How to Get the Most Out of Your Therapy Sessions

Counseling costs money and time, so you want to make sure to get the most out of your sessions, but sometimes it can feel confusing, awkward, or overwhelming. It can be hard to know what would be most helpful to talk about and even harder to remember what was said and apply it outside of session. Here are some ways to make sure you get the most out of your sessions:

• Take Notes – A big part of therapy is learning – learning about how your emotions, thoughts, and behaviors interact, learning skills to cope that are new to you, learning new ways of communicating, learning information that is evidence-based about psychology, society, and human interactions, etc. For most of us, if we sit down in a class, but have no way to retain the important or interesting concepts, it will fly right out of our heads as soon as the class is over. The same can be true for therapy –  You can discuss something with your therapist talk all day long, but if you can’t remember the takeaways or how to apply them next time a relevant situation comes up, it’s not going to do much good. Taking notes will help you remember what was important during your session and helps you remember to apply the skills discussed after you leave. Writing things down is also a good way to  stay engaged in the discussion and avoid zoning out or getting off track during sessions. Some people like to keep a notebook or folder with handouts and notes so they can build on their previous sessions, review concepts as needed, and look back on how far they’ve come since starting therapy.
• Avoid Multitasking- It’s hard to focus on therapy if you’re still in the middle of work emails or thinking about what you have to do later. Allow yourself to prioritize your session and set boundaries with yourself and others to have the space, privacy, and time needed for session. Turn off distracting notifications, put away other activities, and consider time needed to prepare before session and process after session if needed. Allow yourself to take a bathroom break, make a snack or a hot tea, and find a cozy chair so you can be comfortable for the hour. Find a private place to have session where you can speak freely and won’t be interrupted. White noise machines and headphones can help with this if you need extra privacy at home. Pet’s can be de-stressing to have nearby, but they can also have their own agendas – if your pet will distract your during sessions consider how you will set boundaries with them or attend to their needs beforehand so they do not become a distraction to your therapy goals. 
• Don’t Be Afraid to Ask Questions – Not asking questions can leave us in a state of unnecessary ignorance, continuing to make errors in life that could be easily resolved.  There is no judgment from your therapist and there are no dumb questions. If you don’t understand something in session or if you’re not sure what would be best to discuss, it’s ok to ask for clarification, ideas, or different examples.  If you don’t get how to apply a skill in certain real-life situations – ask. If you’re unsure why you’re therapist is doing something or asking you to do something – ask. If there’s a specific topic or skill you’re interested in – ask. Your therapist will be more than happy to answer most questions you have. Do make sure the questions are relevant to your growth and goals – if they are distracting from your goals, not relevant, or a diversion from doing some tough therapeutic work your therapist may set a boundary or discuss this with you. There may be times when it’s more therapeutic to help you uncover an answer yourself, but your therapist can help you through this process. Your therapist may need to save the topic for another time or may need to redirect to a bigger issue like safety, but they will communicate that and should make an effort to revisit the topic when it’s appropriate.
• Don’t Get Stuck in the Details – Sometimes when we’re recounting something in therapy we can feel it vividly, like it’s happening all over again. We can remember every detail of that thing our coworker said that really ticked us off last week, where we were, why we were there, what we were wearing, what they were eating, the temperature it was outside, and so on… Likely you have already replayed it in your head countless times, re-living the hurt or anger and hoping that maybe if you mull it over one more time you’ll figure out a way to fix it, think of a good comeback, or help yourself feel less bad about it. It feels good to vent and sometimes that’s what we need. And at the same time, you’ve already given up enough of your life to that interaction and getting lost in the details can be distracting from our bigger goal/purpose. Our minds are great at forming connections and links from one topic to another which can lead to going down rabbit holes of tons of detailed stories from the past that may or may not be relevant in the present moment. In your therapy session you have a limited amount of time to get through everything – what went on in the past, how you feel in the present, & how you can improve coping in the future. Try to narrow down what the most important information is and start there, your therapist can ask for more details or clarification if needed. Remember the event you’re recounting is about you – try to reflect on why it’s important to you? Why does it matter? Does it reflect a bigger pattern or problem that needs attention? Try to help yourself regulate your emotions when describing the memory by reminding yourself you are in the present moment, safely remembering the past moment for the purpose of reflection, growth, & change.
• Respect Your Time – Speaking of having limited time in session, use your time in session well. Avoid arriving late or leaving early, which cut into your session time. Sometimes it helps to layout topics/recent events you want to discuss at the beginning and you and your therapist can make a plan for what the time will look like. It can be helpful to make a list of topics to discuss ahead of time and bring them with you. Think of it as if you’re planning a business meeting or making a “to do list” of what to cover together. There may be things that have to be prioritized or saved for next session to leave room for important skill education, safety check-ins, etc. but at least you won’t have to walk away feeling like there were a million issues that weren’t brought up.  If you want to focus more on skill building rather than discussing recent issues, let your therapist know that as well. Also, bring up big deal information at the beginning of your session. 5 minutes before the end of your hour-long session is not the best time to bring up a recent traumatic event, suicide attempt, self-harm, etc. Try to acknowledge avoidant/ embarassed/fearful feelings and get it off your chest early on.  That being said, it’s certainly better to bring it up at the end of the session rather than not bringing it up at all.
• Attend Consistently– Consistent attendance is important for success in therapy for many reasons.  If you have been recommended a certain frequency of therapy that is because your therapist feels your symptoms need that intensity level of treatment and this can be a safety issue. Therapy is not intended to be on a “drop in” or as needed basis. There are levels of care in mental health treatment based on your past and present symptoms and treatment history. When symptoms are more intense, higher frequency is needed. Generally sessions with an outpatient, solo provider like myself range from twice weekly to monthly sessions. Most people start out attending sessions every 1-2 weeks, then gradually step down in frequency as appropriate for them. People with more intense symptoms, frequent hospitalizations, or that outpatient therapy isn’t working for may need higher intensity services like an Intensive Outpatient (IOP), day treatment, partial hospitalization, or residential program.  Long, unintentional gaps between session may cause you to have to waste a lot of your session time catching your therapist up on what has been happening, can make it harder to build on what was discussed last time or see progress, or stressors may have already passed or a crisis has already happened.  If you frequently miss appointments it may impact your ability to schedule with your therapist. Different types of therapy can also be impacted by session frequency. For example, Dialectical Behavior Therapy (DBT) programs are intended to be intensive with daily homework and weekly group and individual sessions – if you are only attending individuals once every 4-6 weeks it is going to be extremely difficult to successfully learn and apply the all of the skills and it is going to make your overall length of time in treatment take longer.  With equine-assisted psychotherapy, attending sessions consistently allows greater ability to build on the metaphors and narrative that unfold in session. If you find that you do need to decrease sessions because your financial situation has changed, your work schedule has changed, you feel in need of a break/vacation, or you feel you are ready to step down to less frequent sessions discuss it with your therapist, they can let you know if there are concerns about decreasing or, if not, help you make a plan for beginning to step down to maintenance sessions or terminating treatment.
• Practice Outside of Session – It is so important to practice your new skills outside of sessions in your everyday life. As mentioned with attendance, mental health and communication skills are a lifestyle change and require daily, intentional, sustainable effort. If skills aren’t being applied outside of session, they aren’t going to help. It doesn’t work to tell yourself “I’m done with therapy until next week” at the end of your session. When forming new habits you are basically re-training your brain and undoing a lifetime of connections to ineffective patterns of responding- each time you repeat ineffective behaviors you reinforce the likelihood that they will continue to happen, but each time you practice the new skillset instead you weaken those old connections and reinforce the new behavior you want.
• Check Your Expectations – Notice your expectations about therapy and discuss them in session to evaluate how realistic they are. Therapy is not always a quick process. If you think about the fact that most of our ineffective behaviors, thoughts, and relationship interactions have been present for and reinforced over the majority of your life, it makes sense that it’s not going to be a quick fix in a session or two. Therapists generally encourage clients to stick with therapy for at least 5-6 sessions to even get a good feel of if it will be a good fit or helpful to them. Many people also need or want ongoing maintenance sessions to help make sure they are continuing to be intentional about the use of their skills, even when everything is going well. It’s also helpful to reflect on expectations about other factors in your life. For example, it can be disappointing when others around you aren’t using the skills you are learning or respond negatively when you start setting boundaries – don’t give up, have awareness of what is in vs. out of your control, and recognize that it may take time but just one person (you) making a consistent change can break unhelpful patterns, help you gain independence, or end those relationships if needed. And lastly, understand that therapy is not always fun and enjoyable. You will discuss uncomfortable topics and be asked to practice new skills that may be out of your comfort zone, which can often bring up negative thoughts or emotions. That’s part of the process and is necessary for growth and change.
• Be Willing to Listen  – Sometimes we feel so tired of being advised by well-intentioned friends and family that we think we just want to vent, be heard, and be validated in therapy. However, part of the change that occurs in therapy often comes from allowing your therapist to ask questions, help you reflect/evaluate, and sharing evidence-based psychoeducation to help you change unhelpful and inaccurate ways of viewing yourself and the world. Allow yourself to be open to feedback, new information, and different perspectives.
• Trust the Process – Some people expect big “aha” moments to happen immediately or every session. Some expect their therapist to have an easy, black-and-white answer to resolve their issues. And some expect their therapist to easily hand them the answers without having to explore it on their own. The journey to resolving issues is where growth and learning happen. It’s not always quick, it’s not always clear, and there’s not usually one answer that works for every person in every situation. Be willing to sit with and discuss discomfort, uncertainty, and impatience. Be willing to stick with it and keep practicing even when it doesn’t feel great.
• Practice Willingness – Some skills and concepts discussed in therapy will bring up a lot of resistance. They may be things that pull you out of your comfort zone or ideas that you’ve been taught to judge negatively your whole life by family, friends, or society. You may think it’s silly or a waste of time. You may think it’s too hard and you’re not capable of doing it. Recognize that if your therapist is trained and licensed they should be providing you with evidence based skills to address your issues, meaning they have been researched and found helpful in resolving the symptoms you’re experiencing. They also want you to succeed and grow, not make you look silly, judge you, or give you an impossible task.  Part of the learning process is doing tasks that are out of our comfort zone and difficult, but not impossible – it may take smaller steps to get there, but the skills are doable. It’s ok to have judgment and resistance come up, but be willing to question it. Try acknowledging it and saying “I’m worried this is going to suck/I won’t be good at it/this won’t work, but I’ll give it a try anyway.” Be willing to look at what’s not working for you in your life and put forth action to change it.  Treat homework as an experiment – don’t decide before hand if it works or doesn’t, try it out and see what happens. Be willing to call yourself out if you’re avoiding, making excuses, or judging.  Discuss ways to trouble shoot & improve skill use when it doesn’t work and recognize that it’s ok if some skills don’t work in some situations. If you’ve sincerely tried, but literally no skills are working discuss it with your therapist they may be able to help or recommend you to a provider with a different therapeutic approach that may be a better fit.
• Honesty – Being open and communicating about relevant issues or events that occur in your life is crucial for successful therapy. Your therapist can’t help you address an issue or build skills for it if they don’t know what’s going on. Often shame, pride, avoidance, and fear of judgment can get in the way of disclosing important symptoms. Your therapist’s main goal is to support you and help keep you and others safe, not to judge, shame, or abandon you. We want and need to know what you’re going through to be effective in helping. Many issues that get in the way of therapy goals such as finances, approach/session content, scheduling, cancellations, judgments/assumptions can be easily resolved with honesty and open communication.
• Stick to the rules– Therapists have rules/expectations for treatment that help things run smoothly for everyone and help hold you accountable for your care. Rules about payment, privacy, boundaries, cancellations, etc. are there to benefit your therapeutic outcomes and safety, even if they can sometimes feel frustrating. Habits you have in life with procrastination, boundary issues, communication, or consistency may come up in the therapeutic relationship. Try to notice when these are occurring and be willing to discuss them with your therapist rather than avoiding or falling out of treatment.
• Think of ways to go deeper – When you feel like you have a good handle on skills on a basic level, think of how to get more out of them. What else might help? What barriers are coming up in your daily practice of skills? Do you need to troubleshoot difficult situations? Are there future goals and aspirations you want to begin focusing on? Are there philosophical concepts, values, or deeply ingrained cognitions that you want to question and explore?

These are just a handful of ways to get the most out of your therapy sessions. Feel free to share other ideas that have been helpful for you to get the most out of your therapy sessions in the comments!

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