What to Expect from Psychotherapy

Taking that first step and calling a stranger to help you isn’t easy, even if friends of yours told you that doctor so-and-so helped them. It’s natural to want things in your life to improve quickly after you’ve made that tough decision to see a therapist.

Unfortunately, change takes time and it’s far from a linear process. By that I mean that part of the process of psychotherapy is taking a good hard look at some pretty unpleasant things. It’s not uncommon for people to feel worse—often far worse—before they start feeling better. Also, many of the things that drive people into a therapist’s office are problems that have been with them for a very long time. It simply isn’t realistic to expect a problem that’s been haunting you since you were fifteen to disappear in a few weeks. Beware of practitioners who promise quick cures.

Against that backdrop is the hard-but-true fact that all change is mediated by clients. By that I mean that your destiny is (and has always been) in your hands. A therapist can point out places where you trip yourself up. He (or she) can also help by giving you tools to deal with your problem areas. But, you are the one who will have to put those tools into practice. Change can be frightening. I’ve had many patients tell me that, while they don’t like their lives very much, at least it represents familiar ground; whereas, what I may be suggesting is truly unknown territory. For many people, it takes a leap of faith to try new things. So, we therapists generally start by suggesting small alterations, not major ones.

One caveat is that, as with any other personal service provider, not all therapist-client combinations work. If you’ve spent a couple of sessions with someone and things don’t seem to be “clicking” for you, bring it up. An ethical practitioner will discuss what they feel is and isn’t working between the two of you and is obligated to provide you with referrals if you decide they’re not a good match for you. It’s your time and your money. This is not a place to be shy and assume that there’s something wrong with you. I have never claimed to be the best psychologist for every patient. That’s something I discuss with all new patients, bringing up how our personalities are blending often in the first few sessions.

Another realistic expectation from psychotherapy is absolute confidentiality. This means that your practitioner cannot discuss any aspect of your care with anyone without a signed release of information from you. There are a few exceptions to this that include if your practitioner believes you are an imminent danger to yourself, or a danger to someone else, they can take appropriate steps to protect you or your named victim. Other than that, your practitioner shouldn’t reveal anything to your wife/husband/friend or anyone else who might call them. In fact, your practitioner should refuse any such calls since they cannot even reveal that you are their patient.

If there are other aspects of expectations around psychotherapy that you're curious about, email me. I'll do my best to answer.