Psychotherapy (or simply "therapy", as it will be identified in the rest of this post) is both an immensely rewarding, and especially challenging experience. It offers an opportunity to confront and/or resolve unhealthy thinking, emotional and behavioural patterns that can be disruptive to one's overall well-being, relationships, daily functioning, and life goals. When you find yourself connected with a therapist whose competencies align well with your needs, the outcomes are remarkable.
However, the path to improved functioning through therapy is not without its risks and discomforts. Because you're invited to challenge long-standing habits and patterns, it can feel incredibly distressing to change your habits, behaviour, and mindset. As a result, some people notice this discomfort or distress and halt the process altogether.
The thing is, change (good or bad) will always trigger our fight-flight-freeze (survival) response. Change prompts perceptions of uncertainty, and we are wired to assess and respond to uncertainty as if it is a threat or danger until we can be assured of safety. That discomfort we feel when we are in the throes of therapy is often that survival response kicking in because new habits mean...change. I often describe the change process as maintaining a garden. Yes, we look forward to enjoying beautiful and sweet-smelling flowers, but in order to get there our hands have to get messy, and we have to do some digging and pruning.
There are things you can do, though, to enhance your overall experience of therapy, and advance your progress towards your goals. Below, I've outlined a few tips for pre-, mid-, and post-therapy that may help.
Before you get started with your therapy session...
Ensure you have sufficent time to feel at ease before you begin. This applies to both virtual and in-person therapy. If you are attending in-person, ensure you follow the in-person protocols as provided by your therapist (if there are any), and try to get there just a few minutes early to situate yourself. Sometimes it is not possible to be there a few minutes early. In that case it would be appropriate to inform your therapist you may need a few minutes to settle in and ground yourself.
The same applies if you are participating in your session virtually. It is recommended that prior to booking your session you leave enough time between a previous appointment and your therapy session to ensure you are on the session platform on time, and you don't feel rushed. However, if this is unavoidable, you may inform your therapist about this and request a moment to feel settled.
Grab a notepad and pen/pencil. Although your therapist documents clinically relevant information emerging from the session, these notes aren't typically provided to the client after the session (unless a formal request is made). You may ask your therapist if it is appropriate to take notes in the session, especially if you intend to do further reflection and journaling after the session. So, prepare for this by ensuring you have writing instruments (pen and paper, notes app, etc).
Ensure you have privacy. This is especially important if you are joining a session virtually. In order to feel at ease during the session without the worry of being overheard, or having to restrict yourself, make sure you are in a space that gives you considerable privacy. If this is unavoidable, discuss this with your therapist before hand to explore possible alternatives.
Ground yourself. "Grounding" refers to the practice of being aware of your sense of presence in the here and now. Doing this helps to calm any discomfort you feel prior to the start of your therapy session. You may read more about grounding and other regulation strategies here. An example of a grounding techninique is the "5-4-3-2-1 method", as explained in the video below:
While you are in your therapy session...
Communicate with your therapist. To be able to feel supported, it is important to be open with your therapist. For sure, the therapy session can feel really intimidating, especially if you are new to the process. This is normal. You may even let your therapist know about any feelings of nervousness or anxiety you may be having about the session itself. This often prompts the therapist to provide interventions that will help you feel at ease, or feel validated. This feedback also helps you and your therapist assess your needs, and collaborate on treatment goals.
Take notes. As mentioned above, it is sometimes helpful to take notes during your session. However, it should be pointed out here that the confidentiality of the notes you take during the session is your responsibility. Taking your own notes during the session not only promotes cognitive processing of the experiences you discuss, but it also promotes your overall progress in therapy because you are able to reflect on, assess, and redirect (if necessary) your growth process.
Use sensory instruments. Sensory instruments are good tools to keep you present and calm during the session. If you usually find these helpful, you can let your therapist know that you would prefer to use them in the session. Sensory instruments include items such as a stress ball, fidget spinner, plush toy, feather, etc. Sometimes when discussing uncomfortable or sensitive topics, our sympathetic nervous system (same thing as our fight-flight response) kicks in, and associated with this is a number of biological processes that prepare us to respond to danger. Sensory items help to regulate the body back to a state of calm.
In this vein, too, it may be helpful to have a glass/bottle of water handy. Besides just staying hydrated, our sympathetic nervous system inhibits the production of saliva, thereby causing dry mouth/throat.
Ask questions. You may have heard it said there are no stupid questions. This is especially true for therapy. The progress you make depends a lot on how you are engaging treatment techniques. If there is something you do not understand, don't hesitate to let your therapist know. This will also help the therapist challenge their own unconscious/unintended bias in the language and framing of their communication with you.
When the session is over...
Take a breath. At the time of scheduling your session, if you are able to do so, ensure you leave yourself a few minutes to ground yourself again. This may include taking a few deep breaths, or practicing a grounding technique as the one above. Some sessions can be stressful, and a competent and attentive therapist would support you with regulating your emotions during the session, and while closing. However, before going into your next task, you may consider taking a few extra moments to reorient yourself using grounding strategies.
Change your scenery. If you attended your session in person, this would already be taken for granted as you will be leaving your therapist's office. The change of scenery allows for a reorientation of your mind to other experiences as you move into a different space.
If you participated in your session virtually, you will have to be more intentional about this. This means stepping away from the device on which you had your session, and going into a different room, or going outdoors and experiencing nature.
Move your body. Remember, your body can become activated during a stressful session. It helps to bring a sense of ease and calm when you engage your body productively. This may look like a short walk, stretching, playing with the kids, or with pets, doing a workout, or engaging in sports.
Do the homework. A therapy session, regardless of its duration, will never be sufficient for optimal progress. Of course, a lot can be covered during your session time, particularly if new observations and insights are made. However, what happens between sessions is the most important factor in your progress as you will have the opportunity to practice new strategies, and apply new concepts in real, everyday life. In the event that your therapist didn't assign homework, take some time to reflect on what was discussed, and write down any thoughts and questions (journaling) that come to mind. You may bring this into your next session, or simply use this journal as a strategy for integrating what you are learning about yourself during your therapy journey.
Therapy can produce really good outcomes, but it's not without its discomforts. Take the time to take care of yourself during the process, and when you do, you are likely to have a more rewarding experience.
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If you would like to discuss your therapeutic needs, and would like to explore the possibility of starting therapy, feel free to contact Heartspring Therapy by calling 416-688-5274, or by booking a free initial consult at heartspringtherapy.ca/book-online. In-person and video therapy sessions are available.
If you are having thoughts of suicide or self harm, or having strong urges to harm someone else, please contact 911, a crisis line, or go to the nearest hospital. You may also contact the Mental Health distress line by dialling 9-8-8.
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