Psychotherapy: What to Expect and How to Find Help

In the last two posts, we have examined together some of the types of psychotherapy and the therapeutic alliance. In this piece, we shall explore what to and not expect in psychotherapy, and how to find the help you need.

Important Qualities of a Great Therapist

Just as there are many different types of therapists with many varying qualifications, finding one that meets your needs may take time and be frustrating. However, if you understand the qualities that make a great therapist you stand a better chance of lowering the probability of not forming a good therapeutic alliance.

(I covered therapeutic alliance in another blog post.)

In this section, you will find a partial list of the qualities of a great therapist.

The Therapist is Willing to be Validating. Validation doesn’t just mean the therapist accepts and acknowledges your emotions and feelings, but that they believe in your ability to grow, and change. This perspective is vital, as you may lack the ability to believe these things about yourself.

Another critical component to psychotherapy is that your therapist must believe in your ability to heal. If your therapist sees you as a “lost cause” or as a threat to their reputation, it will translate to you non-verbally even if they never say a word. Their posture, facial expressions, and other body movements that are entirely subconscious on their part will be recognized by your internal referencing system.

If you find yourself in a situation with a therapist where you are not healing like you believe you should, do not hesitate to ask the important questions. These include, “Do you believe I will heal?” or “Are you not believing I can move on from the effects of my trauma and my diagnosis of DID?”

Asking these questions and others will help both you and your therapist have a deep and honest discussion about their beliefs on your healing.

Your Therapist Attempts to Understand Your World. There can be many differences in the upbringing of you are your therapist. Some are obvious, such as religion and minority, others are less obvious such as sexual orientation and family of origin dysfunctions.

A great Therapist will seek to lay aside their own biases to work well with you. An example might be if your therapist is a Catholic, and you are an avowed Atheist. Your therapist will not change themselves into an Atheist, but they will also not try to push their religious beliefs onto you.

Although licensed therapists of all types receive training to recognize and treat childhood trauma, it can be extremely difficult if they did not experience it themselves. This is where empathy comes in, which I will describe in detail later.

A Good Therapist Does Not Act or Feel Superior to Their Clients. There are a lot of ways that humans can feel superior to others, such as intelligence, financial affluence, or health. A great therapist does not hold such views.

Your therapist should not look down upon you or be condescending to you. A therapist who looks down on you because they feel they are superior in intelligence, financial stability, or because they do not struggle with a mental health diagnosis, is not worth your time.

A therapist who treats you as if you were a child is also a waste of time. As I stated earlier, even if they do not say it with words (which many do in their tone of voice), their non-verbal body language speaks volumes.

No matter who you are, where you have been, or how unstable you are, you deserve a treatment that shows dignity and respect, and you should receive treatment respecting you are an adult.

Your Therapist Should Show Appropriate Empathy. According to an article appearing in The Greater Good Magazine, a publication of the Greater Good Science Center from the University of California Berkeley, empathy can be defined as follows:

“Empathy is a building block of morality—for people to follow the Golden Rule, it helps if they can put themselves in someone else’s shoes. It is also a key ingredient of successful relationships because it helps us understand the perspectives, needs, and intentions of others.”

Empathy is vital to forming a solid therapeutic alliance, but to be honest, there are some therapists who didn’t get the memo. They are so worried about billing and either doing it by the book or ignoring what you have to say that they show little to no empathy at all.

In a paper titled Empathy (Bohart and Greenberg 1997), the authors gave an explanation between three types of empathy that are useful in the psychotherapeutic alliance. There isn’t room to give the specifics of each type in this piece, so I shall offer you a synopsis.

Empathy from your therapist includes meeting you where you are and accepting you while knowing your life history. Your therapist should become attuned to your body language and speech patterns to better understand the impact of what has happened to bring you to their office.

Your therapist has the ability, through their experiences and training, to understand and make sense of your experiences.

Empathy does not mean sympathy.

Sympathy is a trap that many people in therapy fall into. While it is important to recognize and grieve over lost opportunities and past events, it is vital to take control of your life and move on. A therapist will not allow her/himself to fall into the habit of feeling sorry for you. If they do, they become ineffectual for your healing.

Your Therapist Should Show Unconditional Positive Regard Toward You. First, let me state here that unconditional positive regard has nothing to do with your therapist liking you or liking what you have done in your life. According to an article from Psychology Today, the definition of unconditional positive regard is that your therapist respects you as a fellow human being. It also means they see you as an adult who can, and should, make your own decisions on how to respond to situations, even if what you choose is dangerous or dysfunctional.

This must be one of the hardest parts of being a therapist. They can offer you suggestions, but also must respect your right to mess up.

Your therapist will not give you the answers to your life’s problems, nor will they try to solve them for you. Why? They are not afraid that you will sue them or that they will mess up, they know that what is good for them is not necessarily good for you. They will not interfere unless it becomes necessary. They respect that your choices in life, are indeed your own.

One good explanation of a therapist’s role is to look at them as seeing-eye dogs.

If you watch a blind person approach a curb, their working dog will stop them by tugging on them. In most cases, they will not try to stop them other than to tug (and whine if necessary). When their master stops, the dog patiently waits for the light to turn green and then signals gently to their person that it is okay to cross now.

The job of the seeing-eye dog isn’t to interfere in the freedom of their master, it is to alert them to danger and give them the suggestion that they need to stop.

The same is true of a therapist. They will not overtly force you to follow what they think you should do, instead, they will offer suggestions and sometimes (rarely) examples from their own lives to help you make the right choices.

The rest is up to you.

Things You Should Not Expect from Therapy

Now, let us explore together some of the most common misconceptions about therapy and therapists. Knowing these pitfalls will help you make a better decision when choosing which therapist is right for you.

Misconception Number One. My therapist is all-wise and will know exactly what to do. While therapists are highly trained individuals, they are human beings and not gods with diplomas. They have failings and weaknesses just like you, and not only do they not have all the answers, they also can get their feelings hurt and become weary.

Because all humans are different and have different temperaments, backgrounds, and personalities, there is no way your therapist will always offer you sage advice (they offer no advice at all in fact). Instead, they utilize the tools of the trade, empathy and unconditional positive regard, to help you find your own answers. They do this all while taking good care of their own emotional needs.

Working with My Therapist Will Make Me Better Immediately. Unfortunately for many of us, nothing could be further from the truth. In our culture of instant gratification, it goes against our grain to recognize that healing takes work and time. Because entering therapy is one of the bravest things a person can do, mainly due to the fact that it forces us to look at ourselves directly and honestly, healing can take anywhere from a few weeks to several years.

Often, therapy sessions help bring up memories, from the depths of our inner-selves, that is accompanied by strong emotions and can be extremely painful. There is no magic fix to these issues.

I will share what my therapist told me when I became frustrated at the slowness of my own healing. I had complained that I should have already been well and that people were asking me why I wasn’t already there.

She sat back in her chair and quietly stated, “Shirley, when people ask you how long you will be in therapy tell them, longer than what you want, but not as long you fear.”

Therapy is Easy. Therapy is some of the hardest and most arduous work there is on the planet. In therapy, we learn to accept ourselves with all our flaws, as well as things that we have done both good and bad. We are forced to also accept our lives, both in the past and present, as belonging to us and then to live with those facts. It takes enormous courage and fortitude to face our problems and shortcomings, let alone share them with a stranger. Healing involves feeling emotions a person would rather not face, and many times weeping, which is part of why many avoid entering therapy let alone continuing it.

Therapy is not easy for anyone. Never try to compare your therapy or therapist to that of someone else’s. It is a waste of time and can cause harm because it is like comparing apples to oranges. Yes, they are both roughly spherical in shape, but they are radically different once you remove the peeling.

Finding the Right Therapeutic Fit for You

Although I have touched on this topic in a previous post, I cannot stress enough the importance of finding the right therapeutic fit. Here are a few helpful hints to guide you in looking for a therapist, that works best with you.

Decide What Gender Identification You Would Feel Most Comfortable Working With. Deciding ahead of time, what gender identification you would and would not tolerate in the intimate relationship that exists in therapy is crucial. While some do not prefer a gender identification, women who have experienced sexual violence at the hands of a male, many times do not wish to enter therapy with one. The same is true of men who do not feel safe or comfortable speaking about their problems with females.

People who identify as LGBTQ might also prefer therapists who do also because, like all humans, therapists have their own biases and beliefs.

Ask Your Acquaintances. This is not possible for most of us. However, for the lucky few, asking around among your acquaintances can lead to some good information.

If you can to ask someone you know about their therapist, then ask questions like “Do you like your therapist?” or ask your acquaintance “Does your therapist have any referral lists you can use?”

Shop Online. In the digital age, you probably expected me to add this suggestion. Finding a therapist using an online service is difficult at best. You cannot see the person you are interested in, and sometimes the profiles you find are wildly inaccurate.

One of the better sites to explore is the “Find a Therapist” pages offered by Psychology Today on their Find a Therapist Directory. I’ve never had any luck using this page myself, but at least you have the ease of researching who is around, and what they treat in your area.

Give Your Potential Therapist a Call. Calling the people you are interested in is a comfortable way to vet your potential therapeutic partner. Giving them a ring allows you time to ask questions and discern if they’d be a good fit for what you are needing in the relationship. You might want to have your questions written down though, as most therapists are busy people and will only have a few moments to answer your inquiries.

You can ask questions about whether they work with others that have your health challenges, what type of modality they use, and how much they charge.

There is one question you should ask; whether they have ever been in therapy themselves and if they finished it successfully. It is important to remember here that, just like you, therapists have the right not to answer this question. However, the avoidance of this inquiry or an answer of no is a red flag, because a therapist who has not lain their own issues to rest will have a hard time creating and enforcing healthy boundaries and managing counter-transference.

In Conclusion

Finding and working with a therapist is a major step toward healing. I hope that this series of articles has helped you have a deeper understanding of how and why therapy works, and additionally what to expect in psychotherapy.

The road less taken is long and windy with many avenues for becoming sidetracked from your destination. The largest and perhaps most important message I hope you take away from this series is that not only can therapy set you on the path to a more prosperous internal life but that you have choices.

Your choices include what therapist you see, how much effort you are willing to put into therapy, and the fact that if you find yourself in a therapeutic relationship that is not working, you have the right to leave.

As ever, we here at the CPTSD Foundation wish you well on your healing journey. We are always here waiting to hear from you.