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Getting the Most Out of Psychotherapy

Reveal Yourself, and Voice Your Concerns

It takes courage to tell a relative stranger about your most sensitive issues. So, one of your first goals in therapy may be the discovery of whether you can trust your therapist enough to reveal yourself openly. If you can put your fears into words, a good therapist can help you understand their origin and whether or not they apply to the current situation. As therapy proceeds, if you still find it difficult to trust your therapist, this is a valid issue to bring up and discuss whenever it arises.

I encourage you to reveal thoughts and feelings that aren’t comfortable because these may have the greatest leverage for growth. I achieved much of my current inner peace through pursuing my own therapy. Once I’d established trust in my therapist, I began to trust my own process to the point that the first issue I would bring up in any session was the one with the greatest emotional charge. That practice accelerated my inner healing. If you feel yourself flooded with feelings or obsessing about thoughts so that they interfere with your inner peace, your therapist may help you to take a break from these thoughts and feelings and improve your dialogue with them.

Ask your therapist to explain anything you don’t understand, even if asking the question may reveal that you’re not as knowledgeable as you think you should be. Ask even the “dumb” questions. If you don’t understand the therapist’s answer, ask for clarification or a different explanation or example.

Polite people often find it difficult to say that they’re dissatisfied with how things are going. Because of this, the nicest people often store the most intense resentments because they’re afraid to bring them up. I encourage you to discuss your frustrations early. Therapy is a healing process, and you may get a different response than what you fear. What are some of the useful ways a therapist can respond?

  1. By taking your complaint seriously
  2. Being open to changing technique or approach to something that will work for you
  3. Showing willingness to admit the therapist’s contribution to any dissatisfaction
  4. Helping you understand your part in the dissatisfying exchange

I encourage you to meet such therapeutic responses with your own best efforts. For example, your chances of success are enhanced if you’re willing to explore your cherished beliefs and attitudes. Be open to discovering your own part in a dissatisfying therapy encounter. This openness can reveal relationship issues you need to address. By understanding the interaction from both sides, you’ve got the opportunity to heal, especially if the therapist responds more openly and fairly than did important figures in your past.

If you still disagree with your therapist’s technique or recommendations, voice your disagreement and invite a discussion about it. This allows the therapist to consider whether her or his technique is the most appropriate and to explore emotional issues that the disagreement may reveal. After such disagreements have been explored thoroughly without a satisfactory resolution, the best solution may be to ask your therapist for referrals to other therapists who may better meet your needs.

Apply Yourself

Clients soon discover that when therapy starts to get at their emotional issues, it’s no walk in the park. When it reaches this level of intensity, therapy becomes an even more powerful opportunity to make decisions and changes that can transform your life. I encourage you to make your best efforts to help your therapy succeed, including following through on your therapist’s recommendations even if this takes substantial effort.

One of the most difficult tasks for any client is facing the truth about addictions, self-destructive habits or impulsive actions that shut down uncomfortable feelings. Ask your therapist for help in overcoming such issues. The solution may include referrals to a medical doctor, specialist or clinic. If you don’t address these very difficult issues, they’ll continue to block your path to happiness and success — or worse.

Understanding the Psychotherapy Framework

“For psychotherapy to be effective, a close rapport is needed …. The rapport consists … in a constant comparison and mutual comprehension, in the dialectical confrontation of two opposing psychic realities. If for some reason these mutual impressions do not impinge on each other, the psychotherapeutic process remains ineffective, and no change is produced. Unless both doctor and patient become a problem to each other, no solution is found.” Carl Jung. [2]

The following discussion of the psychotherapy framework is intended to help you understand some of the “rules of the game,” why they’ve been established, and their role in making therapy effective. Although there are many approaches to psychotherapy, some elements are found in most approaches. These elements include:

  • A standard session length
  • Frequent sessions held at the same time(s) each week
  • Typical roles and tasks of therapist and client(s)
  • Disruptions of the framework that can lead to breakthroughs
  • Activation of childlike responses
  • Stages of therapy
  • Types of questions and comments presented by the therapist
  • Adherence to legal and ethical standards

Session Length

People often wonder why the typical “therapy hour” is 45 to 50 minutes. Group therapy sessions usually last longer and brief therapy interventions may take much less time. One answer that’s funny and probably true is that psychotherapy pioneer Sigmund Freud couldn’t last more than 50 minutes before visiting the bathroom! [3] There are other useful reasons for this session length:

  1. Therapy can be emotionally intense and someone may learn many things in session. More time in session can be difficult to absorb mentally and emotionally.
  2. Psychotherapists spend time outside of session thinking about the client(s), completing required notes and doing treatment planning. The minimum needed is 5-10 minutes, so the standard session time allows for scheduling of sessions on the hour. In some situations a therapist may offer longer sessions. For instance, a couple in therapy may find themselves just getting into a long-needed conversation. Added time may help them maintain the momentum.
  3. A standard session time helps the therapist pace the session for the client, for instance, giving them time to pull themselves together before going back to work. This predictable session length helps establish an expected emotional rhythm to even intense sessions. It instills a sense of emotional safety and teaches the client that he or she can choose to open up difficult feelings and then contain them.
  4. Standard starting and stopping times and session length provide a way for client and therapist to notice if emotional reactions or issues are expressed in lateness or attempts to stay beyond the end of the session. Exploring such attempts to go “outside the therapy frame” often gives the client powerful and unexpected insights.
  5. Often clients bring up significant issues at the very end of the session. This can occur for many reasons. Sometimes it’s because the issue is uncomfortable to talk about, but as the end of the session approaches, the client realizes it’s something she or he really wants to bring up. This happens so often, there’s even a name for it — “doorknob therapy”! [4]
Getting the Most Out of Psychotherapy


Gary Seeman, Ph.D

Gary Seeman, Ph.D. is a psychologist in private practice in Corte Madera and San Francisco, CA. He works with adult individuals and couples, specializing in addictions, bereavement, creativity, life transitions, personal fulfillment, relationships and spirituality. He maintains a website at www.drgaryseeman.com.

APA Reference
Seeman, G. (2020). Getting the Most Out of Psychotherapy. Psych Central. Retrieved on September 25, 2020, from https://psychcentral.com/lib/getting-the-most-out-of-psychotherapy/
Scientifically Reviewed
Last updated: 17 May 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 17 May 2020
Published on Psych Central.com. All rights reserved.