Therapist Reveals 10 Things They Wish Their Clients Knew Before Seeing Them
Tearing down myths to reveal what therapy is really about and what therapists actually do.
Hrant Khachatryan | Unsplash Starting herapy can be daunting — an unfamiliar experience that requires some vulnerability and a willingness to share one’s deepest emotions.
For some folks, digging deep to gain greater self-awareness alongside the guidance of a trained psychotherapist might sound appealing. But for others, psychotherapy might seem like the last place they want to be. I see this understandable hesitation among clients in my psychotherapy practice regularly.
"I would rather walk into a building, guns drawn, than be in a therapist’s office," claimed a former psychotherapy client, a retired police officer. Leanna (whose name is changed to protect her confidentiality) was only partly joking about her fears. Fortunately, she could laugh about her comment and settle into a conversation about her troubles.
Like Leanna, many folks overcome their hesitation and choose therapy as a resource to weather difficult times. “Therapy helps you learn how your mind works,” says Mental Health America, a non-profit advocacy organization. “It allows you to navigate your feelings, build healthier habits, and change your mindset so that your life looks more like you want.” They cite research indicating that psychotherapy can modify brain functioning and works “just as well or even better than medication to treat various mental health conditions, including anxiety, depression, and obsessive-compulsive disorder.”
Psychotherapy can address a range of problems, such as emotional distress, parenting or career struggles, marital and family conflict, child behavioral concerns, and addictions. Although results can vary depending on the skill and experience of the therapist and how well the therapist’s interventions align with the client’s needs, research backs its effectiveness. According to the American Psychological Association, psychotherapy is effective, often reduces the need for supplementary medication, and its positive effects endure after treatment is over.
Unfortunately, both psychotherapy and the role psychotherapists play are frequently misunderstood and subject to cringe-worthy portrayals in film and the media. Particularly troubling are descriptions of therapy as an exercise in advice-giving, or even worse, depictions of therapists who violate boundaries, befriend their clients, or seem to get their personal needs met through their work.
So what’s the big deal?
Misinformation is damaging. It deters people from seeking therapy when they need it most. Building trust in psychotherapy at a time of great vulnerability is a challenge for anyone. Confusing and negative misrepresentations only serve to muddy the waters. When there are lingering doubts about the psychotherapist’s ethics or motives, or basic misconceptions about what therapists actually do in therapy, trust might never develop.
In my decades of clinical psychology practice, I have seen the benefits, limitations, and pitfalls inherent in psychotherapy. Therapy is far from perfect. But it can be the best possible support and even a lifesaver under certain circumstances.
So, I would like to set the record straight — at least based on my experience and perspective. And while I cannot speak for every therapist out there, I have heard similar concerns in my collaboration with scores of psychotherapists over the years.
Here are 10 things your therapist wishes you knew about psychotherapy:
1. Your hesitation is normal
Most people start psychotherapy with a healthy dose of skepticism, along with some hesitation, worries, and doubts. The process of opening up to a stranger about fears, insecurities, and even feelings of shame is daunting. It takes time to trust that the therapist gets you, that they understand your background, values, and emotions, and that they are on your side. Your initial hesitation is a sign of your emotional health; take it seriously, but don’t let it deter you from getting the help you need.
2. You, as a client, are essential to the process
Therapy requires your input. The therapist guides you with questions and comments, but your active participation is critical. You will be asked to share your thoughts and feelings, along with aspirations, mistakes, regrets, and unresolved dilemmas from the past — and sometimes even those concerns you might have carefully avoided for a long time. The more open and honest you are about your struggles, the more you will get out of it. Openness to expressing such concerns, though, is difficult for anyone starting in therapy.
A recent Washington Post article, "Yes, We Know You Lie to Your Therapist," highlights the challenges inherent in sharing when you feel most vulnerable. “This can lead you to say you’re doing well, even when you’re not. Or to tell your therapist you never use substances, even though you drink or smoke.” In fact, in one study of psychotherapy clients conducted by psychology researcher Matt Blanchard, 93% reported lying at least once to their therapist.
It is human nature to present yourself in the best possible light. But taking that first step to openly express your troubles is essential if you want to get the most out of therapy.
3. Psychotherapy is not just about receiving advice
Psychotherapists at their best offer an empathetic understanding of your concerns. They bear witness to what you have endured and calmly listen to your struggles, aware of the courage it takes to overcome fear and ambivalence. Most of what happens in psychotherapy involves a collaborative exchange of ideas designed to help you arrive at the best possible decisions. Despite common misconceptions, they rarely offer direct advice or insert their personal opinions.
But wait… it might seem like direct advice is exactly what you want. Why should you pay a therapist who isn’t going to offer advice?
Simplistic advice-giving, while an easy shortcut, rarely leads to the changes you might be seeking. It sometimes bypasses and overlooks your fears and hesitations, and it may not be tailored to your readiness to change. “Advice giving in psychotherapy may carry different meanings and generate different consequences than in other relationships,” says psychology professor Changming Duan. In other words, suggestions from your therapist carry a different weight than advice offered by friends, family, or your hairstylist.
Yes, therapists sometimes suggest specific approaches or perspectives (or sometimes, even “homework” assignments where you are encouraged to try out new behaviors). However, they carefully consider the costs and benefits of offering their suggestions.
4. Psychotherapists are working hard — even when they look relaxed
Your psychotherapist might seem chill, but their mind is working overtime. They may look relaxed, but they are listening intently, considering what may be causing your troubles, and carefully weighing what to say and when and how to say it. Psychotherapists work hard to gain your trust. While some therapists espouse certain niche skills and techniques, the basic foundation of psychotherapy rests on the therapist’s ability to provide a safe space where you can share your deepest concerns.
While your therapist might challenge you at times (like when you resort to self-defeating behaviors), this occurs within an already accepting and collaborative relationship.
5. Psychotherapists are real people
Psychotherapists are a quirky bunch. Like most artists, creatives, and those with a “calling,” they inhabit a world somewhat outside the norm. They derive great meaning from exploring the human psyche and helping others eliminate distress — some might say that’s not a “normal” life pursuit, but it’s an important job, and somebody with a creative mindset has to do it. Regardless, they are typically highly educated and professional in their demeanor. They’ve just chosen a career path that may be difficult for others to fully grasp.
Psychotherapists experience joys and sorrows in their own lives, just like you do. They make mistakes and are imperfect, just like all humans. But their job is to keep their personal lives separate from their work with you. Your psychotherapist is not a mind-reader or a “blank screen” or a “sounding board” — stereotypical concepts that diminish who they are, and ignore the very real person sitting across from you. They also have very real reactions and emotions about what you say.
“Wow, you’re getting wrinkles, too,” exclaimed a psychotherapy client who was relieved that I was also showing signs of aging. She never considered, of course, how her comments about my aging complexion might affect me!
Most therapists develop a thick skin, though, and even invite negative comments about the therapy process, since this encourages greater authenticity and clears the air if a client is feeling misunderstood. You don’t need to protect your therapist from your reactions and perceptions. But realize that sometimes, your comments make a dent.
6. Psychotherapy is not a place for therapists to solve their problems, be your friend, or form a special relationship with you
Contrary to widespread myths, psychotherapists are not in this career to meet their own needs or resolve their conflicts. They are not using you to feel better about themselves, and although they may be excited about your progress, they don’t take much credit for it or use it to boost their own ego.
Unlike the reciprocal sharing found in friendships, the therapist uses careful restraint and does not expect you to support their emotions, bolster their ego, or offer advice.
Most importantly, psychotherapists should never cross boundaries. Certain actions are never acceptable, such as forming a sexual or romantic relationship with a client. But other boundary violations — such as sharing highly personal information or developing close friendships or work relationships — are subtle but still unacceptable. Your therapist may like you a lot, but can never become your friend outside of therapy, since this would compromise your trust.
7. Psychotherapists are not at work 24/7
Since therapy is a “helping profession,” some people assume that therapists are always on, that they never stop analyzing others, and are always eagerly willing to listen to others’ problems. While most therapists are intrinsically helpful and have a curiosity about the human condition, they really do relax and act like everyone else.
So when you meet a therapist at a social event, don’t assume that they are scrutinizing your every word. Don’t expect them to be careful, conscientious, and completely “together” in their daily lives. And please, don’t ask them for a quick evaluation.
Most therapists would relish the freedom to share their day-to-day events and family milestones with a client. However, they realize that the more you know about them, the more it could inhibit your willingness to share about yourself. So don’t expect your therapist to share deeply personal information — how they might have recovered from addiction, lost weight, or weathered a rough patch in their marriage.
Whatever worked for your therapist in their own life will not necessarily work for you in yours, and their presumed success might spur comparisons that could block your progress.
8. Ethical behavior is essential to the practice of psychotherapy
Unlike film portrayals of “dual relationships,” where therapists wine and dine (or more) with their clients, psychotherapists must adhere to strict ethical guidelines. They behave responsibly and only practice within the scope of their training and expertise. They recognize their limitations and are clear about what they can and cannot offer.
A therapist trained to work with adults, for example, would not be competent to work as a child psychotherapist. A therapist specializing in behavior therapy would not be competent to provide psychoanalysis.
It takes years of training and experience to gain expertise. As I shared previously, clinical psychology training is a long road. Licensed psychologists, for example, typically receive at least five years of education and clinical training beyond college, along with post-doctoral training. They continue to learn throughout their careers and are required to pursue continuing education to enhance their skills.
While some bad actors can be found in any profession (including psychotherapy), licensing laws are designed as safeguards to prevent harm to the public. Psychotherapists should be licensed in your state or province and should adhere to a code of ethics, including maintaining confidentiality, boundaries, and integrity.
If you feel uncomfortable about how your therapist is talking to you, if they use physical touch (beyond a handshake) without your permission, or if it seems like you are listening to your therapist’s troubles more than sharing your own, speak up and ask them for clarification. If there is no clear and reasonable explanation for their behavior or a misunderstanding is not resolved, consider a second opinion with another therapist.
9. Psychotherapists want to be paid for their services
It should not be a news flash, but yes, therapists expect to be paid. Like everyone else, therapists have to pay bills, raise a family, and in many cases pay back colossal student loans. Psychotherapy can indeed be a “calling” coupled with a deep desire to help. And it may be confusing for clients, who question how genuine a therapist’s caring relationship is when they must pay for it. What you are paying for, though, is the therapist’s time and expertise. Even if your therapist likes and cares about you (and perhaps, would have befriended you in a different context), they are “working” with you and should be paid for their efforts.
In reality, psychotherapists are rarely paid as much as other professionals with similar years of training (ranging from attorneys to accountants to general contractors), many of whom rarely seem apologetic when they expect timely compensation for their services.
While many prospective clients have limited financial resources, some feel guilty about paying for therapy because they don’t feel they deserve it. However, if you are struggling financially, you can search for a therapist who lowers their fees for those in need. Most offer some pro bono services. Many therapists have insurance contracts and opt to accept insurance reimbursement rates, which only require a co-pay from you.
10. Psychotherapy is not a luxury, an indulgence, or for those who are weak
Unfortunately, such stereotypes and stigma are a deterrent to seeking needed support. Psychotherapy cannot solve every problem and is only one of many resources available to support you in time of need. The importance of community, family, friends, and colleagues cannot be overstated. However, therapy can be an essential support and even a lifesaver at times. Don’t let stigma and stereotypes stop you from finding what you need.
Therapy is also hard work. Self-awareness and a willingness to self-reflect is hard. Change is even harder. It is far from an indulgence.
You will need to think about what you have discussed between sessions and try out new behaviors. You might even need to do a little digging into long-buried family issues to rid yourself of entrenched patterns that influence you now. You won’t always walk out of a session feeling great; sometimes you’ll feel sad or angry because of emotions that have surfaced. But the awareness and understanding you will gain is worth it. So be prepared to roll up your sleeves and dig in!
If you are looking for a psychotherapist, you can start by asking your physician, school counselor, religious advisor, friends, or another trusted referral source for recommendations. Although starting therapy can be daunting, and not easy for the first few sessions, trust your instincts and consider shopping around if you feel uncomfortable or misunderstood. Meeting with several licensed psychotherapists before making a decision can be helpful, along with asking questions about what to expect during therapy. Be cautious about unlicensed therapists who use the term “doctor” or those with an alphabet soup of letters after their names or life coaches who claim that coaching is the same as psychotherapy. Psychotherapists are far from perfect, but they can help you gather the insight, understanding, motivation, and self-compassion you need to move ahead on your chosen path.
Gail Post, Ph.D. is a Clinical Psychologist, parenting coach, and Associate Professor of Psychiatry at the University of Pennsylvania School of Medicine. She has written hundreds of articles and blog posts, several book chapters, and a new book, The Gifted Parenting Journey.