Below two seasoned psychologists debunk common myths about psychotherapy and offer pointers on making the most out of therapy.

Misconceptions and Concerns About Psychotherapy

According to Ryan Howes, Ph.D, psychologist, writer and professor in Pasadena, California, “Some clients expect their therapists to give them direct advice, telling them who to date and what to study and when to break up.” It’s easy to think this way considering that TV therapists dole out advice without hesitation. “But most therapists resist giving advice because they believe it’s better for the client to learn to solve their own problems,” he says.

Clients also worry about what others will think. They wonder what’ll happen if their co-workers or friends find out they’re going to therapy. They might automatically assume others will think they’re “weak, flawed [or] crazy,” comments Chicago psychologist and life coach John Duffy, Ph.D. In reality, though, “More often than not, people tend to be very supportive,” he says. Plus, it’s up to you who you tell about your therapy, and confidentiality laws protect your privacy.

The therapy process itself can get confusing. According to Duffy, people might have questions like: “Is it brainwashing? Will it change my personality? What if focusing on my problems will make them worse, not better?”

These myths and concerns stem from various sources, including therapists themselves. Howes says: “…no two therapies/therapists are alike, the media does a lousy job of portraying realistic therapy, many people are still too ashamed to talk about it and therapists don’t always do a good job of teaching clients the best ways to get the most from their therapy.”

How to Make the Most of Therapy

1. Do your homework.

Be a discerning consumer by doing your research. Therapists “have different approaches, and come from different schools of thought,” Duffy says. For instance, you might learn the differences between treatment approaches, such as cognitive-behavioral therapy and psychodynamic therapy, he says.

2. Ask for referrals.

“It is difficult to determine on paper or via a website who will work for you,” Duffy says, “So ask around.”

3. Consider expertise.

“If you are seeking a therapist for a teenager, for instance, you probably want to avoid the therapist who focuses on couples work,” Duffy explains. Similarly, if you know your diagnosis, see someone who specializes in that disorder.

4. Be open to change and the process.

Change is hard. And it’s a pivotal part of therapy. As Duffy says, “By definition, therapy is a change process, and it will and should foster a bit of discomfort. This is not a bad thing.”

Engaging fully in therapy increases the chances of its effectiveness, he says. Think of it this way: “In order to get a different result, you’ll probably need to try a different approach,” Howes says.

So trust the process. “Some of the techniques therapists use — like the empty chair, reflective listening and thought stopping — can seem corny at first, but many people find them effective.” And keep in mind that some issues will require bigger changes than you initially thought, he adds.

5. Limit the process.

Another way to foster change is to remember that the therapeutic process doesn’t go on forever. “That is, if we think therapy has no end, we may put off the changes we want and need to make. If we know we’re working together for about 6, or 12 or even 20 weeks, that timing provides a context for us to think about and enact change,” Duffy says.

6. Make therapy part of your life.

Many people expect change to happen from an hour a week at the therapist’s office, Duffy points out. But “…in order for the process to foster real change, a great deal of the work has to take place outside of the therapy room.”

This “might range from a simple meditation to a significant change in work habits to ending a dysfunctional relationship.”

In other words, “Therapy is one of those ‘you get out of it what you put into it’ activities,” Howes says. He suggests “Keep a journal, show up to appointments on time, read books about your issue, do your homework and dive in.”

The key, Duffy says, is to hold yourself accountable for this outside work.

7. Be brutally honest.

For instance, whether you have positive or negative feelings about your therapist, don’t be afraid to bring them up, Howes says. In fact, “…this sort of discussion can provide some of the best results therapy has to offer.”

Consequently, he says, “Whether you’re talking about yourself, your past, your ‘craziest’ thoughts or the relationship with the therapist, brutal honesty is the quickest route to results.”

8. Realize that “things can get worse before they get better,” Howes says.

“After a few sessions of poking around in a person’s psyche, we’ve opened several cans of worms and it can feel overwhelming,” he says. It’s not uncommon that “…people come in to work on one problem and soon realize they have four.”

9. Talk about challenges regarding therapy.

Therapy requires resources, namely time and money, which as Howes says, “are increasingly hard to come by.” Also, some people might not have access to community resources or a good support system. Then there are also what Howes refers to as “backseat drivers,” “well-meaning loved ones who try to tell [clients] what to talk about in therapy, ask a million questions about it or even poke fun at them for being in therapy.”

Many clients don’t bring up these issues to their therapists. Instead, they might suddenly stop therapy or keep getting stressed out. Howes emphasizes the importance of talking to your therapist about these concerns, because together you can brainstorm solutions.

In general, therapy offers many benefits, whether you’re struggling with mental illness, a difficult life transition or other concerns. According to Howes, therapy is an opportunity “to try new things. It’s a place for thinkers to try feeling, busy people to practice slowing down, non-confrontational people to be assertive, people pleasers to practice thinking only about themselves, and cut-and-run people to learn the art of a healthy goodbye.”

He concludes, “It’s like taking a college course where you are the topic. Make the most of it!”

Photo by Code Pink, available under a Creative Commons attribution license.

Although the approaches are often seen as distinct, in the implementation and even theoretically there is often overlap. Rigidly adhering to one way of thinking or approaching therapy often limits results and misses the whole picture, and may result in an approach that feels foreign or false to the patient.

The psychodynamic approach focuses on understanding where the patient’s problems or symptoms came from. The therapist helps the patient recognize how the past is repeated in the present.

Attachment theories have become more popular recently as new research emerges. These approaches use empirically-based and neurobiological research to understand problematic relationship styles. Scientific studies on attachment have found that issues in adult relationships can be reliably predicted from objectively identifiable, early patterns of attachment between parents and children. Therapists using attachment-based approaches aim for healing unconscious psychological and biological processes in the brain and promoting the development of higher-level capacities. Such capacities include the ability to recognize and reflect upon what is happening in one’s own mind and the minds of others, and sort out one from the other.

This approach to therapy is also particularly helpful for teaching parents ways to react that optimize children’s psychological and brain development and improve parent-child relationships.

Cognitive-behavioral approaches emphasize learning to recognize and change maladaptive thought patterns and behaviors, improve how feelings and worries are handled, and break the cycle of dysfunctional habitual behaviors. This perspective helps people see the connection between how they think, what they tell themselves, and the feelings and actions that follow.

Interpersonal approaches emphasize identifying and understanding self-defeating patterns in relationships, figuring out why a particular situation is happening in a particular context, changing patterns that don’t work and developing healthier ones. In this approach, relationships and the here-and-now are the focus.

Systemic approaches understand problems in a contextual framework and focus on understanding and shifting the current dynamics of relationships, families, and even work settings. The roles and behaviors that people take on in a particular family or context are understood to be determined by the unspoken rules of that system and interaction among its members. Change in any part of the family system or group is the route to changing symptoms and dynamics, whether or not the “identified patient” is specifically involved in those changes. In this type of therapy, the “identified patient” in a family – the one seen by family members as having the problem — is viewed by the therapist as part of a larger system that is creating or sustaining this problem. This approach can be particularly useful when one member of a family seems resistant to therapy or to change; it opens up other avenues for intervention.

Other therapeutic approaches are centered around self-expression, with therapy providing a safe and private place to express feelings, confusion, worries, secrets and ideas.

In general, regardless of the therapist’s preferred way of working, people find therapy to be most useful when therapists are responsive, engaged, and offer feedback.

Many people who have been in therapy or have interviewed different therapists report better results when they like and feel comfortable with a therapist experienced in their particular issue. In addition, some of what makes a good match has to do with “chemistry.” Chemistry involves more subtle factors such as the therapist’s personality and whether he or she is someone in whom the client would want to talk and confide.