What is going on with you internally–what are the feelings and thoughts inside– right before, during, and after your therapy session?

I call this the inner therapy session.

On one level, there is tremendous energy being generated, although you might not always feel that way. Before a session you may feel excited, anxious, positive, negative, or have other strong feelings.

Sometimes, though, a patient will feel apathetic about therapy. Assuming the patient is working with a good therapist, and one who is right for him or her, the feelings of apathy could be a cover for feelings of anger and fear. Sometimes uncovering your problems and seeing yourself more objectively can be scary. You might unconsciously quash these uncomfortable feelings by feeling, or convincing yourself, that you feel apathetic.

If you find yourself feeling apathetic (or overtly fearful, angry, or confused about therapy), this should be discussed during your sessions. Even if you don’t tell him, your therapist should be able to discern your feelings of discomfort during the course of a session.

In addition to your actual words, or lack of them, your nonverbal language should help clue your therapist in to the fact that something is holding you back or upsetting you. Your therapist really has to work at being in tune with you—that’s his job.

If for some reason he hasn’t perceived that something is troubling you, you should make every effort to tell him what is going on inside. An experienced, caring therapist will want to use his skills to help address the issues you’re dealing with.

For example, if your therapist finds that you have uncomfortable feelings about therapy—or about him—he might make use of important techniques, such as immediacy and self-disclosure.

Immediacy (also known as you-me talk) is the experience of and discussion about therapy itself, as well as the relationship between the therapist and the patient. This very direct approach brings the relationship you have with your therapist into view. Saying, “I sense that something is not right between us. Is there something going on between you and me that we should talk about?” He might also say, “Did I miss something important that I should be focusing on?” Or, “You seem upset with me. Can we talk about that?” These are all examples of the use of immediacy by a therapist.

Your therapist might bring your nonverbal behavior into the open—into immediacy—by describing what he sees. “Since you came in you’ve been looking at the floor, and you haven’t been as communicative as in the past. Also, your eyes seem a bit teary. I’m wondering if you are okay, and if you would like to tell me what you’re thinking about.” This kind of you-me talk helps the patient understand that the therapist is aware of, and cares about, him and the relationship.

Rarely your therapist will use another technique, called self-disclosure, which is not used often. Self-disclosure is a clinical technique that involves the telling of specific, limited amounts of personal information by a therapist. He might (briefly) tell you something about his own life that could inspire you and help you expand your understanding of your own issues.

However, and this is a very big however, therapy should never be about your therapist. If he does use this technique, it should be used very sparingly, and it should be tailored to spur you to self-exploration. Also, he should never reveal intimate details about his relationships or use names.

Often, in order to steer the session toward inward exploration, your therapist will ask the kinds of open-ended questions that refer to your inner thoughts and feelings. They might come at the start of or during the session. “What were you thinking about right before your session, today?” or “What are you feeling right now?” These questions are usually too pointed or direct unless you already have a trusting relationship with your therapist.

As you become more and more comfortable with therapy, your therapist will use these questions in order to help you articulate feelings and thoughts you may not even know you have. He may even make this a part of your written treatment plan. After exploring your inner session further, you both may eventually decide to modify your treatment goals. Sometimes on a journey, if you catch a glimpse of a mountain or a valley, you’ll want to examine the map and take a detour that will bring you to these yearned-for places. A skilled therapist knows when that detour is called for.

For example, if your primary treatment goal is to explore your fear of intimate relationships, but you are also depressed, after talking about your feelings, you and your therapist may come to the conclusion that your treatment goal should be redefined temporarily. Perhaps understanding and managing symptoms of depression would be a worthwhile goal.

Conversely, there will be times when your therapist will want to help you focus on other important goals you may not even be aware of and may steer you gently toward them. Of course, he must have clinical justification for suggesting you focus on any specific problem. Ultimately, the feelings, emotions, thoughts, and behaviors you have during or in between sessions will all have a part to play in how therapy will unfold.

 

Adapted from Therapy Revolution: Find Help, Get Better, and Move On (HCI)