Therapy is becoming more and more acceptable in people’s everyday lives. A relatively new practice popularized by Sigmund Freud only a century ago, therapy used to be a very time-consuming and expensive process for the client. This meant it was only available to the upper class and was more often for women; after all, they weren’t working as much as men and could afford to spend hundreds of hours reclining on Freud’s couch. Therapy has also historically been poorly understood by the general public and therefore highly stigmatized.
Today, therapy is much more commonplace. Insurance coverage makes it affordable for the masses. Its widespread use and supportive empirical data have helped dissolve some of the social stigma attached to having a therapist. More and more, going to therapy is understood to mean resolving one’s personal difficulties, focusing on self-improvement, and working toward attaining a greater sense of life satisfaction. In short, therapy is widely available and accepted.
With many people attending therapy at one time or another, it’s no wonder there is burgeoning online discussion in forums, blogs, and articles to address therapy topics. Often these topics revolve around the questions or comments people are too nervous to ask their therapists. Ideally, one would develop enough rapport to share openly about these topics in therapy; but of course, even the closest of human relationships can still involve some degree of veiled inhibitions. Here, I’ll attempt to answer five questions you may be too afraid to ask in therapy.
1. Why won’t my therapist just give me advice?
The ultimate goal is to help you identify and achieve your therapeutic objectives. The idea is not for your therapist to tell you what to do. In fact, when I hear this question lurking in the subtext of my client’s dialogue, I often ask them, “Why would you want me, someone you’ve known only a few hours out of your life, to tell you how to live it?”
One of the greatest misconceptions about therapy is that you’ll receive advice. Blame it on Hollywood for its pervasive misrepresentations of therapy in films and on television. Often therapy is portrayed as a client sharing his struggles and receiving the perfect solution from his wise sage of a therapist. In reality, good therapy should look nothing like a scripted scene meant to further a Hollywood plot.
Therapy, as I’ve referred to it throughout this post, is a reference to psychotherapy. Psychotherapy is defined as “the treatment of psychological disorders or maladjustments by a professional technique, as psychoanalysis, group therapy, or behavioral therapy.” ¹ The therapist is there to help you understand your problem and utilize her professional knowledge and skills to help you overcome it. This can happen in a plethora of therapeutic fashions including practicing new skills, provision of psychoeducation, and even specific listening and speaking skills your therapist has honed throughout her training and career. The ultimate goal is to help you identify and achieve your therapeutic objectives. The idea is not for your therapist to tell you what to do. In fact, when I hear this question lurking in the subtext of my client’s dialogue, I often ask them, “Why would you want me, someone you’ve known only a few hours out of your life, to tell you how to live it?” This can help explore the greater concerns related to that desire for direction which can range from insecurity to meaninglessness or to a lack of problem solving skills. Once the greater dilemma is identified, we can work together toward improving it.
2. Does my therapist dislike me?
It’s understandable to wonder about your likability in session. After all, you’re baring everything with a person you trust to be an understanding confidant; and yet, you’re paying that person to have that role. It’s an odd dichotomy that is rarely dealt with in any other relationship. Often your therapist is the person you’re most open, honest, and vulnerable with. When you share so deeply with another person it’s natural to want a genuine connection with her.
Though your therapist should be authentic, there is also a professional boundary that takes place in therapy. Your therapist will share little about herself and will strive to provide unconditional positive regard. So how do you know if she doesn’t actually like you?
Truly, the question ought to be irrelevant. The therapy relationship is a professional one and your therapist is there to provide a service. More realistically, though, your therapist is still human and cannot remain wholly objective. She might have something going on in her personal life which could cause her to dread going to work that day. The work of a therapist is emotionally taxing and sometimes, knowing a client is dealing with certain struggles, it can be difficult to be in session with him. That said, if there is an ongoing emotional reaction to the client (called countertransference) it is the therapist’s job to address this within herself or through professional consultation. If the countertransference is too much of a barrier then she has an ethical duty to refer you to a therapist who can better serve you. Odds are, if your therapist is continuing to work with you, this isn’t an issue. If you’re truly concerned about it I would encourage you to bring it up in your next session.
3. What should I do if I’m attracted to my therapist?
The answer to this is actually quite similar to the previous question. As I mentioned, therapists are human and can have emotional reactions to clients, called countertransference. The flip side of this is transference: a client’s emotional reaction to his therapist.
Don’t worry, you’re not alone. This phenomenon is so common that we’ve created a term for it, and the study of transference is a focus of every graduate program for budding therapists. In fact, the specific dilemma of client attraction is discussed in the ethics classes your therapist had to pass in order to get her job.
It is normal to feel an emotional reaction to your therapist. After all, this is the person you confide in, trust, and who seems to really understand. It’s entirely understandable that you would develop an attraction in that setting. The best thing you can do is tell your therapist about it. Like I said, it’s common and you’re probably not the first to say this to her. She will likely be flattered. Telling her allows you to discuss how your feelings might be affecting your participation in therapy. If the two of you agree it is not too big a barrier, you can discuss how to move forward in therapy. If the two of you decide that continuing therapy will be inappropriate or difficult in light of this transference, she will suggest other referral options and assist with your transition to a new therapist. Either way, it’s important you bring it up lest your emotions continue and interfere with your progress in therapy.
4. Does my therapist actually remember our sessions?
“…if your therapist isn’t listening or remembering your sessions at all, that’s a definite red flag…”
The short answer to this is “kind of.” There are a few things to consider when thinking about this question.
First, remember you aren’t your therapist’s only session that week. While you have only one session to think about week to week, your therapist carries an active caseload of 20-40 weekly appointments. When is the last time you had to keep straight all of the personal details of 30 people? It’s comparable to an average person trying to have 30 “best friends,” (though of course therapy is not a friendship). I’m sure you can imagine it would be hard to juggle the information disclosed by 30 individuals. After a while your therapist does get to know you and will remember many details about you and your sessions. If you’re new to therapy or if it’s been a while since you discussed a certain subject, cut your therapist some slack.
Second, keep in mind your therapist will never remember everything. A good rule of thumb is to never expect her to remember more than you do. She shouldn’t expect you to recall every word spoken throughout the hour session you had two weeks ago, and likewise, you shouldn’t expect as much of her. Human memory is a tricky thing and much of what happens in an hour gets filtered out or altered. The important points will stick for both of you.
Finally, if your therapist isn’t listening or remembering your sessions at all, that’s a definite red flag. If you have to repeatedly remind her week to week that Bob is your husband, she’s not paying very close attention. As always, I encourage communication with such issues. If nothing else it could be a good learning point for her to be a better therapist for other clients. Regardless, this is probably a sign that you should start seeking a different therapist.
5. How do I tell my therapist that I don’t think therapy is helping?
The effectiveness of therapy should be a point of ongoing discussion. Early on you would have created a treatment plan, or your goals for therapy, and agreed on them with your therapist. As therapy continues these goals should be a point of regular discussion and consistent focus. If it hasn’t come up in a while, your therapist is probably due to review this with you anyway. I would strongly encourage you to talk to her about it. And don’t worry about offending her- it’s rare that clients are so honest about such a barrier in therapy, and she will probably be grateful for the opportunity to discuss it with you rather than having you “ghost,” or stop showing up. Being ghosted by clients is far more troublesome to therapists than getting a chance to problem-solve a therapy plateau.
If you’re feeling stuck or not seeing progress, there can be a variety of factors to consider. These can include a revision of therapy goals, trying new techniques, and examining your effort in creating change. If nothing else, your therapist should be able to refer you to other professionals who might be more skilled or a better fit. Whatever conclusion you arrive at together, having this discussion will help you achieve the progress you want to attain, and that’s what is most important to your therapist.
¹Psychotherapy. (2018). Retrieved July 1, 2018, from http://www.dictionary.com/browse/psychotherapy?s=t
What are your thoughts? Have you had any of these dilemmas with your therapist? Are you a therapist with different input? I would love to hear it! Comment below: