Unlike a visit to the dentist, (open, rinse, say ahhh, spit) the rules for a psychotherapy session are not so simple or clear. Most therapists are unlikely to give you step by step instructions for engaging the session, (talk about your mother, cry, tell me a story from your childhood).  That’s partly because it’s the nature of psychotherapy for the patient or client to “show up” and initiate topics, set the initial direction, and open up.
But that can be very difficult, especially if therapy is new to you or if trust is one of the issues you’re going to therapy to address. The question of how to “do” therapy is further complicated by the fact that there are many different therapeutic techniques, modalities, and styles out there, each one requiring a different type and level of patient involvement.
The following suggestions will not guarantee that every therapy session will be a transformative experience, but they may help you engage therapy more confidently and, therefore, more effectively. Remember that it’s up to you to “show up (physically, intellectually, and especially emotionally in order for therapy to be effective–even if your initial reason for going is because someone else in the family is having the problem)! These simple tips might make that sometimes challenging process of engaging therapy easier.
Honesty is the foundation of good therapy. Honesty doesn’t mean that you immediately open up about everything or instantly share your deepest darkest secret. It means checking in with yourself and speaking frankly–even about the fact that you might be struggling to open up. “I’m not comfortable sharing some of the things I think are relevant to my therapy,” is honest! Talking about something other than what is emotionally relevant or feigning emotions you don’t feel is not honest and, therefore, not helpful to the therapeutic process. So remember that the process of opening up should take as much time as you need. Being honest, though, can happen right away in therapy.
It’s absolutely your right to ask questions of your therapist. On the front end, it’s a good idea to share a little about your situation and ask if your therapist has experience with that particular issue. Ask about the therapist’s therapeutic style, pricing, expectations (in terms of frequency of visits), etc. Once therapy has started you should continue to feel the freedom to ask questions. If you have a concern or question or fear, (anything from a billing question to why your therapist keeps giving you “that look”) ask it. Asking questions (and getting honest, satisfactory answers) is a critical part of the trust-building process. Trust, of course, is fundamental to successful therapy.
It can help to journal or talk with a trusted friend about your reasons for going to therapy before you actually go. Knowing what problem you’re trying to solve or what part of your life you want to be more effective in (even in broad strokes) can help make your initial conversations with a therapist more fruitful. That’s because it helps you take ownership of your therapeutic process, which in turn leads to greater levels of engagement. Your reasons for being in therapy may change over time, especially if the therapy is going well. So continue to check in with yourself and apprise your therapist of evolving reasons for being in a therapeutic process.
Some styles of therapy are very interactive, with the therapist and client actively engaging and even pushing each other. Other forms are didactic or technique oriented, with the therapist teaching specific skills or administering a treatment (like hypnotherapy or biofeedback). Still other forms favor a passive role for the therapist, leaving the client to do virtually all of the initiating and talking. Ask your therapist about the style of therapy he or she favors in your case and what your respective roles are in the process. If, for instance, you go to a hypnotherapist and talk the whole time, or to a psychoanalyst and don’t say a word, it won’t go very well!
Being a good therapy client, i.e. making therapeutic progress, actually takes some practice. Being an effective client requires engagement, trust, and openness. All of those things can be tough to muster when you’re first in therapy because the whole context is an unfamiliar one. With time and practice, though, you’ll find yourself more able to relax and engage the process. Stick with it.
As a caveat to the previous point of understanding your own reasons for going to therapy, be open to surprises. Many, if not most, “breakthroughs” (i.e. experiences of sudden growth or insight) come completely by surprise. That’s because one of the points of therapy is to move us through or to new and unexplored or highly protected parts of ourselves. When we first enter therapy, we may only know that we’re tired of feeling depressed (or angry, or anxious, or frustrated, or numb). Our sole purpose for coming may be to seek emotional relief from that feeling. But what we might discover along the way is that our depression is connected to something we didn’t even know bothered us (like resentment toward our spouse or a parent).  Communicating our feelings toward that person might be the key to relieving your depression, rather than tackling the depression (or other feeling) directly. Being open to surprises even as you pursue your original objectives for therapy can create the greatest therapeutic opportunities.
It takes time to establish a trusting relationship. This is true of friendships, romantic relationships, and work relationships. It’s just as true of a therapeutic relationship. While a talented therapist may be able to shorten that time by creating a safe environment and skillfully building rapport, there is always a process involved in connecting and trusting, especially when the emotional stakes are high, as they generally are in therapy.