Why Therapy Takes More Than That First Session

How Widespread is Therapy Today?

Among the myriad of characteristics dubbed “Millennial,” perhaps one of the most avant-garde is the generation’s affinity for self care and mental health awareness. As a result, we’ve entered a new era of treatment. Whether it stems from the current social and political climate, economic strains, or the impending fear of climate change, therapy has become more common than ever. While therapy may not be completely devoid of stigma, the prospect of seeking care is increasingly prevalent both in practice and social acceptance. In fact, according to the Anxiety and Depression Association of America (ADAA), adults that are age 54 or younger are more likely to have received treatment for a mental health disorder than those age 55 and older. 

What Challenges Must Patients Overcome?

In a recent Vice article titled “I Can’t Stop Ghosting My Therapists,” writer Kristi Pahr, opens up about her recurring struggle to maintain a therapeutic alliance. She takes the conversation beyond the issue of seeking care, and broaches the challenges that ultimately follow when continuing care- a struggle that can be difficult for a multitude of reasons. The first obstacle for anyone dealing with a mental illness is seeking help, but what lies beyond that first therapy session can be just as daunting for new patients.

According to Mental Health America, over 44 million American adults suffer from mental illness, but  nine million still report having an unmet need. While it’s plausible to attribute much of this to inaccessible mental healthcare, scheduling difficulties, and other logistical challenges, there is a portion of that statistic that accounts for something deeper. As Pahr states in her article, 20 percent of people who begin therapy don’t complete their course of treatment.

Dr. John Grohol of PsychCentral sheds light on the complexity of a patient-therapist relationship, which is different from other relationships in one’s life. It can take time to develop the trust necessary to overcome the initial sense of oversharing, which can often lead to a feeling of post-session remorse. It can be tempting to run from the discomfort that arises from self disclosure, which often leads new patients to “ghost” or never return to therapy.

In addition to that initial discomfort, it can be helpful to remember that it often takes multiple sessions to develop a comfortable and trusting patient-therapist relationship. While therapists are trained to ease patients into the therapeutic dynamic, it is still a new social context, complete with conversational elements, nonverbal subtleties, and two personalities working together to create a safe environment. This all takes time and it’s helpful for patients to be prepared for the time it can take to develop a sense of comfort with a particular therapist.

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How Can You Get the Most Out of Your Therapy Sessions?

  1. Prepare to be your full self. That means leaving any facades at the door, and allowing your vulnerabilities to shine through. This will save both you and your therapist from sessions spent merely chipping away at your emotional walls, so you can get the most out of your treatment.  At the same time, recognize that it may take some time to feel safe, and it’s okay for the process of becoming vulnerable to be a gradual one.

  2. Focus on YOU. Unless your friends or colleagues are present at your therapy sessions, there’s no reason they should be the focus of your conversations. Talking about others may be a way to distract from any discomfort you may feel discussing your particular concerns.  You made the brave decision to go to therapy, so you should be the one benefitting from your therapist’s insights and expertise. 

  3. Reflect between sessions. It’s easy to unload and leave feeling lighter and rejuvenated after a therapy session, or even to leave a more taxing session relieved that it’s over. This is normal! But it is an important and impactful part of the process to reflect on the discussions that brought you to that place. There were likely difficult topics, maybe a few tears, and negative memories brought to the surface – these pieces of your therapy sessions are all tools in your proverbial toolbox, so be sure to remind yourself of previous sessions before walking into your next. 

  4. The Collective’s Clinical Advisor Dr. Monisha Vasa suggests practicing having difficult conversations. Dr. Vasa shared, “If you feel uneasy, uncomfortable, or uncertain about whether therapy or your therapist is for you, see if you can talk about it with your clinician.  It can be challenging to have difficult conversations like these, but often your therapist may share something that allows you to better understand why you may be feeling that way. Even if ending therapy or switching to a new therapist is the next best step, it is important to process that transition too.  Having those hard conversations in therapy also makes it just a little easier to have hard conversations in real life too.”

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  • Written by: S. Mishkin

  • Clinical Advisor: Dr. Monisha Vasa, MD