Peek Inside The Therapy Room: What Really Happens In Therapy

Apr 25, 20245 min
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Conversations around mental health and therapy are currently in the spotlight on social media. We may have a vague idea about therapy - perhaps the image that comes to mind is of a professional with a clipboard gently asking questions about your childhood, interspersed with the famous question, “And how do you feel about that?”.  Maybe it’s Shah Rukh Khan healing Alia Bhatt’s childhood trauma in a few sessions with his pithy quips and anecdotes. 

But what happens in therapy, really? 

To put it very simply, a therapy session is a conversation with a professional to understand yourself more deeply, grow and heal from difficulties. It can vary across therapists, but when it comes to talk therapy, there are a few things that can be helpful to know. 

Taking the first step into the therapy room (or Zoom meeting)

People often come in wanting guidance on how to solve their problems and we truly wish it were that easy. In reality, the first session is when your therapist is only just starting to get to know you and setting the tone for sessions to come. 

Most therapists will begin their sessions with you by asking you about what brings you to the space, your goals and expectations from your work together. They will also provide you information about their qualifications, their therapeutic approach and assure you that your conversations together are confidential. Ideally, they should also provide you the space to clarify any questions or concerns you may have about therapy during this conversation.  

Every therapist has their own ‘dance’ 

This means each therapist will have their own rhythm and style of conversation. Some therapists will be very structured and will take more control of steering the conversation, others will let you lead by talking about what you feel is important, while many will find a delicate balance between the two. Like dancing, there’s no right way of doing this - it depends on what the client and therapist are both comfortable with. If something about who is leading the session isn’t working for you, it’s a good idea to share it with your therapist, some might adjust their style according to what works for you. 

To share or not to share in therapy

You can talk about anything and everything in therapy - it’s your space (and yes, we'd absolutely love to hear that funny story about your pet). The content of the conversation will usually depend on what your hopes from therapy are. Your therapist will guide you by asking you questions about events in your life, your behaviours, thoughts and feelings. 

They will be non-judgemental and encouraging while you share things about your life that may be difficult to talk about. Your relationships, struggles, habits and sometimes (but not always) your childhood may also be other topics that would come up in your conversations with your therapist. Along with working on your concerns, therapy may also help you discover and build on your strengths. Your therapist should ideally be affirming of your identities and knowledgeable about them, such as if you’re from an oppressed caste or if you identify as queer as these too, influence your mental health and come up in conversations. 

It’s important to know you don’t necessarily have to bare your soul and tell your therapist your darkest secrets and a good therapist will never push you to talk about something you’re not comfortable bringing up. 

How to get an ‘A+’ in therapy 

Well, the truth is, you can’t!  We promise therapists aren’t evaluating you in a conventional sense - they are not giving you marks on how good your mental health is, or how well you set boundaries. 

They would however be observing certain patterns in your relationships and behaviours and how your history might relate with them. They would also be paying attention to your body language and voice while you speak about certain things. This is because a lot of our feelings may be communicated nonverbally and therapists will try to help you connect more deeply with feelings you may not be fully aware of.  Some therapists take a diagnostic approach and may be trying to understand what label may suit you the best. This could be putting a word to something you feel like you were alone in with labels like ‘anxiety’ or ‘depression’. 

More than to evaluate whether you’re doing well or not, this information that they’re collecting is to understand you better. Eventually (or sometimes immediately) they will  share these observations with you so you can understand yourself more deeply and change your patterns if you’d like to. A therapist might say something as simple as, “I noticed your tone of voice shifting as you spoke about the self doubt” or something as complex as, “I wonder if your friend avoiding you is bringing up so much anger because it reminds you of how things used to be with your father?” 

All about advice - or Not 

It can be disappointing to find out that your therapist is unlikely to tell you what to do or give you advice frequently. This is because there’s no one ‘right’ decision or ‘right’ way to support your mental health - it can be different for different people. Your therapist might offer you suggestions of things you could try, like visiting a support group or trying out a breathing technique when you feel anxious. They may sometimes give you ‘homework’ by giving you questions to think about or a worksheet to fill up. 

While your therapist will not give you advice about major decisions, you’ll likely arrive at a conclusion or a decision through your conversations with them. This is helpful because therapy is ultimately about equipping yourself to make your own decisions. Conversations and questions and strategically oriented towards enabling you to arrive at a decision that works for you.

You’d expect that techniques, advice, or interpretation would be what is important in therapy, but research has shown that the therapeutic relationship is what really heals. This means that it’s important that the bond between the client and therapist is strong and authentic. It also means that both the client and therapist should be on the same page about the process and outcomes of therapy. 

What happens in therapy is that you feel heard, supported and witnessed.  What happens in therapy and what heals in therapy is that you can be your authentic self and feel deeply accepted and understood by another human being. At times, it is about the process and experience of being in this space which therapists carefully curate. 

Citations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592639/

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Shama Shah
Therapy and Supervision