up, and so on.

Just like some physicians specialize in curing life-threatening illnesses, while others treat "everyday" illnesses like flus, coughs, and colds, psychotherapists can serve a very wide range of clients with a wide range of needs and goals, too.

Q: How can I choose the right therapist for my issue / goal / situation?

A: Choosing a therapist is just like choosing any other service provider -- it's a good idea to visit the professional's website, read client testimonials or reviews (if they have any -- many therapists do not, for confidentiality reasons), ask friends and family members (or your physician) for referrals, and of course, check to see who is included in your health insurance network.

If you are hoping to work on a specific issue -- say, overeating, quitting smoking, making a career change, etc. -- try to find a therapist who has expertise in that area. Many therapists list their "specialties" or "areas of focus" on their website. There are therapists who specialize in relationship issues, parenting issues, anger management, weight issues, or sexuality -- pretty much most issues, goals, or situations that you can imagine.

If you're not sure about someone's zone of expertise, just call the therapist you're considering and ask, "Do you have experience working with people who [describe your situation or goal]?" The therapist you're contacting will let you know, and if they can't be of assistance, they may be able to refer you to someone who can.

Q: What actually happens during a therapy session?

A: Each therapy session is, essentially, a "problem solving session." You describe your current situation, and your feelings about that situation, and then the therapist uses their expertise to assist you in trying to resolve that problem so you can move closer to having the life you wish to have.

At the beginning of a session, the therapist invariably begins by inviting you to share what's been going on in your life, what's on your mind, what's bothering you, any goals you'd like to discuss--things like that.

You'll be invited to speak openly. The therapist will listen and may take notes as you speak (some therapists, like myself, take notes after the session). You won't be criticized, interrupted or judged as you speak. Your conversation will be kept in the strictest confidentiality. This is a special, unique type of conversation where you can say exactly what you feel -- total honesty -- without worrying that you're going to hurt someone's feelings, damage a relationship, or be penalized in any way. Anything you want -- or need -- to say is OK!

Some therapists (like myself) often give clients some "homework" to complete after a session. Depending on your goals, your homework might be to set up an online dating profile and bravely set up your first date, or exercise three times a week, or spend some time each day pounding a pillow to safely release pent-up emotions, or make a nightly journal entry, or any number of other "steps" and "challenges" that are relevant to your goals. Then during your next therapy session, you might give a homework-update, share your progress, and address any areas where you got frustrated, stuck, or somehow off-track.

Of course, every therapist is different, every client is different, and every therapist-client relationship is different, too. Which means that there is no universal description of a therapy session, either. Some therapists incorporate dream interpretation into their work. Others incorporate music or art therapy practices into their work. Others incorporate hypnotherapy, life coaching, meditation, visualization, role-playing exercises to "rehearse" challenging conversations -- the list goes on and on. Ultimately -- regardless of their approach -- a therapist will listen without judgment and help clients try to find solutions to problems or challenges that they are facing.

Q: Will I have to talk about my childhood?

A: Not necessarily. Many people think that visiting a therapist means "digging up" old skeletons from your childhood, or talking about how "awful" your mother was, and so on. That is a myth. What you talk about during a therapy session will largely depend on your unique situation and goals.

Depending on your goals, you may not talk about your "past" that much. The focus of your therapy more on your present-day reality and the future that you wish to create.

That being said, if you REALLY do NOT want to discuss your childhood, the intensity of your desire to NOT talk about it might suggest that, maybe, you should! When people have strong negative emotions -- about their childhood or any other topic -- it's typically worth doing some excavating to figure out why that is, because whatever is causing them to feel such strong emotions about the past is more than likely impacting their present-day life in some way, too.

Q: How long will I have to go to therapy?

A: This varies from person to person. I've had clients who booked one session we worked out their issue(s), and they were all set! They marched ahead and didn't need a follow up session. Sometimes, one brave, honest conversation is all that's needed!

Other clients have booked sessions with me over a period of several weeks or months, focusing on one issue, resolving that issue, then perhaps moving on to a different challenge. Then there are other clients who I've been working with for some time -- they appreciate having a weekly, bi-weekly, or monthly "check-in" to share their feelings, sharpen their life skills as needed, and perhaps enjoy a deeply nourishing, guided meditation or hypnotherapy experience to de-stress. As one client aptly put it, "Each time I meet with you every two weeks, I leave your office feeling like you pressed my reset button!"

Therapy is really about whatever a client needs -- a one-time conversation, a temporary source of support during a tricky life transition, or an ongoing experience to optimized health--physically, mentally, emotionally and spiritually.

Whatever frequency / duration of support is uniquely best for you, is what can be set up.

Q: Is meeting with a therapist over the phone -- or through video-chat -- just as effective as meeting in person?

A: That depends on your personality and preferences. In the State of Hawaii, where I live, doing therapy virtually, via video-chat (like Skype or Facetime) is covered by at least one insurer that I know of, making it a convenient option for people.

Many of my clients enjoy having some--or all--of their sessions via video-chat because it means they don't have to take time out of their busy schedules to drive, park, and so on. They can just close their bedroom or office door, pick up the phone or log in, and away we go! Very convenient.

Where feasible, I suggest trying out both ways -- do a traditional, in person therapy session and then do a video session -- and see which format is the best fit for you.

Q: Why see a therapist? Why not just talk to a friend or someone in my family?

A: If you are blessed with caring, supportive family members and friends, by all means, share your feelings, goals, and dreams with those people. They are a part of your support network, and their insights and encouragement can be very helpful!

However, people who already know you might not always be completely "unbiased" or "objective" when listening to you. For example, if you want to change your career, and you confess this dream to your wife, she may want to support you one hundred percent, and she may try her very best to do so, but she may also be dealing with emotions of her own -- fear, anxiety, thoughts like "How will this change our life?" "What about our income?" "Will we have to move?" and so on. These emotions could make it difficult for her to listen and support you objectively.

That's why working with a therapist can be so valuable. When you speak with a therapist, you have a unique opportunity to share everything you're feeling, and everything you want to create, without anyone interrupting you, imposing his or her own anxieties onto you, or telling you that you're "wrong" or that you "can't."

A therapy session is a space where you don't have to worry about hurting anyone else's feelings, which means you can be totally honest, which means that problems have the potential to be solved faster and with greater success. In the long run? That's better for you and for everyone else who's involved in your life, too.

To sum it up:

Therapy is a valuable tool that can help you to solve problems, set and achieve goals, improve your communication skills, teach you new ways to track your emotions and keep your stress levels in check, and help you to build the life, career, and relationships that you want.

Therapy is appropriate for people dealing with "severe" issues, as well as people dealing with more "typical" or "everyday" challenges, too. There's a therapist for just about every type of challenge, situation, goal or need under the sun!

Does everybody "need" therapy? No. But if you are curious about working with a therapist, that curiosity is worth pursuing! Consider setting up one or two sessions, keep an open mind, and see how things unfold.

You have very little to lose and, potentially, a whole lot of clarity, focus, self-understanding, and long-lasting happiness to gain.

Want to find a therapist in your own city? Here's a database--from the American Psychotherapy Association--where you might begin your search. Or log into your health insurer's website and search there.


Suzanne Gelb, Ph.D., J.D, is a clinical psychologist and life coach. She believes that it is never too late to become the person you want to be: Strong. Confident. Calm. Creative. Free of all of the burdens that have held you back--no matter what has happened in the past.

Her insights on personal growth have been featured on more than 200 radio programs, 200 TV interviews and online at Time, Forbes, Newsweek, The Huffington Post, NBC's Today, The Daily Love, Positively Positive, and much more.

Step into her virtual office at DrSuzanneGelb.com, explore her blog, book a session, or sign up to receive a free meditation and her writings on health, happiness and self-respect.

Disclaimer: This article is for informational purposes only. It is not a substitute for professional or psychological advice, diagnosis, or treatment. Always contact your qualified health provider before implementing any new personal growth or wellness technique and with any questions about your well-being.

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