Great question! You’re looking for a “match,” meaning someone who practices psychotherapy in a way that sounds beneficial and intriguing, who listens and understands you, and who inspires you to work hard, be vulnerable, and make changes. Also, it doesn’t hurt if you find your therapist at least a little bit funny, interesting, exciting. Psychotherapy is a time consuming, emotionally demanding, expensive process, but it doesn’t have to be a miserable slog. If you find the right therapist, psychotherapy can also sometimes be—dare I say it?—fun.
Barring vacations, emergencies, and illness, go to every session. This is a special period in your life when you commit time, energy, and money to a transformational project. So for now, prioritize your therapy. Your mind evolves every day, and psychotherapy accelerates and empowers this natural process. But your therapist may have only 45 minutes per week to challenge the conditioning of decades. Also, your attendance impacts your relationship with your therapist. You said you would come every week, and your therapist took you at your word. So come.
Pour your heart out. Be honest. Don’t censor yourself. Say whatever comes to mind. Allow your speech to stumble. Search for the words. Find them or let yourself keep looking. And if you need help, ask for it. Tell your therapist you’re not sure what to say, and he or she can you help you get started.
You may want to bring a notebook and a pen to write down an important idea or homework assignment. Also, feel free to bring notes, journal entries, drawings, stories, art, etc., and definitely your dreams. If your therapist gives you a form to complete at home, try to return the form in the next session, as it may be important to your care.
Try to strike a balance between being prepared with a subject you’d like to discuss and remaining open to spontaneous detours. Eventually, you may realize it’s hard to go “off topic” or really change the subject because a good therapist can see connections between whatever you’re talking about and the larger issues you’re facing. Also, since expressing emotion and processing difficult memories are standing goals in most psychotherapies, your therapist may propose pausing a discussion so that you can free associate, i.e., sit quietly for a moment and allow some space for pertinent emotions and memories to surface.
Some people really seem to enjoy saying that they don’t—perhaps this lets them off the hook to change themselves. But yes, people absolutely change. I see it all the time. You can change, in ascending order of difficulty, your thoughts, beliefs, emotions, behaviors, and personality. Making these changes within yourself will encourage you to make changes in the world around you: in your romantic and familial relationships, work, hobbies, creative endeavors, and maybe even on larger scale social or political issues. Changing yourself may also allow you to better accept aspects of life that do not change, like past mistakes, illness, loss, tragedy, and mortality.
Well, let’s be clear. In therapy, you’re not just talking. You’re having an open, honest conversation with an empathic person who listens carefully to what you’re saying. You in turn are listening to the therapist’s responses and earnestly considering whether to incorporate those responses into your way of being. When psychotherapy doesn’t work, it’s usually due to breakdown in that process.
Having an open, honest conversation about a subject—whether a recent experience, future event, memory, emotion, dream, desire, or person—changes your relationship to that subject. You are no longer alone with it; now another person is with you. The presence of another person may help you feel soothed, encouraged, empathized with, and understood. As a result, you may be able to take a different perspective on the subject and experience less shame and anxiety—two emotional additives that simply ruin life.
To be clear, not all painful emotions are “bad.” Sadness, guilt, and worry are natural, important parts of being a human, and can lead to useful, informative, and deep experiences. But brutalizing self-shame and obsessive, ruminative anxiety contribute nothing and are extremely detrimental to living a full life. Shame and anxiety may be understood as aspects of a poor, non-empathic relationship with yourself. An open, honest conversation with your therapist that takes into account all the complexity of what you’ve been through in life can serve as a model for a healthy relationship with yourself. Actually being with yourself may be an enormous change and encourage the other important changes you’d like to make.
If your therapist asks you for a memory from childhood and nothing comes to mind, that may mean you really have no memory. Alternatively, it may mean that your childhood was painful enough that your experiences were “repressed,” i.e. removed from conscious awareness. This is especially likely if you thought, as children often do, that you were to blame for the situation. One of your therapist’s primary jobs is to help you overcome this type of amnesia. The more you talk about the past, the more memories will return.
Processing painful of childhood experiences isn’t about some homeopathic discharge or cinematic catharsis. It’s about reconsidering those experiences from an adult’s perspective. For example, as you tell the story of your childhood, we may discover that you blame yourself for what happened and believe you were a “bad kid.” Thus, you may be harboring a sense of essential badness that is incredibly painful and wholly unwarranted. Also, in general, we need to talk about your history so we can understand how you may be repeating it. Unless you pause to reflect, you may automatically live your life within in the constraints set by your early environment. A solid map of your past will help us understand the limits of your present course and help you expand into new territory.
This is one of the most challenging subjects you will encounter in psychotherapy. A lot of patients struggle with the issue of whether the suffering they experienced in childhood is relevant to their current mental health and whether that suffering counts as “trauma.” When therapists say “trauma,” they may mean “gross trauma,” i.e., an shocking event or series of events that were particularly damaging to your sense of safety, like abuse or tragedy. Therapists may also mean “complex trauma,” i.e., a prolonged period of adversity or neglect during which your suffering became normalized.
I believe you when you say your parents loved you, and I’m glad you didn’t experience gross abuse or tragedy. But if you’re suffering now for reasons you can’t explain, it may mean that as a child you had certain needs that your parents didn’t recognize or couldn’t meet. Experiencing your parents’ love as inconsistent may be enough to cause significant pain to a child. (bell hooks in All About Love does a particularly good job of explaining this.) So even though your parents did their best, it may not have been enough to protect you and help you thrive. As a result, you may feel anger at them and deep disappointment, as well as love and empathy for their own histories and struggles.
Clearly this is a complex issue and deserves a full discussion, but here’s one more idea for your consideration: as a culture, we do a terrible job of empathizing with children’s pain. I think we struggle to recognize just how difficult childhood can be, especially when caregivers are limited or unavailable. So you may be looking back at your younger self without adequate empathy for what you went through. All I’m asking is that you consider a kind and forgiving orientation toward your younger self who may still be suffering.
That may be true. But if I ask what you’re feeling, it’s probably because something you said suggested the likelihood of an emotional reaction. I may have even see the emotion on your face or heard it in your voice. So take a moment. Are you sure you don’t feel anything? And even if you don’t, let’s not assume emotion is fully absent. Just like memories, emotions can be repressed. To hold emotions out of awareness is a huge waste of energy and may be the cause of many psychiatric symptoms, particularly anxiety. Part of you knows something is wrong, but due to the repression, you’ve lost the ability to understand what the emotion is trying to tell you.
