“You should get help.” For many, a statement like this is a first step to seeking therapy. But what exactly does that mean? What goes on in therapy and how does it help? While everybody is familiar with therapy as an idea, far less are aware of what actually occurs in the therapy room. This often raises confusion and possibly even anxiety for the newcomer. For simplicity, therapy can be divided into three main parts including 1) the intake, 2) the protocol and 3) the therapeutic relationship.
The intake occurs during the first time a therapist meets a potential client. During this first session, the therapist attempts to understand the nature of the issues the client is facing (diagnosis), and develop a working relationship with the client (rapport). The client can expect to be asked many questions about every aspect of their lives including their upbringing, familial relationships, friendships, romantic relationship, education/work history, substance use history, history of psychological treatment, family history of psychological treatment, legal history, and any suicidal thoughts or attempts in the past. While it may seem tough to answer so many questions in a 50-minute session, the intake is guided primarily by the therapist. Talented therapists integrate this first diagnostic session well with building a working a relationship.
A therapy protocol is a guide for the interventions a therapist uses; some protocols are highly structured while some are much more open-ended. The bulk of a therapist’s book-learning focuses on protocols including how to implement them and which ones to choose. A common protocol for people with depression involves tracking specific thoughts the client is having that are distressing and unhelpful (i.e., “I am worthless” or “I am a bad parent”). After identifying this thought, some protocols suggest challenging the thoughts by “putting them on trial” to determine if they are realistic thoughts. Other protocols suggest accepting these thoughts and committing to personally held values.
Not all protocols are made equal and different protocols work for different problems. Just as antibiotics and vaccines each serve their individual purposes, different protocols address different issues. Protocols that are considered to be the gold standard are called empirically supported therapies. Empirically supported therapies have been demonstrated by researchers to improve quality of life for participants. There are literally hundreds of different protocols but only a handful have obtained the badge of empirically supported therapies. A useful guide to the empirically supported therapies for various disorders can be found here: http://www.div12.org/psychological-treatments/.
The Therapeutic Relationship
According to research, the most important aspect of therapy is the quality of relationship between the therapist and client. Another word for this is rapport and it begins during the intake. New clients should keep an eye out for unworkable relationships with their therapist (poor rapport) after the intake. Poor rapport between client and therapist is characterized by a lack of trust, feelings of doubt, and feelings of being misunderstood. While most therapists will push for a follow-up to the intake, every client should consider if they want another session with that therapist or if they want to continue shopping around. It is much harder to switch therapists 3 or 4 sessions in as opposed to following the intake only.
When it comes to evaluating therapeutic relationship, in most cases the client should trust their feelings and thoughts about the therapist. Does the therapist truly listen? Do they seem like they know what they’re talking about? Is there a sense of engagement and genuine care? At the end of the day, the client should trust their gut about their therapist.