What’s Therapy REALLY Like?

So, let’s bust some myths right from the beginning:

• you aren’t going to lay on my couch

• unless your mother is relevant to your presenting problem or what you want to discuss, she isn’t going to be the focus of our time together. 

You are going to be doing a lot of the talking. Oh, and there’s going to be homework, too. 

The image of a person stretched out on a couch, staring at the ceiling, was at one point accurate. In the early days of therapy, sessions with a psychoanalysis typically looked like that.

There are still therapists today who utilize psychoanalysis or who call themselves psychoanalysts, and those do still use the couch sometimes. 

But overall, as other approaches have expanded, most modern-day psychotherapy sessions involve you sitting upright in a comfortable chair or couch across from your psychotherapist in a matching or similar chair. 

There is also a growing use of online or virtual therapy.

While there’s some debate within the field as to the pros and cons of this approach, many find virtual therapy to be a more convenient, accessible option.

Here in Ontario, we have the Telehealth network for a variety of healthcare services, and many psychotherapists were able to utilize it to transition quickly from in-person to online at the start of the COVID-19 pandemic.

And while I personally think that only hearing a client’s voice, or dealing with technical difficulties, or missing some of their body language isn’t ideal, being able to provide services to those who could never have utilized them otherwise makes it more than worth it.

Now I can’t tell you exactly what your therapy sessions will look like. That is going to depend on you, your presenting problem, and your therapist. 

Psychotherapy typically follows the 50-minute, weekly format, but not always. It’s important to discuss your goals and expectations with your therapist as early as possible, preferably before or during your very first session. 

To put it simply: therapy is a space for you to talk and work through things that you are struggling with in your life. 

Your therapist is there to ask questions and guide that conversation as needed, or observe patterns or points that you might want to consider or think about. My goal as a therapist is to help you come to your own conclusions and to make sense of your circumstances. 

Think of it like this:

you have a ball of tangled yarn. In talking things through, that yarn begins to unravel, and you realize that there may be several different strands in that ball that you can now begin to gently pull on to detangle it.

This also doesn’t mean that we’re going to dive right into your childhood. There might be times when it’s relevant and comes into the conversation, but typically behaviour or cognitive approaches to psychotherapy don’t rely on relating every little thing to your past.

And most importantly, you set the boundaries. Your therapy sessions are your time to talk about what YOU want to talk about.

Your therapist is there to listen and teach you coping strategies. This is where the homework comes in. Psychotherapy isn’t massage therapy: you can’t come in, have it done and feel amazing, and then do nothing until your next appointment.

I mean, you can, but you won’t get as much out of it. 

Psychotherapy involves putting what you discuss in session into practice in your life. It’s about actually utilizing the techniques and strategies, and then reflecting on their impact on yourself and your life.

And lastly good therapy doesn’t always make you feel good. Sometimes it’s uncomfortable and hard, and that’s okay. But if it’s consistently causing you distress, that’s something you need to discuss with your therapist. 

Your feedback about their approach and your sessions is SO so important for good therapy. You and your therapist are collaborating, and if that isn’t working, it needs to be addressed as soon as possible.