Why should I talk to a therapist instead of a friend or family member?
Therapists are required to maintain confidentiality, which means they keep your conversations private. They are ethically and legally required to do so.
Sometimes friends and family members have their own specific interest in guiding you a certain direction in a conflict, not out of malice but as a part of your family or friend system. Especially if what you as a client are grappling with involves your family or friends, it is best to get perspective and insight from somebody who isn't involved in the issue that you're seeking help with.
Therapists are also trained to see patterns and themes that emerge in people's narratives, which friends and family may not be able to notice. Recognizing unhelpful patterns in one's own behavior and thoughts can help you change them.
A lot of times I hear people expressing worry about sharing personal details of their life with a stranger. Just like making a new friend, getting to know a therapist is a process that takes time, and therapists are used to developing new relationships and establishing trust. They will guide new clients in this process and are accepting of any discomfort or questions that clients have along the way. Therapists hold clients in unconditional positive regard. This means they won't judge you for bad-mouthing someone else or having thoughts or feelings that others might not approve of.
How do you know when you should go to therapy?
What I would tell a friend is that it's best to see a therapist when several areas of your life have become unmanageable or significantly stressful for you. If you feel dissatisfied or sad with friends, at work, at school, and or at home, and the ways you have been trying to cope aren't sufficient, I would seek professional guidance.
Any combination of these things could mean it’s time to seek professional support:
Falling behind in schoolwork or having difficulty completing tasks on time at their job.
Snapping at their children more often because they aren’t sure how to manage their own stress.
Feeling themselves growing emotionally distant from their partner, friends, and family.
Not sleeping well, forgetting important events or dates, and often feeling on the verge of tears.
Dealing with feelings about moving to a new home, losing a beloved pet, or a friend or family member who has a chronic illness.
Isolating themselves because of a loss of interest in socializing or new anxiety that comes with talking in public spaces.
What to expect during your intake appointment and beyond?
At your first appointment, the therapist will discuss some “housekeeping” items - length and frequency of sessions, communication expectations between clients and therapist, policies of the practice, where to park, etc.
Depending on the therapist’s flow, they may ask you a prescribed set of questions to begin to get to know you - tell me about your family, work, friends, home life.
They may instead ask you what is in the forefront of your mind, and if you’d like to talk about that today.
The first 4 or 5 sessions will address issues that bring you to therapy, but also will serve to begin to build rapport - that is, build a trusting, honest relationship between you and the therapist, nurturing your emotional safety, which enables you to share things that you may or may not share with anyone else in your life.
It’s okay if you spend the first several sessions doing most of the talking! Some clients apologize for this, but it’s your time! If you need to say things out loud to understand them better, or let someone else bear witness to what you have experienced, that is okay! Some therapists talk more than others, and it is important for you to say in each session what your preferences are.
It is best to come to each session with ideas, written or otherwise, of what you’d like to focus on that day. It can be a continuation of what was discussed previously or something new that is troubling you.
How do I make sure I get the most out of therapy?
It is true when people say, “You get out as much as you put in.” This means if you’re coming into therapy, not sharing the scary things or the things you feel judged by others about, you won’t get much out of the time and energy you spend. Because some people are new to therapy, they might not know “what you’re allowed to say to the therapist.” You can say anything!
The only limits of confidentiality (the only things therapists aren’t allowed to keep private) are statements about:
a client being aware of child or elder abuse
engaging in the abuse of a child or elder
planning to harm themselves or someone else
A good therapist shows clients empathy, validates their difficult emotions and choices, and helps them identify alternatives to things they would prefer to do differently next time. A good therapist doesn’t use guilt, shame, or blame.