How to Get the Most Out of Therapy
Read the corny self-help books. Do the homework. Let your therapist know when they’ve screwed up.
Read the corny self-help books. Do the homework. Let your therapist know when they’ve screwed up.
I started therapy last August, after years of fits and starts. Every previous time I’d tried to start therapy, it had been a mild catastrophe. I could never seem to find a shrink who was a good fit. Either they were all unable to see who I was, or I was too emotionally shut down to really show it to them. Inevitably, they’d give me advice that struck me as really bad and pointless, and I’d smile and nod and say nothing. Then I’d cancel my next appointment and run gleefully back into the familiar, cold arms of emotional suppression.
There was the social anxiety therapist I saw in graduate school, who watched me shake with violent sobs for an hour and just stared with a placid, sad smile on her face, saying nothing.
There was the mindfulness-obsessed e-therapist I contacted when my former abuser started hurting new victims, who recommended I deal with trauma by washing the dishes in a more slow, contemplative fashion.
And along the way, there were countless therapists-in-training I encountered in classrooms, who spoke so judgmentally and dismissively of their patients that it made me doubt I’d ever find an accepting, safe professional I could open up to.
But this time, it’s been different. My therapist and I have truly connected. He isn’t like the therapists I’ve seen before — he’s accepting and involved, and can see me for the ambitious, genderqueer, perverted, insecure, codependent, lovable car wreck that I am. I’m different now too. I’m not the withdrawn, chilly person I was when I tried to get help all those times in the past. I came into my current therapist’s office ready to make changes, and willing to take steps that could initially hurt. And that has made all the difference.
During the last 15 months, and with some nudging from my therapist, I’ve changed my life in dozens of far-reaching ways. I’ve totally rearranged my work priorities, focusing on writing and activism rather than the grueling busywork that used to define my career. I’ve dialed back on the friendships that always left me feeling insecure and invisible. I’ve replaced those shallow connections with more genuine bonds. I’ve had several hard conversations with my partner that I’d been putting off for literal years — and our lives have improved because of it.
Therapy didn’t do all of this instantly. It didn’t do anything, in fact. I had to do it. Therapy informed the changes that I made in my life, sure — but I was the one who had to enact them and maintain them.
Here are my five tips for maximizing what you get out of therapy. They’re rooted in my own experiences, but also backed by the scientific literature on the subject.
1. Be picky about who you work with
Researchers find it time and time again: The quality of the therapeutic relationship really matters. You have to work with someone who can respect your goals while also challenging you to shake up old patterns and question your priorities, and you have to feel safe and comfortable around your therapist. If their way of actively listening bugs you out or makes you feel like a specimen under a microscope, you’re not going to feel comfy bearing your soul to them.
During my past attempts at therapy, I always accepted the first person I got. I’d take whoever was available at my university’s wellness center, or I’d sign up for online therapy and be assigned a shrink by an algorithm. I’d usually wind up with a soft-spoken, smiling, white, cishet lady whose therapeutic style involved a lot of listening, nodding, and saying shit like, “That must have been hard.” That type of therapeutic presence appeals to many people, but I always found it cloying. I needed someone with more of an edge.
The first therapist you see might not be a good fit for you.
This time around, I trawled Psychology Today’s Therapist Finder. I used the advanced search options to identify someone who was a truly good fit for me. After weighing a couple of options, I found a guy who was highly informed on trans issues, anxiety, and trauma, and who worked with all kinds of clients, including kinky and polyamorous people. He was covered in nerdy tattoos. At my first appointment, he casually mentioned being a BDSM dom.
I instantly felt at ease with this person. I knew he wouldn’t see me as a freak. All the therapists I’d seen in the past had been very conventionally-minded people, and they had trouble understanding me. I needed someone who was a little more wild and unconventional in order to feel safe and accepted. Because he was as strange and nerdy as I was, we immediately got off on the right foot.
The first therapist you see might not be a good fit for you. Remember that you deserve to be picky. Give a new person a try — see them two or three times, just to be sure — but if you feel judged, uncomfortable, or misunderstood when you’re around them, that’s a good sign it’s time to move on.
2. Do the homework, even if it sounds pointless
At some point, your therapist is probably going to assign you some homework. It might look like actual homework — some therapists really do hand out worksheets and assign reading lists — or it might just be a recommendation to meditate two nights a week. When you first get assigned homework, you’re probably going to hate it and resent it.
But if you want to get the most out of therapy, you really should play along. Studies consistently show that patients who complete their therapeutic homework do much better than patients who don’t. That’s because therapeutic homework helps to deepen learning and it encourages patients to develop new social and emotional skills.
One session of therapy per week just isn’t enough time to fundamentally shake up your life. You can’t leave the important work of improving your mental health at the door of your shrink’s office. Try to think of your therapist not as a doctor providing you with treatment, but as a personal trainer giving you a workout plan. You have to take the exercises they teach you and use them on your own time if they’re really going to work.
This was a hard one for me to learn. Most of the early homework my therapist assigned struck me as really inane and pointless. For example, he told me to schedule time each week to sit down and intentionally “feel my feelings.” I was supposed to just sit still, doing nothing, for half an hour, letting myself cry, fume with rage, or mourn, as needed.
One session of therapy per week just isn’t enough time to fundamentally shake up your life.
I thought it sounded like complete bullshit. For weeks I protested, saying that there was no way anybody in human history had ever done something as stupid and frivolous as that. But then I gave it a try. And I kept at it, setting aside time to “feel my feelings” every week. Suddenly, I wasn’t crying myself to sleep anymore or screaming with rage at my computer when it froze. I started noticing my emotions more throughout the day, and dealing with anxiety and resentment quickly rather than letting it bubble up.
“I can’t believe it,” I told my therapist. “This stupid, feel-my-feelings shit actually works.”
He just laughed.
3. Supplement therapy with outside reading
When my therapist suggested I might have been emotionally abused as a kid, I initially felt pretty defensive. My dad was an unstable, unpredictable person, sure, but he hadn’t meant to do me any harm. I was sometimes mocked or criticized for showing emotions when I was a child, but nobody who did that to me had any malice in their hearts. As an adult, I remained hypervigilant for signs of rejection, always scrambling to figure out how everybody around me felt — but could I really blame that on my upbringing? It seemed unfair to call what I had experienced abuse.
I told my therapist about all my reservations. He pondered for a moment and said to me, “Look, if I was a surgeon, and you came to the ER with an arm that was broken in a way that was consistent with physical abuse, I couldn’t really prove that you’d been physically abused. But I could tell you, hey, the way you’re hurting, and the type of damage that’s been done here, is consistent with abuse.”
His comments left me feeling curious and receptive, rather than defensive. So I resolved to learn more about childhood emotional abuse and the impact it has on grown people. I read the book Adult Children of Emotionally Immature Parents, and saw myself reflected in many of the author’s patients. Then I picked up a copy of How to Deal with Emotionally Explosive People, and caught glimpses of both my father and myself.
I used to hate self-help books. I found them preachy, superficial, and corny. But after a few months of therapy, I was ready to give them a try. I approached these books with the same sincerity and interest that I had learned (begrudgingly) to bring to my therapy homework. The things I read and learned outside of therapy helped to deepen the conversations I had within therapy.
This is a pretty common experience among patients. While self-help books widely vary in quality, many therapists do assign good ones to their clients. Research suggests that reading high-quality self-help books helps patients, too. Don’t be afraid to seek out additional resources for yourself, or to ask your therapist for their recommendations.
4. Show your ugly side
Many people struggle with being emotionally vulnerable, both in and out of therapy. I cry easily and have trouble stopping once I’ve started, and yet I’ve always been ashamed of my tears. Until recently, I couldn’t remember a time when I had cried in front of someone without apologizing for it. Throughout my adult life, the sadness that provoked the crying always ended up being eclipsed by the shame of having “broken down” in front of somebody.
I brought this conflicted, shameful tangle of feelings with me into therapy. For months, I’d try to avoid any subject or line of conversation that would lead me to cry. I’d let two or three tears leak out at most, and then cover my face and demand that we move on to something else. This got in the way of me talking about hard things.
My therapist really had to push back against that. He didn’t make me cry, by any means. But he did reinforce, time and time again, that it was normal and good to cry in front of people, especially a therapist. He reminded me that if being around emotionally distressed people was annoying to him, he should have picked a different job.
Seek out a shrink who can be real with you, rather than one who wears an impassive, neutral mask.
Slowly, painfully, I got better at letting the tears come. Instead of letting me shut the conversation down or pivot to another topic, my therapist encouraged me to fully experience what I was feeling, and to talk about it — even if my words were punctuated with sobs. The more comfortable I got sharing my feelings, the easier it became to talk about their causes.
Eventually, I learned how to bring up other feelings that caused me shame — especially anger and irritation, years-old resentments, and selfish desires that I initially tried to hide from my therapist because I wanted him to have a good impression of me. This helped me address issues that I desperately needed to work on in therapy, and it also helped me get a bit better at sharing my feelings with my loved ones, too.
It’s really important to express your true emotions in therapy. For decades, studies have found that clients who share and show their feelings get much more out of therapy than those that don’t. Clients also benefit when their therapists are emotionally expressive — so seek out a shrink who can be real with you, rather than one who wears an impassive, neutral mask, like my earlier therapists did.
5. Tell your therapist when their advice sucks
Being honest and authentic in therapy doesn’t end at being openly angry or sad. You also have to be real with your therapist about how therapy is going — and that includes telling them when you think their advice sucks.
A few months ago, I noticed a pattern in my therapist’s advice that was starting to worry me. Any time I told him about a struggle with a friend, he seemed to want me to end the relationship or drastically reduce my commitment to the person who was causing me stress.
At first, I wanted to just privately be huffy and pissy about my therapist’s feedback. It felt good to stew about how wrong he was, and how wise and compassionate I was. Of course, those feelings were distorted a little — or perhaps a lot — by my own defensiveness. So I brought my concerns to him.
“I’ve noticed that whenever I tell you about a friend who demands a lot out of me,” I said, “your advice kind of points toward me cutting them off. But if I did that with everyone who overstepped the line, I’d be really lonely.”
My therapist was very receptive to talking about this. He thought about it a moment, and then said, “I’m sorry if I’ve been implying that. I don’t think you have to stop talking or hanging out with each of these people. But I have noticed that you have a pattern with being afraid to disappoint people, and with letting other people’s expectations influence your decisions.”
Together, we brainstormed alternate solutions to this problem, ones that didn’t involve burning bridges. One solution we hit on was that I should practice disappointing people more. I’m generally terrified to let people down, which leads to a lot of my relationships feeling unbalanced. If I could get more comfortable with being my full self in my friendships, warts and limitations and all, I could repair some of the relationships that weren’t well-balanced.
This has remained an ongoing point of discussion in therapy. Whenever I get caught up with trying to be a people-pleaser, my therapist asks me hard-hitting questions about it. Sometimes, I am left wondering why I bother hanging out with someone who makes me feel bad. Other times, I push back on his assumptions and point out that the relationship is multifaceted and worth keeping — I just need to manage it better.
If your therapist cares about doing their job well, they’ll want to hear when you have reservations about how therapy is going. It’s much better to name a conflict and to confront it head-on, rather than to pretend you’re going to follow advice that you don’t respect.
Therapists and their clients should generally be on the same page about what the goals for therapy are — but it’s useful to have frank conversations about what the best route is to getting there. Research suggests it’s useful for a client to bring up when a therapist has said or done something that’s hurt them, or misread a situation. Not only will these conversations improve the therapeutic relationship, but they’re also good practice for addressing conflict out in the real world.
I put the work into therapy, and in return, therapy gave a ton back.
Since starting therapy over a year ago, my life has improved in dozens of ways. I don’t sob myself to sleep the way I used to. I’m eating better. I have the energy and drive to lift weights three or four days per week. I socialize more, and make new friends more easily. I’m getting better at setting limits with people. I’m in the process of writing a book and building a new professional life for myself.
It’s astonishing to me, how much I’ve grown. It’s also a total pain in the ass a lot of the time. I don’t usually want to drag myself to therapy. Talking about my feelings is mortifying. Crying is embarrassing. Reading touchy-feely books has made me start to talk and think like a total new-age sap. But it works, dammit — the proof is so palpable that I can’t deny it. I put the work into therapy, and in return, therapy gave a ton back.
If you’ve been contemplating therapy, or you just started up the process of asking for help, give these tips a try. If you find a good practitioner and truly invest in building the relationship, it can really pay dividends. But you have to be ready to do that work.