What Therapy Is and Isn’t

As a psychotherapist on the cusp of being independently licensed, my past few years in the field have been quite emotionally draining.  My personal licensing process has involved countless hours of conducting therapy sessions (group, family, and individual,) case management duties (i.e. phone calls and meetings with schools, guidance counselors, in-home therapists, treatment team, and any other individuals who have a hand in the psychological well-being of my clients), and supervision hours (where I inevitably sometimes discuss my anxieties about already being burned out, when I have not yet even been in the field a solid five years).


It made me feel a bit embarrassed to come to my supervisor with the burnout concern, as I am always far too hard on myself, and wrongfully believe I have to have it all together all the time.  I worried that it somehow meant I was “not cut out” to be a therapist; that I was failing at helping my clients live better lives, because I was too stressed out with the multitude of clinical and familial issues that I would see every day.  Add on top of that 50 phone calls about things like transportation, school suspensions, and IEP meetings, and you have a perfect storm of “I am SO not ready for licensure” negative self-talk.


But my clinical supervisor (being the Godsend that she is) had me reframe those thoughts by posing a question to me: “Do your clients and their families have a good idea of what therapy truly is, or what it is supposed to be about?”  At the time, I had been working with many individuals and families who would take an hour to “vent,” i.e. simply lay all the “bad stuff” out about their children without truly showing any insight on what had to change for things to improve at home and school for their child.  I would come into session with my agenda (i.e. review how behavior plans were working, discuss positive praise of the child for what he or she is doing well, discuss fitting consequences for transgressions, etc.). And the parents would inevitably mean well (as many do), but would start right in with, “He is not getting better, he is getting worse….”  Cue negative self talk: “If you were better at your job, the kid would show improvement.”  I would try to redirect the conversation by validating concerns of the parents, but then gently directing them towards what could be done to change the problem behaviors.  But no.  What always followed was more talk about what their child did that week to make their lives harder.


After several weeks of this with many families, I knew I had to feel partially responsible for the direction of my sessions and moving the clients toward change, while also respecting their individual processes and meeting them where they were currently at.  But I also had to step back and realize that maybe my supervisor was right: they did not know the true meaning of what it means to be in therapy.  I thought it would be helpful for my own sense of security in my job abilities (and for the readers of the blog) to see a list of a few things that therapy is and is not.  I hope that anyone looking to make positive changes finds this helpful.


Therapy IS meant to be a safe space.  What initially drew me to the field of counseling was the unique relationship that a therapist has with his or her clients.  I find it beyond rewarding to collaborate with my clients on treatment goals, and to watch them as they try new coping skills and see the power within themselves to change their problematic emotions, thoughts, and behaviors.  A client should feel empowered within the therapeutic relationship to talk about things that he or she may not want to say to others; however, therapy IS NOT simply a vent session.  While it is okay to spend maybe a few minutes airing out difficult circumstances and emotions and expecting validation, sitting on a clinician’s couch for an hour to talk about how difficult other people make your life is not ever going to lead to positive changes.  Because you cannot (no matter how hard you try) change other people.


Therapy IS sometimes a tough journey.  It is not an easy thing to meet a therapist for the first time and spend weeks to months allowing them to know intimate details of your life.  The client/therapist relationship is one that is quite amazing, but also difficult, because your therapist IS NOT meant to be your friend.  He or she arguably should be the perfect blend of supportive AND directive.  He or she may tell you things that you do not necessarily want to hear.  Now, this type of talk should always be balanced with empathy, of course, but any good therapist knows that they are partially responsible for helping you hold yourself accountable for your achievement of your treatment goals.  So, please don’t cease going to therapy if you have a particularly tough session.  Tough sessions are a good thing.


Therapy DOES sometimes involve homework.  I know, I know.  But spare me the complaints here.  The previous paragraph just outlined the idea of a good therapist being supportive, directive, and able to hold clients accountable for their own success.  There may be times when your therapist asks you to complete tasks outside of your sessions, and then report back next time on the outcomes.  These exercises are meant to help your progress, not give you added stress.  Yes, we are all busy in life.  But if you are struggling to accept the fact that therapy sometimes involves work outside of the sessions…maybe you are not ready for real change.


Therapy DOES take time.  It may take several weeks to months to see real change.  The first few sessions (depending on the setting you seek services in) may simply be for rapport-building between you and the therapist.  That is because your therapist cares about helping you, and wants you to feel comfortable to discuss potentially sensitive topics.  I couldn’t ever expect my teenage clients to give me details about their private lives if I simply plopped into my chair and said, “Ok, the intake paperwork says you’re here because you told your guidance counselor that you are passively suicidal.”  Sometimes, it is worthwhile to spend time simply doing something the client likes (with kids and teens, therapists have many options) or talking about something the client likes (maybe TV shows or favorite hobbies).  But the point still stands that change is not going to happen overnight, and it takes some time to trust your therapist enough to open up appropriately and adequately.


I realize that the above statements may seem harsh (and I promise I am not absolving myself from the responsibility of helping clients by giving all the responsibility to clients out there).  I simply want to help people understand that therapy is so much more than talking about personal issues to someone you pay to listen.  Therapy is a wonderful thing.  And even in my days and weeks of feeling burned out and upset that “my clients are not improving at the rate I’d like,” I try to remember that I chose this field for a reason.  The process of change is both magnificent and difficult.  If you arm yourself with a solid understanding of what may be in store for you as you start the therapeutic journey, you may just have that much more of a chance of sticking it out and really making changes that last.  Rome wasn’t built in a day, and neither were your problematic behaviors, thoughts, and feelings (or your child’s problematic behaviors, thoughts, and feelings).  Give it the right amount of time and effort, and you will see the changes you seek.

-Diandra Meloni

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