What I Wish Someone Had Told Me About How Therapy Actually Works

The first time I pulled my car up to a therapist’s office, I had no idea what the experience would be like. The only images I had were from “Good Will Hunting” and “Equus,” both great movies but ones that don’t accurately portray therapy. I was skeptical, worried it would be a waste of time and money.

After years of chatting with therapists, other therapy-goers and people who were on the fence, I learned many people who consider therapy feel similarly before they commit. Therapy is a different for everyone, but there are common myths and misconceptions that aren’t true, ones that prevent people from receiving the benefits I have.

To break this stigma barrier, I reached out to therapists and drew upon my own experience. Keep reading to learn the truth about therapy.

There is No ‘It’s Not Your Fault’ Moment – Progress Happens Gradually

Remember that great scene in “Good Will Hunting” where Robin Williams’ character hugs Will and tells him “It’s not your fault” until he breaks down and cries for the first time? After that, Will turns his life around and seems to instantly overcome his attachment disorder. The movie heavily implies he begins making use of his brilliance, stops bumming around with his friends as much and drives to California to get back together with his girlfriend.

It’s a great movie and that scene made me cry the first time I saw it. But there is no big eureka moment in therapy where you overcome your issues with one big cry. Therapy is more like a series of small breakthroughs.

I’ve had moments in therapy where I came to a huge realization and experienced a catharsis, but I didn’t immediately change my behavior and beliefs to the point where it wasn’t an issue anymore. I had to work on it outside of therapy and revisit the issue in my next session, something Will doesn’t do.

Therapy Does Not ‘Fix’ You Because You Are Not Broken

This is one of the areas where therapy and medical treatment vastly differ. With medical treatment, the best outcome is a cure where you eradicate the illness and ensure it doesn’t return. In therapy, this isn’t possible because mental illnesses, negative beliefs and maladaptive behaviors are not diseases.

“Therapy helps clients uncover strengths and learn new skills that will allow them to deal with the challenges that arise in life,” counselor Crystal Johnson told Talkspace. “A successful therapy experience does not mean a client is cured, it means the person has the inner and outer resources to deal with the ups and downs of life.”

This is how I feel about my therapy experience. Therapy has reduced some of the psychosomatic symptoms of my mental illness, but it’s not going to eradicate it. It is mostly a tool for me to better cope with my problems. It can’t fix me because I was never broken.

Therapy Can Be Affordable

The average cost of a therapy session is between $75 and $150, but you don’t have to pay that much. Here are some options for affordable therapy:

• Group therapy
• Free counseling from schools (if offered)
• Online therapy from licensed therapists

There Isn’t Always a Couch and People Don’t Always Lie Down On It

This is another cliche film and television perpetuate. Many therapists have couches in their offices, but few will insist you lie down on it and look away from them. There are as many offices with no couch, only chairs and some tissue boxes.

This perception lingers because of psychoanalysis and Freud’s influence on psychology. During Freud’s time, it was common for therapists to insist patients lie down on a couch and look away from them because they believed it made the patient more open. This, however, also makes it more difficult to bond with the therapist.

Today, therapists who practice psychoanalysis are rare while cognitive behavioral therapy [CBT] and other practices have become popular.

What happens during therapy?

Therapy sessions can be viewed as problem-solving workshops. At each session, a discussion with your therapist will analyze where you stand and the status of the issue that brought you in. Remember that therapy is an incremental process that happens with time and growth, and each therapy session serves as a step in your progress. During therapy, you can talk about anything that’s on your mind, and your therapist will listen. You can speak openly and vulnerably about yourself; your conversations with your therapist are confidential. 

After you unpack your feelings, your therapist might provide you with some insight in response or help you deconstruct and synthesize what you just shared. They also might give you a task or something to think about if they think it’s important for your process. 

Overall, during therapy you will be able to unpack and disclose whatever is bothering you and receive constructive feedback to help you improve your mental health.

Therapists Do More Than Listening

The “blank screen” cliche where therapists barely engage with clients is another leftover from the early days of psychotherapy.

Talkspace spoke with therapist Donna Corbett, who offered an accurate description of how active therapists are.

“Therapy is an interactive process because it is a relationship,” she said. “In the beginning, I may speak less or ask more questions as I am getting to know my patient but as time goes on, I do share my thoughts when it will be helpful.”

Some therapists take an even more active role than Corbett. I had one who talked more than I do, which is saying a lot.

But Therapists Don’t Tell You What To Do

Therapists are different than coaches. They will guide you to solutions they believe are best, but won’t directly suggest things. Therapist Bethany Raab had a message for potential clients who worry about this issue.

“I cannot make you do anything, nor do I want to do so,” she said.

It’s up to clients to apply what they learn during sessions, she added.

Or Ask ‘How Does That Make You Feel?’

This is another film and television cliche. If you think about how stupid the question can be, you’ll understand why most therapists don’t do this.

Imagine you told a therapist your father cheated on your mother and ran out on you when you were a kid. Then he responded with “And how does that make you feel?”

Obviously it made you feel terrible, so why bother with such a useless question?

Therapist Rick Cormier is familiar with this cliche and has half-jokingly told his clients: “I promise never to ask how anything makes you feel. I care about how you function.”

Therapy Does Not Have to Be About Your Childhood

Speaking of Freud, his influence has made prospective patients worry their therapists will needlessly connect everything to their childhood and obsess over sex, digging for unconscious issues that don’t exist. You might have to talk about your childhood if it’s relevant, but it will be far from the only thing you discuss.

“Gone are the days of Freud and hyper-focus on unconscious factors,” said Northeastern University Professor Kristen Lee Costa. “Today, more than ever, we have evidence-based, promising treatment modalities that are practical and proven.”

Therapy has become more scientific since the heyday of psychoanalysis. Freud based much of his work on assumptions and theories while modern therapy has numerous studies backing its efficacy.

Therapy Is Not Easy

I enjoy therapy, but making progress is not easy. When I started, I had to challenge negative beliefs that felt as deep as my marrow, things I clung to for nearly a decade. At times, it seemed impossible to change. I had to spend dozens of hours thinking and challenging myself outside of therapy to develop positive and objective beliefs.

For others, therapy is even more difficult. Before getting to the beliefs, you have to open up, which can be challenging.

But It Doesn’t Have to Last for the Rest of Your Life

People often don’t commit to therapy because they fear they will be stuck there until they die. There’s nothing wrong with continuing therapy for the rest of your life, but you don’t have to. Therapists don’t want your money that badly.

I actually had one therapist who sort of dumped me. He said I didn’t need him and had made enough progress to permanently leave therapy. I didn’t feel dependent on him, but I disagreed, mostly because my symptoms had not reduced to the level I wanted.

One way to avoid this is to sign up for short-term therapy such as the kind counselor Alicia Taverner offers.

“In the initial session, I talk with clients about goals and when they’ll know they don’t have to come to therapy anymore,” Taverner said. “This sets the stage for continually checking in on their goals and assessing when therapy will end.”

If you want to ensure therapy doesn’t last too long, try finding someone with Taverner’s approach or asking your therapist to set long-term goals for eventually leaving.

Online Therapy is a Thing (And Online Therapists Are Just as Good)

For many years after I started therapy, I didn’t know online therapy existed. After I learned of it, I doubted the efficacy. Part of this was because of the Showtime series “Web Therapy” where Lisa Kudrow plays Fiona Wallace, a terrible and self-obsessed therapist. I loved the show and thought Lisa Kudrow was hilarious, but it subconsciously warped my view like “Good Will Hunting” did. I assumed online therapists were not as credible as in-office ones.

Now I have gone to both online and in-office therapists. Both were licensed and equally skilled. I actually wish I had started online therapy sooner because it was difficult to convince my last boss to allow me to take time off from work to go to therapy sessions. I had to prove myself at the company before he felt comfortable letting me come in late once a week. With online therapy the schedule is more flexible and I don’t have to take time off work.

Having a Male or Female Therapist Doesn’t Make a Difference

It’s OK to have a gender preference for your therapist, but don’t think picking a therapist of the same gender will significantly improve the quality of your sessions. Gender is also not likely to change the way a therapist treats you.

When I was looking for a therapist, I had trepidations about picking a woman. I thought any female therapist would be equally qualified and efficient, but I worried she would judge me if I talked about sleeping with women or used politically incorrect language.

Now that I’ve had several female therapists, I know my anxieties were unfounded. Male or female, therapists do not judge you. They want you to feel free to be yourself and say what’s on your mind without mincing words.

Therapists Cannot Read Minds and Don’t Get Kicks from Analyzing People

Some potential clients worry therapists will predict what they are thinking or breakdown their problems in a Sherlock Holmes-style demonstration of analytical prowess.

When therapist Angela Essary was younger, she encountered people who — when learning of her profession — asked questions such as “What am I thinking now?” or “Are you analyzing things all the time?”

People aren’t seeking her help for that reason, she said, so she tries not to be intrusive.

Remember, good therapists want to help you. You’re not a specimen to them. You’re a client, someone they care about.

Therapists Cannot Legally Prescribe Medication

Don’t be concerned about throwing in with a pill pusher. Only doctors and psychiatrists can legally prescribe medication such as antidepressants. A therapist might refer clients to an in-person or online psychiatrist if they think symptoms are severe enough to warrant mediation, but they prefer to treat you with psychotherapy alone. They don’t receive any compensation for such referrals.

Understanding is the First Step to a Better Life

Once I understood how therapy worked and how I could leverage it, it changed my world. After a crippling episode of depression in college where I was unable to sleep for four days, therapy helped me stay in school, work on my symptoms and develop beliefs that improved my social and romantic life.

Because I didn’t read something like this, my parents had to push through my stubbornness and convince me to go. But once you know what it’s actually like, there is one less thing holding you back. You can be a stubborn 20-year-old like I was or a wise 40-year-old who is skeptical of therapy. Either way, it’s never too late.

Want to learn more about Talkspace? Here are some reviews.