How to Get the Most Out of Therapy
By Peggy Loo, PhD
Getting to therapy can be quite the process. After weighing the pros and cons for therapy, navigating a therapist search, an introductory consultation, and finally - a weekly time and day added to your calendar. You’ve made it, and real congratulations are in order for persevering through all the steps to get here.
It can be understandable that at this point you may want to defer to your therapist to take the lead (if simply to catch your breath!) There are also sociocultural and historical underpinnings to this default role. We’ve been introduced to psychotherapists as “blank slate” analysts behind a couch with a notepad or as white coat psychiatrists in a hospital wing (also with a notepad). Both the psychoanalytic and medical context for therapy don’t immediately make people see themselves as proactive collaborators in deciding how their sessions go. These frameworks still exist and work for some, but they don’t represent how all therapists work, or how you have to approach your own therapy if you’re hoping for something different.
Part of our social justice approach to therapy at Manhattan Therapy Collective is to empower our patients by sharing what we know and encouraging mental health literacy for all. We don’t believe that only mental health professionals can or should be highly knowledgeable about mental health. After all, if everyone had the opportunity, information, and support needed to take small steps towards improved physical health, the ripple effects would be apparent - not just in individual lives, but in families and communities. We believe the same is true for mental health- when we empower one person through supporting their emotional wellbeing, it can make a difference across multiple lives. So we are just as invested as you are in making the most of the opportunity to be in therapy.
So how do you make sure that once you’re in therapy, that you get the most (or more) out of it? Here are some tips that I share with my own therapy patients as a full-time psychologist in Manhattan.
Six practical tips about how to get the most (or more) out of therapy
Tip #1: Ask lots of questions.
Don’t be afraid to ask questions. It can be about mental health in general, how your therapist works, or why they may be introducing a particular discussion topic or exercise in session. We don’t believe in operating like the Wizard of Oz behind a mysterious curtain - we want you to understand whatever you have questions about and experience what you’re hoping for out of therapy. You may have asked questions during an introductory call, but I encourage you to keep asking questions throughout your sessions.
Tip #2: Identify and share your short-term goals.
Setting goals creates intention and direction for therapy. Think about what you’d specifically like to see change or feel different as a result of being in therapy. When you start therapy, it can feel like you may want a lot to change or it may feel daunting to imagine the process. Feeling overwhelmed is understandable, but picking 1-2 short term goals you’d like to take actionable steps toward in the first few months is a great start. If you’re unsure how to narrow your focus down, talk about your ideas with your therapist. You might want to reflect on what would impact you immediately or mean the most to you if you could make progress with weekly support. Having achievable goals can create a unifying thread between sessions, especially if you feel like you tend to hop from one topic to another each week or struggle to decide what to talk about. Knowing your goals can also help your therapist listen to whatever you share with your overarching intentions in mind. If you’ve met your goals, brainstorm new ones!
Tip #3: Make peace with your starting point.
If you happen to be a high achiever or perfectionist, sometimes unrealistic expectations can get in the way of making the most of therapy. For example, I often work with adults that want to respond differently to strong emotions because the way they tend to respond doesn’t serve them well in their personal life, career, or relationships. A first step I may take as a therapist is to help build the skill of observing and naming a range of feelings, prior to making any specific changes to how they respond to strong emotions. This is often a crucial building block for later choosing a more helpful response when feeling a lot. It can be easy to be impatient or want to skip steps in the hopes of making faster progress in therapy. Or you may notice yourself feeling self-critical about whatever your first step or starting point is, especially if you’re used to advanced levels of achievement. Adults can struggle with being a beginner, because it’s something we often associate with children. However, openness to a beginner’s or growth mindset is an incredible asset in therapy and is often key to the progress you’re hoping for.
Tip #4: Reflect on your preexisting ideas about emotions or vulnerability.
Regardless of what brings you to therapy or the therapy approach your therapist takes in your sessions, it’s inevitable that talking about your emotions or experiencing them during session will come up. Your emotional world is a vital part of who you are and taking care of your wellbeing. We all come to therapy with assumptions about emotions or what it means to be vulnerable, both positive and negative, from our caregivers and upbringing. Furthermore, our inherited views are shaped by our multicultural identity. For example, generational, cultural, gendered, and racialized messaging will influence whether you find sharing or showing your emotions a welcome opportunity or discouraged. Bearing this in mind, it can be really helpful to reflect on beliefs that interfere with you being able to talk openly or honestly about yourself in therapy. For example, what comes to mind when you think about telling someone you’re feeling sad, or being sad in front of someone? Angry? Hurt? Working on your relationship with your emotions may be the reason you're interested in therapy, which is great! But if not, and you’re noticing yourself holding back - it can be clarifying to see if some assumptions are getting in the way of getting more out of therapy.
Tip #5: Create habits that support your therapy sessions.
Think about what your habits and preferences are when you exercise. Chances are, you have your own approach. Some people prefer a light snack beforehand or have invested in specific athletic wear that helps. Some work out to a personalized playlist. Others have a post-exercise stretch routine or schedule an “off day” the following day to let sore muscles recover. The same can apply in therapy! While showing up on time for your sessions may be all you need to get what you want out of therapy - if it’s not, that’s perfectly okay. This may mean experimenting with habits that support you being focused and present in session, your memory of what was discussed, or the days between sessions. For some, this may mean you purchase a notebook for sessions so you can jot down topics you want to remember for later. You might want to download a mood tracking app if you have trouble recalling how you’ve been feeling by the time you get to your Friday session. Depending on what you’re working on in therapy or what you notice comes up, establishing a post-session habit like taking a quick walk or staying off your work email for a few hours may help you move through the rest of your day adaptively. Habits can be kept simple and tailored to what works for you.
Tip #6: Talk with your therapist about establishing check-ins.
It’s healthy in every relationship to reflect at some point about how it’s going, separately and together. Do you feel like you’re on the same wavelength and understanding each other? Or would a clarifying conversation help you reconnect? The same is true for your relationship with your therapist. It can be helpful to set up a check-in every so often to bring up any ideas, questions, or concerns that may be on your mind about how therapy is going - but may not get air time in session. Here at Manhattan Therapy Collective, we uphold a social justice orientation to the practice of therapy - which means that instead of recreating unnecessary power differentials, we work towards empowering our patients and strengthening genuine collaboration. Your therapist may ask every so often how you feel like therapy is going - but if you prefer a more regular check-in, don’t hesitate to ask!
About the Author: Dr. Peggy Loo is a licensed psychologist and founding director of Manhattan Therapy Collective. She loves working with first-timers and all-timers to therapy with her dog Hamilton.