What to expect when you see a therapist

I hear my friends talk about seeing a therapist…to whom are they referring? 

When people say they are consulting a therapist (or shrink), they mean they are seeing a University-trained mental health professional who is either a Psychiatrist, Psychologist, Social-Worker, or even a Mental- Health Nurse. These people are well-educated in a range of psychological areas, are experienced in dealing with a variety of difficulties and types of people, and they are usually required by law to be registered by a government board and/or a professional association.

Checking out the person online is easy, as most boards and associations have websites with practitioner lists, and therapists often have their own website. Most therapists will give you an Information and Consent Document at the first session, which outlines their qualifications, affiliations, experience, expertise, fees, and so on. 

Are psychotherapy, counselling, and therapy different things? 

No, not really. They are simply different terms used to describe the process whereby a therapist facilitates the development of self-exploration, insight and emotional awareness as they work together with a patient toward an agreed goal. Remember that therapy is for individuals, couples, families, and groups, depending upon need and context. 

What kind of therapy will be best for me or for the problem I have? 

Therapists work in different ways. Some are very insight-oriented, while others are quite action-oriented. Some will be problem-focused, whilst other therapists become solution-focused reasonably quickly. Some therapists say very little, preferring to listen and reflect. Others are very interactive and analytical or educative. Whatever your therapist's personal style, theoretical approach or type of training, what is critical is that you can form a warm, close relationship with them, that you feel comfortable exploring the relevant issues in your life, and that you reach the outcomes you are after.

A collaborative and harmonious relationship may be more important than the specific type of therapy used. Whatever way you look at the process of therapy and styles of therapists, there are two things all therapies have in common; therapy helps you change how you think, feel or live; it also gives you hope. So it is hard to know what is best for you until you think about your preferences and try it. 

How do I find a good therapist? And how much do sessions cost?

We get recommendations if we are seeking a new restaurant or car mechanic. Finding a therapist should be no different. Ask the people you know for the name of any therapist they have seen or heard about. Particularly seek the advice of your family doctor as they will possibly be referring you to the therapist anyway, and hopefully, they know you and the therapist fairly well. You can find names of therapists on websites of professional associations. This can be very useful as you can find someone who is close to your home or work, or who has expertise in your area of concern.

Fees for sessions will vary depending upon profession, training, expertise, and location. The fee may range from about $160 to $260 per one-hour session. A psychiatrist's fee is usually more, given their medical training and the nature of their expertise (remember, they are the only therapists who prescribe medication). Often fees attract a rebate from private or public health funds, or sometimes organisations have schemes whereby therapy can be accessed at no cost to the employee.

What should I do if I don't like the therapist I go to, or if they aren't helpful? What do I do if I have a complaint about a therapist?

Just in the same way you wouldn't return to a mechanic who doesn't listen to you or who isn't able to help with your problem, you will probably end up leaving a therapist you think isn't interested in you and isn't helpful. First, try to attend a couple of sessions to enable the therapist to find how best to treat you and get a clear sense of what you are after. Next, discuss with them if you don't feel heard, or you don't like their style and be upfront about what you prefer and what it is that you want to work toward. Even therapists need reminders sometimes to stay on track. Then if you continue to not get what you are after, find someone else to see.

Just because one therapist wasn't helpful, does not mean you should give up on your desire for change. If you have significant concerns about the professionalism of your therapist, discuss this with them (if you feel comfortable enough), or contact their registration board and/or professional association if you think they have been unprofessional or unethical. These bodies will be able to guide you on whether or not you have cause for concern and possible next steps.

I have talked to friends and talking hasn't helped, so why would talking to a therapist, a stranger, help? How do I know I need to see a therapist and for how long will I see them?

Cultures have survived for a long time without therapy. For the most part, people solve their own challenges and talk with friends, family and colleagues for help. These are the people you get friendly support and advice from, but sometimes that's not enough to overcome your challenges. Occasionally individuals and couples find their resources are low or the challenge is significant, and they need the support and guidance of a professional to help with important concerns. So they see a therapist who they know won't judge them and who has the expertise to help.

A therapist helps you clarify what is really going on and finds a way forward that friends and family haven't been able to. Also, people are able to talk to a therapist in a way they can't with the people they are close to, as the therapist doesn't have a personal vested interest. Most people need only a few sessions to achieve the relief, self-awareness and problem solving they are after, while others require many sessions over an extended period of time. Ask your therapist how many sessions they think may be needed to sort through your issues. Remember that you are in control and may end the therapy process whenever you want, and you are not crazy because you see a therapist, you simply need more or different help than what others can provide.

Will a therapist tell me what to do?

Typically no. As they help you to understand your issues better, and you get to know more about how you operate, you will work out what it is that you want to do for yourself. Sometimes therapists will give you suggestions or tasks that will help you get back on track in a way that fits with the person that you are, or the person you want to be. Sometimes a therapist will be very explicit about what needs to be done, usually only if you are in a significant crisis or a high-risk situation. What is more common is that a therapist will want you to make your own decisions so that you have ownership of the plans and responsibility for outcomes. It should be noted that with some issues a therapist will teach you particular skills that will help you.

I am not sure how therapy starts….what will the first session be like?

I am a bit nervous. It is normal to have some doubts and fears about the first session. You are about to share some fairly important personal information with your therapist, and they will be trying to get a good understanding of the type of person you are. Be open and honest about your issues. Know that the therapist is also a little anxious to do a good job so that they can be helpful, and that you return to continue the important work toward your goals.

Is what I say to a therapist really private and confidential?

Yes (and No). You should feel comfortable that whatever you are talking about with your therapist will go no further, just in the same way when you talk with your doctor, a priest or best friend. Without being able to trust your therapist, the helping process would be compromised and it is their responsibility to create an atmosphere and relationship that makes you feel cared for and safe. The only time a therapist will breach confidentiality and this rarely happens, is if it required by law (e.g., perhaps in cases of abuse, or if there is an order from a law court or an insurance company), if you or another person is at serious and imminent risk of harm, or if the therapist needs to report back to your referring doctor. Therapists are very good at keeping secrets and your personal stuff will generally stay only with them.

How can I get the most out of my therapy?

Lots of research has shown that therapy works in helping change people's lives, so you can relax in the knowledge that it is a proven process. Because therapy is expensive and time-consuming, you can maximize your time in therapy by being ready and committed to talking openly and frankly about your concerns. Trust and faith are central to the relationship and process. Take some risks to challenge yourself to look at new ideas and to do things differently between sessions.

Your therapist might suggest books or courses as an adjunct, so be receptive as you would with your doctor. Develop a system of people around you who are supportive of you improving your life. Some people find keeping a journal helpful during the process of therapy as they reflect each day on what they are getting from the therapy, and what they are experiencing in their lives. Finally, be patient as you work hard to make changes; it may not be easy but it is possible and worth it.

What if I experience a crisis during the time I'm seeing a therapist?

If the crisis is life-threatening then you should call an ambulance or the police for assistance, or go to the Accident and Emergency Department of your closest hospital. You should let your therapist know what has happened after you are safe. There are support services for people with specific significant needs who experience a crisis between sessions. You can discuss these options with your therapist in session as the need arises.

As a therapist how is it that you don't get affected by your patients' troubles and traumas?

This is a great question, as helping people through tough times can be difficult. What I enjoy about providing therapy is being able to use my curiosity about people's lives, seeing how they cope, connect with them, and watch as they grow and develop using their resources. Although the stories I hear are often quite distressing, and the therapeutic relationship can be intense, I know therapy is a time-limited connection, that my role is to facilitate healing, and not to be unduly concerned for people's wellbeing. I know that people who have problems are still quite resilient and have lots of capacity for self-care.

Outside of the therapy room my quality relationships, diverse interests, and support from colleagues ensure that I stay in good shape personally and professionally so I can continue to do the work that I enjoy without being significantly negatively impacted.