A pragmatic approach to the ever-evolving art of talk therapy
by Colin Stack-Troost, MFT
Our generation is savvy enough to know the many ways we can take care of ourselves: exercise regularly, get a good night’s sleep; and of course, eat your veggies. It’s important to remember that a diverse portfolio of self-care techniques is integral to maintaining a balanced life. “Self-care” and “therapy” come in many forms — a walk in the woods, a night sweating on a dance floor, perhaps a really good orgasm —sometimes, though, you just need to have someone listen to your story. Offer an unbiased reflection. Help you notice patterns. And perhaps most importantly, hold space for both the terrible and wonderful things that have happened in your life.
This is what I do for a living. I’ve been seeing clients for individual and couple’s therapy for over six years. I joke that I’m in the business to be out of business because my hope is that people’s lives are peaceful and fulfilling enough that therapy becomes unnecessary. In the meantime, however, I’m here to help; and as someone who cares deeply about my clients and the consumers of my profession, I want to offer these insights to keep in mind as you engage in the profoundly personal and introspective journey of talk-therapy.
1. Budget for it.
Whether you’re using insurance or private pay, make sure you’ve got a plan for how you can pay for sessions before you start therapy. Your therapist is required to be up front about their fee before you meet, so don’t feel weird about asking. Check with your insurance company about covered clinicians, out-of-network reimbursements, or seeing if your therapist will meet on a biweekly basis to make it more affordable for you. There are also extremely talented trainees and associates in the process of earning their degrees or hours for licensure who are eager to help, and who’s rates will be much lower. Every therapist has to start somewhere!
2. This is an investment in yourself, so make the time.
Just like any other class, training, or practice; a regular frequency of sessions will substantially deepen the work (especially as you are getting started and building rapport with your therapist). With a regular occurrence of sessions, it will keep both you and your therapist engaged in the work. Like a personal trainer or learning a new language - you get what you put into it.
3. Shop around
There are lots of different therapists out there, and that is a good thing, because not every therapeutic style works for everyone and I would be wary of any therapist who tells you otherwise. CBT models are not a fit for everyone, nor is EMDR. Ask for referrals, search for key words, check out therapist’s websites and see if you can chat with them on the phone to check for therapeutic match. Remember this is an investment in yourself, so make sure you are working with someone who supports the kind of work you want to do and has the skills to help you do so. If you’re part of the Burning Man or BDSM community (or both, woohoo!) you’ll probably want to work with someone who has a grasp of those communities so you won’t spend half of your session explaining what MOOP or a “switch” is.
4. Have Goals in Mind
Be prepared to answer every therapist’s first question after the initial pleasantries: why are you there? What has brought you to their office at this moment in your life? A recent upheaval? An obstacle? Perhaps you experienced something traumatic or disturbing, recently or long ago, that needs some healing? You can also just use therapy as a time to reflect on yourself and your relationships, and with an investment in therapy will have a go-to person with whom to discuss life’s peaks and valleys who is familiar with your background and lived experience. Therapy can be short, or go on for years. You are the captain of your ship, so you decide. More on that later.
5. Be honest
It can be hard enough as it is to be honest with ourselves, not to mention laying all our cards on the table in front of someone else. I often use the “mirror” analogy to describe the importance of full-disclosure: we sometimes grow accustomed to looking at ourselves in a fogged up mirror; the truth obscured by ways we’ve shaped our narrative to avoid shame, accountability or discomfort. Your therapist is not there to judge your character. Together, you can squeegee that mirror to get a better look at what’s being reflected so you can really ask yourself what things are working for you. It can be one of the most helpful parts of the therapeutic process, albeit sometimes the most uncomfortable, but ultimately leads us to growth. The acorn must break apart for the tree to grow.
6. Don’t expect your therapist to have a magic wand
This is hard for therapists, too. Trust me. Years of listening to the harrowing stories of what people have been through really makes me wish I could cast some spells sometimes. This leads us to the double-edged sword of deleting wisdom gained from challenges, the diamond out of coal. Therapists can offer tools, perspectives, reflections, and point out patterns, but be careful of expecting a fairy-godmother experience or anyone who promises something of the like.
7. Be prepared to be challenged
“Do you think that aligns with the goal you set?”
“That sounds different from how you felt last week.”
“What are the facts here? What is being assumed?”
These are all things that I have said to challenge clients over the years, though there is certainly an art to it. When people tell me about their unpleasant therapy experiences, it usually comes down to two things: they either felt judged, or they felt like their therapist just sat there and nodded, without really engaging. Our job as professionals is to create an atmosphere that is both supportive and productive. When the truth is served, sometimes our feelings are hurt. It’s part of the process, and you should feel safe to talk about how it feels to be challenged or if your therapist should pump the brakes a bit. Remember, humans are experts at hiding things from ourselves. When a blindspot is revealed, it’s normal to feel your ego bruise or need a moment to sit with the revelation.
8. Get creative
The days of lying on the couch as a therapist jots down your stream of consciousness are long gone…or are they? Would that feel like something helpful to your process? Perhaps it’s spending a session listening to music that is really emotive or important to you, drawing pictures, sharing photos or photo albums, or acting out scenarios with figurines or stuffed animals. These are some ways you can get creative with therapy, all of which can be evocative and offer new perspectives for both you and your therapist. I once had a client suggest that they communicate only via music for an entire session. It was so powerful that it changed the course of our work from that point forward, so don’t be afraid to make suggestions and be creative with your time. It’s your time.
9. Your therapist doesn’t have it all figured out
Those off us in the biz wince every time we here this one: “AND he’s a THERAPIST!!”
As if a master’s degree has designated us as the sages of all that is human behavior and relationships, to have all the right answers, and to know exactly how to handle things. We, too, have off days, deal with loss, disappointment, heartbreak, get sick, run late, forget things, fantasize, make mistakes, and are generally human. That being said, inconsistencies in your clinician should not distract from you, the client. It is the therapist’s job to make sure they are not overloading their caseload, traveling too frequently, and are taking care of themselves in order to best be of service to their clients.
10. How to “end” therapy
I’ve seen clients for as few as 2 sessions, and have others with whom I’ve been working for over six years. Some therapeutic relationships end naturally, after a crisis has blown over; some rather abruptly due to a move, breakup, finances, or a therapeutic rupture. This is really a question for you, the consumer, about the value you are deriving from the process. Many choose to have this weekly designated space to reflect and emote, even during less bumpy points in their lives. One of the therapist’s jobs is to gently check in now and then to make sure that their client is getting the therapy they want.
Therapy doesn’t just have to END end. I have had clients who started out coming twice per week, then once per week; eventually evolving into booking sessions only as needed. That’s the great part about having an established connection with your clinician — they know your story, your joys and sorrows, so are able to carry valuable context into helping you through whatever new challenges may arise.
It is a great honor to support the healing and growth of others. Though I try not to take work home, there is a piece of my heart that holds the story of every client I have ever worked with, and as such I will forever see the world through many, many lenses.
doodles by CST
