Therapy explained.
Society’s perception of mental health, its treatment, and the professionals in the field has improved significantly over the past years, yet stigma and misconceptions are still widespread. Looking back, had I based my perception solely on the traditional representation of therapy in the media, I myself might not have become a psychologist. So, I’d like to shed some light on what therapy really is, what it’s not, and what to expect.
I’m writing this as a person who has been on both sides of the therapy room (or, more recently, the screen). You may or may not know this, but most postgraduate degrees in psychology or psychotherapy require its trainees to attend therapy themselves. So in addition to the experiences which our clients share with us, we also have our own first-hand experiences of therapy. We know how challenging it can be to enter a therapy room for the first time and to share the most private or painful parts of your life with someone who is initially a stranger. Understanding how therapy works can help with that.
Therapy is not only for people who are in a crisis or who are diagnosed with a mental illness. Anyone can benefit from therapy. People can get to know themselves better, improve their relationships, cope with difficult life experiences, learn to manage their mental health, work through past traumas, improve their mood, break unhealthy habits, and the list goes on. Perhaps surprisingly, sometimes the most interesting things can emerge when no particular pressing issue is brought to therapy, so feel free to keep your scheduled appointment even if nothing out of the ordinary happened that week.
Different types of therapy have different approaches with regards to how change happens. In brief, therapeutic change can be brought about by understanding how underlying drives and patterns impact us (psychoanalysis); changing one’s thoughts can consequently change behaviour and emotions (CBT); developing self-acceptance (humanistic therapy); finding ways to interact and communicate better in relationships (systemic therapy), amongst others.
Therapy takes time to work. No big changes are generally expected in the first few sessions. Change happens gradually, and in a non-linear way. Each session lasts between 45 minutes to 1 hour. A minimum of 8 sessions, and up to as many as you may need, is generally recommended until you feel that you are ready to end.
Therapists do not have all the answers, they do not tell you what to do, and they do not do things instead of you. They help you to manage your life more effectively and independently. Think of us more as a sounding board or a mirror, rather than a mind reader or an advice-giver. Therapy is a collaborative process, and we help you to reach your own conclusions. Unlike surgery, where the patient is passive and put under anaesthetic to be operated upon, in therapy the client needs to be fully active and engaged in the treatment.
I’ve often heard people share concerns about how talking about an issue will make it worse. I like to compare this to taking your car to the mechanic. Of course, if you never take your car to the mechanic, you’ll never really find out what damages there are, and the chances are that one day your car will break down. If you do take your car to the mechanic, you’ll see what the damages are, and you’ll have to pay and wait for their reparation. Had you not gone to the mechanic, you would not have known the extent of the damage, but that doesn’t mean that the damage wasn’t there. Similarly, therapy sheds light on the issue, and awareness is the first step to working through things. At the same time, if you do not feel ready to delve into certain things, it’s important to pay attention to this too, to discuss this with your therapist, and to respect your pace.
Therapists will not force you to do anything you don’t want to do. You won’t be made to lie on a couch. You won’t be made to talk about your past if you don’t want to. While openness is useful, it’s more about understanding, rather than about pushing you into things.
Therapy isn’t always easy. But we will do our best to help you cope with the difficult parts of it. It’s also important to remember to take care of yourself after therapy, especially after a challenging session. Coping and self-care strategies vary from one person to the other, for example some people might find relaxing music soothing while others may find it frustrating, so it’s best to explore what works for you.
Therapists can be wrong and can at times make mistakes. A good therapist will acknowledge this and will be open to working through hurdles with you. You should feel free to give feedback, ask questions, and talk about the process of therapy with your therapist. Speaking about the therapeutic relationship (the relationship between the therapist and client) is key to effective therapy.
Therapy is different to speaking to a friend. I came across a quote on Facebook which read “Good friends are cheaper than therapy”. They might be cheaper (depending on how expensive their tastes are), but it’s not about comparing which is better, they are two very different relationships. In fact, the therapeutic relationship is unlike any other relationship. The focus is on you, which may be unusual or even overwhelming at times, but it provides a unique opportunity to explore parts of yourself, which you cannot do in two-way relationships.
On your first session, the therapist will likely discuss the therapeutic contract or frame with you. This includes information such as confidentiality, meaning that what is discussed in therapy will remain between the two of you, except if you inform the therapist that there is a serious risk of harm to yourself or others. You will also notice that therapists will stick to the boundaries of the session closely, for example ending the session on time, keeping the relationship professional, and so on. This is very important for creating a unique and safe therapeutic space.
There is often an element of repetition in therapy. This might be frustrating at times and might feel like if you are repeating things then you must not be moving forward. However, repetition is an important part of the process. Children are often very comfortable with repetition: they will sing the same song over and over again, ask the same question until their parents’ ears bleed, and play with the same toy until it falls to pieces. But as adults, we sometimes forget its importance. In the rush and pressure to perform and see results, we forget how many times we had to practice riding the bike until we mastered it, how many times we had to repeat the verbs until we learnt the new language. A similar concept applies here, we need to manage our expectations and be patient with ourselves. However, if you feel stuck in therapy, it’s useful to talk about this with your therapist to see whether this process is happening, or whether something needs to be done differently.
Each therapist is different. You have a right to choose a therapist, just as you would choose any other professional or service provider. It’s important to have a good fit because, as mentioned earlier, the therapeutic relationship is one of the most important factors in bringing about change. There are different types of professionals, depending on their training, such as psychotherapists (trained in a particular therapeutic modality, as listed earlier), counsellors (focus on support, guidance and solutions), psychologists (carry out psychological testing as well as intervention). In addition to training, each therapist also has their own personal style, and the way this fits with each client is different, making each experience of therapy unique.
I hope that you have found this overview useful in gaining a better understanding of some of the ins and outs of therapy. If you have any questions, please feel free to reach out to us at info@taascmalta.com or therapy@taascmalta.com if you wish to learn more about the services offered at TAASC.
Ms Kelsey Renaud,
Clinical Psychology Practitioner
Kelsey graduated with a Bachelor in Psychology (Honours) from the University of Malta in 2014, during which she participated in exchange programs in the USA and the UK. She later graduated with a Master of Psychology in Clinical Psychology from the University of Malta in 2019. As part of her master programme, she studied suicide in the Maltese Islands between 1995 and 2018 in order to identify trends and risk factors in the local context.
Kelsey has had experience working with mental health issues in various settings. These include working in community mental health rehabilitation with Richmond Foundation, as well as providing online support to young people with Kellimni.com on a voluntary basis. She has also had experience in teaching Mental Health First Aid; carrying out work in research and policy at Victim Support Malta; and carrying out assessments at Corradino Correctional Facility.
Kelsey is currently working as a psychology practitioner in the Ministry for Health’s Mental Health Services, where she carries out psychological assessment and intervention with adults, mainly in the community services, and some inpatient services. Kelsey also forms part of the TAASC team where her role includes providing psychological intervention to clients with various presenting issues.
Special Interests: Adult and young adult mental health, Mood, Anxiety, Attachment and relationships, Trauma and Adjustment