What to Expect from Psychotherapy

Peter M. Barach, Ph.D.

© Copyright 2001 Peter M. Barach, Ph.D.
Not to be reprinted in any form without permission of the author. All rights reserved.

What is Psychotherapy?

Psychotherapy is a process in which the therapist and client talk and work together to try to resolve the client’s problems. Sometimes the “client” is more than one person at a time, such as a couple or a family.

In the first few sessions, the client and I will try to identify what is bothering the client (the “presenting complaint”), what he or she would like to get out of therapy, and what the client has already tried to resolve the problem. I also ask the client about current life issues and the client’s background.

During these first few sessions, the exact nature of the client’s problem may become clearer, and the client may realize that issues other than the presenting complaint should really be the focus of treatment. For example, a client may come for help with a sleep problem, and might soon realize that the sleep problem is the result of anxiety about work.

Once the client and I have a reasonable agreement on what the problem is and what the desired goals of treatment are, we will discuss a treatment plan. The plan involves some general or specific goals, a description of the treatment approach I’m recommending, and usually a ballpark estimate of how long treatment might take. If there are several possible treatment options, I try to provide an overview of each so that the client can decide which one to pursue.

Once the initial sessions are completed, the client is in charge of what is to be discussed in each session. Although clients occasionally like to make notes about what to discuss, most of the time psychotherapy goes better when clients start each session with what is foremost on their minds.

Although I usually wait for the client to start each session, I am not a passive therapist. You can expect me to ask questions, to ask for further details, to try and help find words for feelings, and to make links between things you’ve said at different points in the therapy. At times I will gently challenge how you see things, or your resistance to trying something new. I will provide plenty of feedback about what you’re saying.

Clients who take an active part in their psychotherapy will make more progress than those who wait for pearls of wisdom to drip from the therapist’s lips. Although some clients come to therapy expecting a “magic pill” to make their problems go away, they soon find that they must actively think about their problems and try new behaviors. Some kinds of psychotherapy ask the client to complete homework assignments in order to try new things, and clients who complete the homework will make better progress.

What Psychotherapy is Not.

Psychotherapy is usually not about giving advice. In contrast to what television and movie therapists do, psychologists usually do not tell clients what to do. I don’t tell clients whether to get married, to stay married, or get divorced. I don’t tell clients whether to have children, whether to change jobs, whether to have contact with family members, or what sexual orientation they “ought” to have.

In addition, psychotherapy is not taking control of the client’s life. Client’s make their own decisions, and I do whatever I can to support their independence and maturity.
Psychotherapy is not the same as friendship. The relationship with a therapist happens only in the therapist’s office; there are no social meetings during treatment or after treatment ends. Also, the relationship with a therapist is one-sided. Clients talk about their lives and problems, but therapists say little or nothing about theirs.