Progress in Psychotherapy Isn't Linear

Clients who are new to psychotherapy often don't know what to expect, which is why it's important for psychotherapists to provide psychoeducation about how psychotherapy works (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works).  One important aspect of psychotherapy to understand is that progress in therapy usually isn't linear, which is the topic of this article.

Progress in Psychotherapy Isn't Linear

Defining the Presenting Problem: Understanding Big T and Small T Trauma
It's understandable that clients want to see that they're making progress in therapy, especially if they've been suffering with longstanding problems.

When a client is in therapy, it's important for the client and the psychotherapist to understand the nature of the presenting problem.  That makes it easier to set therapy goals and to measure progress in treatment.  This might take a while to reveal itself as the client comes to therapy and gives the therapist information about the history of the problem and how it's affecting her now.

Usually, the narrower the problem, the easier it is to make progress and resolve the problem in therapy.  For instance, if a client comes to therapy after she has been robbed and, prior to the robbery everything was basically going well with no history of prior trauma, this is a simpler case than someone who comes to therapy with longstanding unresolved trauma from childhood (also known as developmental trauma).

Saying that it's a simpler case is in no way meant to minimize the traumatic experience of being robbed.  But compared to an adult client with a long history of being abused and neglected as a child, it's a less complex case.

With regard to definitions of trauma, the unresolved developmental trauma would be considered a "Big T trauma" and the one-time traumatic event, like getting robbed, where there was no prior trauma, is considered a "Small T trauma" (see my article: Big T and Small T Trauma).

For Small T trauma, the goals are usually more narrowly defined. These might include: The client being able to walk down the same street where she was robbed without fear or being able to leave the house without fear.  If someone who was robbed is very frightened, this is important and it might seem daunting.  But relative to Big T trauma, the scope is narrower.

For Big T trauma, the goals are more complex and might be multi-layered.  For instance, a client who was abused and neglected as a child might be fearful of experiencing his feelings.  He might have constricted affect and not even understand his feelings because he had to protect himself as a child so he wouldn't feel so vulnerable.  This, in turn, usually leads to problems in adult relationships.  So, you can see that Big T trauma is more complex, and there will be layers of trauma to work on.

Understanding the scope of the problem involves exploration.  For instance, a client might begin therapy by saying that she has a problem communicating with others.  This is, of course, a very general definition of a problem, and the psychotherapist would need to ask questions to make it more specific:  Does she have problems talking to everyone or only people at work?  Is the problem related to a medical issue or is it a psychological issue or both?  When did the problem start?  How does the client experience this problem?  How is this problem affecting the client internally and interpersonally?  And so on.

As the client and psychotherapist explore these questions and the history of the problem, they might discover that the problem is longstanding and the client cannot remember a time when she didn't have this problem, even as a child.

As they continue to explore this issue, they might discover that the problem is pervasive in all areas of the client's life.  The client reveals that all possible medical issues have been ruled out and the client's doctor recommended that the client seek psychological help.  Furthermore, the client reveals that whenever she has to speak, whether it's one-on-one or in a group, she becomes panicky and she has had a few panic attacks recently.

It soon becomes clear that the client's problem talking to others is a symptom of a much larger problem, and her anxiety is related to longstanding unresolved trauma.  As a result, the problem is much more complex than the client originally thought.  This sounds like Big T trauma, and it will require further exploration to discover the root of the problem.

In contrast to Big T trauma, if a client came to therapy and says she has problems speaking up at staff meetings ever since her boss humiliated her in a prior staff meeting, but she never had this problem before, she never has this problem in any other situation, and there is no developmental trauma, this is probably a Small T trauma.  It's not multi-layered like Big T trauma, and the goals in therapy would probably be narrower and more easily achieved.

The Circular Nature of Progress in Therapy
Even when a client has had a significant breakthrough in therapy in a prior therapy session, he might come in the next week experiencing many of the same problem that he did before the breakthrough.

You might ask:  "Why is this?"

Well, there are many reasons.  One reason is that many clients need at least a few "Aha!" moments in therapy in order for breakthroughs to stick.

Another reason is that, even when a client really wants to make progress in therapy and resolve his problems, there is almost always ambivalence and some anxiety about changing.  For many clients, the "devil" (or problem) they know is easier to deal with than the "devil" they don't know (change) (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

Many clients will tell their therapists that they are fearful of who they would be if they didn't have a longstanding problem because they've had the problem for so long, and they've learned to identify with their problem as if it's a part of themselves.

As a result, a client might have to go over the same material several times or more before the change "holds" and remains.  They might have to circle back many times to rework the same or various aspects of the same problem.  Along the way, other aspects of the issues they're struggling with might come to the surface in order to get worked through.

This is one of the main reasons why progress isn't usually linear.  Most of the time it's circular:  Two steps forward and one step back.

For people who are in recovery for addiction, one of the first things that they learn in recovery is that relapse is part of the process.  Many clients new to recovery will hear this and say that they have made a firm commitment to their recovery and they will never relapse.  But being human means that clients often do go back a step or two before they can go forward.

It's no different for most other problems that people come to therapy to resolve.  And the more complex the problem, the more likely that progress will be circular and not linear.

Conclusion
Most clients who are new to psychotherapy expect that their progress will be a linear progression, like a straight arrow, where they keep making progress and never backslide.  But this is rarely the case, especially if their problems are longstanding and complex.

Understanding the problem, the problem's history, how it affects the client now, and so on, is important to setting therapy goals.  The simpler the problem, the easier it will be to resolve, so Small T trauma is less complex than Big T trauma and will be more readily resolved, all other things being equal.

Sometimes, the client either doesn't know what the problem is or thinks the problem is narrower than it is.  As the client and psychotherapist explore the problem, they can define the problem better to understand if it is a new problem which is narrow in scope or if it is a multi-layered problem with a long history, which makes it much more complex.

Assuming that clients come to therapy on a regular basis and they are working with a skilled psychotherapist, most clients' progress is circular rather than linear--two steps forward and one step back.  The more complex the problem, the more likely that clients will occasionally have setbacks (see my article:  Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).  This is human nature.

For more complex problems, if there is progress, it can usually be seen over time by comparing how clients were when they first started therapy to how they are feeling, thinking and behaving now.

With regard to making progress in therapy, knowing what to expect in terms of this going forward/occasionally going backward dynamic helps clients to have reasonable expectations of themselves and their therapy.

Getting Help in Therapy
Making a decision to change and asking for help in therapy are courageous initial step (see my article: Developing the Courage to Change).

If you have been struggling with unresolved problems, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist can help you to overcome your problems so that you can live a more fulfilling life, free from the history of your problems (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Striving to Be a Lifelong Learner

Lifelong learners are people who are inherently curious and self motivated to continue learning way beyond what's required in high school and college.  Striving to be a lifelong learner not only helps you to understand yourself, but it helps you to develop insight into other people and the world around you, whether you learn through reading, listening to music or traveling and meeting new people and discovering another culture (see my articles: Reading Literature and the Positive Effect on the Brain and Learning About Yourself While Traveling).

Striving to Be a Lifelong Learner

When I was in junior high school and high school, much of what I was required to learn was boring to me.  I learned my lessons because I had to and I got good grades, but throughout my life, whenever I've been bored with whatever I'm required to learn, I find something else that captivates me.  

That meant that my best friend in high school and I would plan our own educational day trip by going to the museum or admiring the architecture in various parts of Manhattan.  This kept us from being weighed down by the tedium of having to memorize dates in history or mathematical formulas that had no meaning for us because of the way it was taught.

In college and graduate school, things improved substantially. The classes were more interesting and I was asked to develop my mind and to think creatively rather than just give back to the instructor what s/he told us in class.  

When I was in college, I was a psychology major and loved my psychology and anthropology classes the most out of all my classes.  Learning about psychological behavior and cultural anthropology fascinated me.

My postgraduate psychoanalytic training was the best.  I enjoyed the classes on contemporary relational psychoanalysis much more than the classes on classical psychoanalysis, so when I was bored with a particular required paper on classical psychoanalysis, I would balance it for myself by reading a book by Stephen Mitchell, Ph.D., who was a contemporary relational psychoanalyst. In fact, he coined the term "relational psychoanalysis." 

I learned the most when I was a teaching fellow in my postgraduate training.  I worked at the mental health center that was connected to my psychoanalytic training department.

Initially, it was challenging because, in my opinion, graduate school hardly prepares you to do psychotherapy, so I was learning how to be a psychotherapist as I was working with clients.  But, despite the challenge, I had excellent supervisors, who provided guidance.

I was also required to be in my own three-time-a-week psychoanalysis, which was the most valuable aspect of my psychoanalytic postgraduate training.  

Even now, almost 20 years after I left the four year postgraduate training, I can say that the immersion process of taking classes, being supervised individually and in group, seeing clients at the mental health center, and being in my own psychoanalysis was one of the most valuable experiences in my life.  Not only did I learn about my clients, but I learned so much about myself.

I love attending clinical workshops and conferences to learn new treatment modalities.  This is one of the reasons why I love being a psychotherapist--as a psychotherapist, you're always learning.  

It's a wonderful time to be in the psychotherapy field because we know so much more now about the brain and the connection between the mind and the body, and this has fostered many different mind-body oriented types of therapy, like EMDR Therapy, Somatic Experiencing as well as the value of clinical hypnosis.

I also still continue to learn so much from my clients.  By listening and being attuned to their experiences, I can relate to what they're going through.  Often, I've gone through many of the same experiences, so I usually understand their problems on many different levels.

Many people have said to me, "How can you stand listening to people's problems day in and day out?" because they think that being a psychotherapist means listening to people complain (see my article: Psychotherapy is Much More Than Just Venting and Psychotherapists Listening and Learning From the Client).  

But being a psychotherapist is so much more than that.  Even when it might not be transparent to the client, psychodynamically trained psychotherapists aren't just "listening to complaints."  They're conceptualizing what's going on internally with the client and how the past and the present might be connected (see my article: Overcoming Trauma: When the Past is in the Present).

They're also listening for the transferential aspects of the therapy (see my articles: What is Transference?, Psychotherapy and the Positive Transference, What is the Negative Transference?, and Psychotherapy and the Erotic Transference: "Falling In Love" With Your Psychotherapist).

Psychotherapists and clients are also involved in an intersubjective experience that's hard to describe in words if you've never experienced it as a psychotherapist or as a client in therapy (see my article: Psychotherapy: A Unique Intersubjective Experience).

The intersubjective dynamic that's between the client and the therapist in a psychotherapy session is alive with meaning.  It's unlike anything that I've ever experienced before, and when the therapist and the client have a good rapport, there is a right brain-to right-brain connection that can be healing for both of them.  Of course, the focus is on the client, but therapists also experience the benefits of this special connection (see my article: The Therapist's Empathic Attunement Can Be Emotionally Reparative For the Client).

Encouraging Lifelong Learning

Becoming curious and psychologically mind is generally one of the broad goals of therapy.  Even when clients come to therapy for a very specific goal, like overcoming a phobia or coping with the death of a loved one, the experience of being in therapy usually broadens them along the way.

It's wonderful to see clients become curious about themselves and others in therapy.  It's like a whole new world has opened up for them.  This is something that I think most psychotherapists encourage because, in my opinion, psychotherapy should be more than just coming to resolve a particular problem.  While it can be that if that's what the client wants,  it's often much more.

Psychoanalysis and other forms of depth psychology aren't as popular as they used to be.  Most people don't want to come to therapy three times a week or focus on their dreams.  

And yet, in integrative psychotherapy, where various types of therapy are used in combination, like psychodynamic therapy and Somatic Experiencing, the client derives the benefits of depth psychology along with the benefits of more focused therapy (see my articles: Contemporary Psychoanalysis and EMDR Therapy and The Therapeutic Benefits of Integrative Psychotherapy).

And even though most clients don't want to talk about their dreams, if they're open to it, I tell them about Embodied Imagination dreamwork, a neo-Jungian form of dreamwork developed by Robert Bosnak, and almost everyone is fascinated by it because it's not the usual type of dream analysis where "this equals that" (see my article: Dreams and Embodied Imagination).

So, I encourage my clients who are open to it to be lifelong learners about themselves, the people around them, and the their larger world.  I believe it enhances personal growth and development, which keeps life fascinating.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who practices integrative therapy to collaboratively develop the best treatment plan for each client (see my articles: The Benefits of Psychotherapy and How to Choose a Psychotherapist)

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW- NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

How to Talk to Your Psychotherapist When Something is Bothering You About Your Therapy

In a prior article, I discussed the importance of psychotherapists providing clients with psychoeducation during the initial stage of therapy.  

I also stressed that it's up to the psychotherapist to check in with the client periodically to find out how the therapy is going from the client's perspective.  

This helps to avoid premature endings in therapy where the client leaves therapy abruptly out of frustration (see my article: When Clients Leave Therapy Prematurely).  

I also indicated that if the therapist doesn't check in, the client can initiate a conversation with the therapist.  But all too often the client has difficulty being assertive enough to initiate this conversation.  So, in this article, I'm focusing on how to talk to your therapist when something is bothering you about the therapy.

How to Talk to Your Psychotherapist

Why Might You Be Having Problems Initiating a Conversation With Your Psychotherapist?

Being Unable to Identify Feelings and Sensations Due to Early Developmental Trauma
Many clients who have difficulty initiating a conversation with their psychotherapist about the therapy also have the same difficulties in other relationships.  This is often a presenting problem for coming to therapy.

Many clients who have problems letting others know that something is wrong never developed this skill as a child because it was discouraged at home when they were growing up.

For instance, if a client grew up in a home where his parents communicated, either explicitly or implicitly, that everything that went wrong in the household was the child's fault, not theirs, this client will probably assume that problems in the therapy are his fault because he wasn't "good enough" or lovable enough for his parents and now he's not "good enough" for his therapist (see my article: Do You Feel Unlovable?).

Many adult clients, who experienced developmental trauma, including abuse or neglect (or both), have difficulty identifying their feelings.  They might know that "something isn't right," but they don't know what it is (see my articles: Developmental Trauma: Living in the Present As If It Were the Past and When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).

In most cases, these clients' primary caregiver wasn't attuned to them as babies, which is crucial for physical and emotional development as well as being able to identify feelings and sensations, and so they didn't develop these skills.

Clients, who have difficulty identifying feelings and sensations, have difficulty putting words to their experiences.  They need a psychotherapist who is highly attuned to what is going on with them in therapy and who can help them to develop the ability to identify and express feelings and sensations, including unconscious feelings (see my articles: The Therapist's Empathic Attainment and The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

If they don't have a highly attuned psychotherapist who can help them to become attuned to the mind-body connection, these clients often feel like they're "not doing therapy right" and this engenders guilt and shame in them.

Clients who were raised in a family where they were placed in the role of caregiving their parents will often unconsciously try to take care of their psychotherapist.  They are often hypervigilant to the  therapist's every facial expression and body language for "clues" as to what might be going on with the therapist and what they think the therapist needs from them, similar to the role they were in as a child with their parents.

Just as they did as children with their parents, these clients try to anticipate the therapist's needs and try to find ways to accommodate the therapist instead of allowing the therapist to help them.  Even though this is a role reversal for the client, the client feels comfortable with in it because it's familiar.

That being said, a skilled therapist will recognize this and address it so the client can learn to allow the therapist to take care of the client's needs.  At first, this might not be easy for the client because he never developed that trust and comfort with his parents as a child, and it's hard to trust as an adult.

Psychotherapist and Client Mismatch
Another common reason for clients not being able to address issues about therapy with their psychotherapist is that the client and therapist are a mismatch.  They're not a "good fit" for each other.

What does it mean that the client and therapist aren't a good match?  It means that, for whatever reason, the client and therapist don't "click."

As I've mentioned in prior articles, every therapist is not for every client.  Even an award-winning psychotherapist, who has published books and articles and is recognized as an expert in her field, might not be the right therapist for a particular client.  This doesn't mean that there's something wrong with the therapist or the client.  It just means they're not a good combination to work together.

This mismatch can make it difficult for the client to communicate with the therapist because they're not on the same wavelength.

If there is a mismatch between the therapist and the client and the client knows he wants to leave, it's still important for the client to address this with the therapist, if the therapist doesn't address it first, rather than aborting therapy without saying anything.

Why is it important to address a mismatch rather than aborting therapy?  Well, the therapeutic relationship, although different from most relationships, is still a relationship, and just like it's important not to suddenly walk out on other relationships, it's also important not to leave therapy without a word.

The importance of talking to the therapist has more to do with learning to speak up for yourself than it does for sparing the therapist's feelings.  Although it's important to be considerate of the therapist, it's more important to be considerate of yourself.  And when you walk out of a relationship without a word, you don't feel good about it.  So, you speak up mostly out of consideration for yourself--not for the therapist.

Boundary Violations
There are also instances where there have been boundary violations between the client and the therapist, including sexual boundary violations.  Needless to say, when this occurs, the therapy is ruined and beyond repair (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).

No matter who initiated the boundary violation, the therapist or the client, the therapist is always responsible.  It's important to leave that therapy to get help from an seasoned, ethical psychotherapist who can help you deal with the traumatic aftermath of the violation.

Transference Issues
There might also be transference issues that get in the way of the client communicating with the psychotherapist. This means that the client might be experiencing the psychotherapist as a parental figure and this hasn't been addressed in the therapy.

For instance, if the client had highly authoritative, punitive parents as a child and he unconsciously experiences the therapist as another authority figure who will fail him like his parents did, the client might have the same difficulty addressing this in therapy as he did with his parents.  This, of course, assumes that the therapist isn't behaving in an punitive, authoritative manner.  If the therapist is behaving in an punitive and authoritative manner, this isn't a good match for this client or any other client for that matter.

There are many other reasons why a client might be having problems addressing issues about the therapy with his therapist, but the ones I've cited are among the main ones.

How to Talk to Your Psychotherapist If Something is Bothering You About the Therapy

Writing It Down First
If you're having problems articulating the issues you have about the therapy to your therapist, you could benefit from writing about it before you attempt to discuss it with your therapist.  This isn't a substitute for talking to your therapist.  It's just an initial step to take to clarify your thoughts.  You still need to have the discussion with your therapist in person.

If even writing about your problems in therapy feels too daunting to you, you can try writing a story about these issues as if they were happening to someone else.  When you externalize the problem as if it's about someone else in a story, it feels a little less personal and you might find ways to think about it that you don't when you're writing about yourself.

Talking About It: It Doesn't Have to Be "Perfect"
Finding your voice might be difficult, but don't assume that you have to communicate the problem "perfectly" in order to be understood.  Just starting the dialog is often a good beginning, even if all you say is, "I think I'm having problems with the therapy."  This lets the therapist know that there's an issue and she can help you to identify and express it.

Making a Decision About the Therapy - A Consultation With Another Therapist Might Help
In many cases, once the problems are out on the table, things can be cleared up, especially if there was a misunderstanding on the therapist's part or the client's part or both.

But if the problem you're having in therapy can't be cleared up and you're not sure what to do, you can have a consultation with another therapist to try to clarify what's going on in your therapy.  The consultation can be done with or without your current therapist.

I usually recommend that clients let their therapist know if they're going for a consultation with another therapist.  But there might be reasons why you don't let your therapist know, especially if there have been serious boundary violations in your therapy.

Whether you go for a consultation with another therapist or not, at some point, you'll need to make a decision as to whether this therapy is working for you or not.

This can be a difficult decision, and there's no magic answer as what to do and when to do it.  Depending upon your particular situation, it can be complicated.

For instance, if you have a history of going from one therapist to the next in a relatively short period of time, there might be other issues going on.  You might get skittish in therapy at the point when you and the therapist are getting to core issues.  If you recognize this pattern, you would do well to think about what's really going on and if you're constantly avoiding dealing with core issues.

Another reason why it's difficult to make a decision of whether you should stay or leave a particular therapy is that, if you're new to therapy, you might not have a basis for comparison to know if the therapy isn't going well or if you had different expectations of therapy.

This gets back to what I discussed in my prior article about having psychoeducation during the early stage of therapy.  But even with psychoeducation, it can be a tough decision to make.

But once you've made the decision of whether to stick with your current therapist or see a different therapist, as I mentioned before, it's important to communicate your decision with your therapist if you've decided to end the therapy rather than just leaving without talking about it.

Getting Help in Therapy
If you've been struggling with a problem on your own and you haven't been able to resolve it, you could benefit form working with a skilled mental health professional who can help you to work through the problem (see my article:  The Benefits of Psychotherapy).

The first step is to make an appointment for a consultation with a therapist, and it's often the hardest step for most people.

At the consultation, you'll have an opportunity to talk about your presenting problem in a broad way and ask the therapist questions.

You might even ask for another consultation to have more time to find out how the therapist works and, more importantly, to get a better sense of the therapist to see if you think the two of you are a good match (see my article: How to Choose a Psychotherapist).

Being able to free yourself in therapy from the problematic parts of your personal history will allow you to live in a more meaningful way with a greater sense of well-being.

About Me
I am a New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrated Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About How Psychotherapy Works

No one knows how to "do therapy" before they've ever been in therapy.  Even clients who have been in therapy before need psychoeducation about the particular therapy modalities that the current therapist uses and how these modalities work.  

So it's important for the therapist to provide clients with this information during the initial stage of psychotherapy (see my articles at the end of this article).

Why It's Important For Therapists to Provide Clients With Psychoeducation About How Psychotherapy Works

It's common for clients to begin therapy with a certain degree of anxiety.  But when clients have an idea of what to expect in therapy, it helps to ease their anxiety.

It's also important, if possible, for clients to say what they would like to get out of therapy.  I say "if possible," because there are times when clients start psychotherapy and they're not sure what they want from therapy or they might only have a vague idea or, during the initial stage of psychotherapy, they might not know how to articulate their needs and they might need help from the therapist to explore and define their needs (see my article: When You "Just Don't Feel Right" and It's Hard to Put Your Feelings Into Words).  

Psychoeducation About How Psychotherapy Works

The type of information that the therapist provides will depend on the type of therapy that she does.

It's helpful for clients to know how particular treatment modalities work and why it's more effective to work with a psychotherapist than it is to talk to a friend (see my article:  How Talking to a Psychotherapist is Different From Talking to a Friend).  

The following topics, which are listed by therapy modality, are some of the most important areas to discuss as part of the psychoeducation process.

Psychoanalysis and Psychodynamic Psychotherapy 

If the therapist does psychoanalysis or psychodynamic psychotherapy, she might talk to the client about transference/countertransference issues (see my article: Psychotherapy and the Positive Transference).

She will also probably discuss the importance of the unconscious mind, dreams, and the intersubjective process in therapy.

See my articles:

Making the Unconscious Conscious, Discovering the Unconscious Emotions at the Root of Your Problems

The Therapy Session: A Unique Intersubjective Experience, Embodied Imagination Dreamwork

Transforming Nightmares Through Creative Dreamwork

Working With Dreams to Develop Your Creative Imagination

Also, within psychoanalysis and psychodynamic psychotherapy, there are various ways of working.  For instance, I work as a Relational psychotherapist, which is a contemporary, interactive form of psychoanalytic/psychodynamic psychotherapy. Another psychotherapist who does psychoanalysis might use a Classical Freudian method or do Kleinian therapy, and so on.

EMDR Therapy 

If the therapist does EMDR therapy, she could talk about how EMDR can resolve trauma through memory reconsolidating and what are considered Big-T and Small-T trauma.

See my articles: 

What is EMDR Therapy?, 

Overcoming Trauma With EMDR Therapy

When the Past is in the Present

Big T and Smaller T Trauma 

What is Adjunctive EMDR Therapy

Somatic Experiencing/Somatic Psychotherapy

If the therapist uses Somatic Experiencing or Somatic Psychotherapy, she would probably talk about the mind-body connection, and how the body holds unconscious memories.

See my articles: 

Mind-Body Oriented Psychotherapy

Somatic Experiencing

The Body Offers a Window Into the Unconscious Mind

What is Somatic Psychotherapy?

Clinical Hypnosis (also known as Hypnotherapy)

If the therapist uses clinical hypnosis, she would probably not only explain hypnosis, but she would also dispel some of the myths about hypnosis that have been perpetuated in movies and TV programs (i.e., the myth that hypnosis is a form of "mind control") and also about how clients maintain a dual awareness during hypnosis about being in the here-and-now as well as in the space of whatever comes up in the hypnosis.

See my articles: 

What is Clinical Hypnosis?

Clinical Hypnosis and the Mind-Body Connection

Hypnosis and Creative Visualization to Manage Stress 

All Hypnosis is Self Hypnosis).

Cognitive Behavioral Therapy (CBT)

For the therapist who uses cognitive-behavioral therapy (also known as CBT), depending upon the problem, she might explain how desensitization works or why there's usually homework in CBT treatment.  She would probably explain when she uses CBT.  For instance, I use CBT for phobias and certain forms of anxiety.

Ego States Therapy (Parts work)

For the psychotherapist who does Ego States therapy (also known as Parts work), she could talk to the client about the different aspects of the self, dissociation, and shifting self states. 

See my articles: 

Parts Work in Therapy: Is a Split Off Part of Yourself Running Your Life?  

How Shifting Self States Can Affect You For Better or Worse).

Integrative Psychotherapy

If the therapist uses Integrative Psychotherapy, as I do, she would explain how she integrates the various treatment modalities for the most effective treatment.

See my articles: 

The Therapeutic Benefits of Integrative Psychotherapy 

Contemporary Psychoanalysis and EMDR Therapy: A Powerful Combination to Overcome Trauma).

Treatment Frame

There are other issues to be discussed during the initial stage of therapy, including the treatment frame (the fee, length of sessions, policies about missed sessions and payment of fees, and so on) so the expectations are clear at the beginning of therapy.

Feedback to and From the Psychotherapist

I believe psychotherapy should be a collaborative process between the client and the therapist.

One of the best predictors of a good outcome in therapy, regardless of the treatment modality, is a good rapport between the therapist and the client, which develops over time.

The Importance of Feedback to and From the Psychotherapist

Regardless of the therapist's experience and skills, if the client and therapist aren't a "good fit," chances are that the therapy won't go well.  That being said, as previously mentioned, most clients feel anxious at the start of therapy because it's uncomfortable for them to talk to a stranger--even the most empathetic stranger, so the client might need to give the process time before deciding if it's a "good fit" or not.

Most therapists are aware that not every therapist is for every client, so they're not offended if the client feels it's not a "good match."   

An open dialog between the client and the therapist is important, especially with regard to whether the therapy is working for the client.  It's important for the therapist to know what's working and what's not working.  

If the client was already informed about the treatment modalities that the therapist uses and how these modalities usually work for the client's presenting problem, he will not be as likely to expect a "quick fix" for a complicated problem.

But if there are areas that might need to be adjusted or if there are things that the therapist might not be aware of (e.g., the client becomes highly activated between sessions and has problems sleeping), this dialog provides the therapist with information to make adjustments to the therapy, if necessary (see my article: Asking For What You Need in Therapy).

If the client doesn't initiate this dialog, I believe it's important for the psychotherapist to "check in" with the client every so often.

Not only does an open dialog provide the client with the important message that the psychotherapist wants and welcomes feedback--even negative feedback--it also reduces the possibility that the client, who has problems expressing his feelings, will leave therapy prematurely (see my article: Ruptures and Repairs in Therapy and When Clients Leave Therapy Prematurely).

The client can also ask for feedback from the therapist about how the therapist thinks the therapy is going from the therapist's perspective.  This helps the client to understand the therapist's thinking about their work together (see my article: A Psychotherapist's Beliefs About Psychotherapy Affect How the Therapist Works With You).

Getting Help in Therapy

As I've mentioned in prior articles, it takes courage to admit you have a problem, even admitting it to yourself, and to get help (see my article: Developing the Courage to Change).

When you know that continuing to do what you've been doing that hasn't worked for you is prolonging your suffering, you owe it to yourself to get help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

Rather than becoming overwhelmed by the process, it's important to take it one step at a time.  After you've acknowledged to yourself that you have a problem, the next step is to contact a psychotherapist for a consultation (see my article: How to Choose a Psychotherapist). 

During the consultation, you can give an overview of your problem and ask the therapists questions.

An experienced psychotherapist can help you to work through your problem so you can liberate yourself from your history and have a sense of well-being.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who provides integrative psychotherapy to individual adults and couples.

To find out more about me, visit my website:

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Psychotherapy is More Than Just Venting

Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent

Common Myths About Psychotherapy: Therapy Takes a Long Time

Common Myths About Psychotherapy: Going to Therapy Means You're "Weak"

Common Myths About Psychotherapy: Therapy is All Talk and No Action).

Psychotherapy is More Than Just Venting: Understanding the Importance of Balancing Content and Process in Therapy

If you've never been in therapy before, you might not know what to expect, which is why I've written several articles to educate people about starting therapy (see my articles: Starting Therapy, Psychotherapy and Beginner's Mind, The Benefits of Psychotherapy and How Talking to a Psychotherapist is Different Than Talking to a Friend).  One important concept in psychotherapy is the importance of balancing content and process.

Psychotherapy: Understanding the Importance of Balancing Content and Process in Your Therapy Sessions

Psychotherapy is More Than Just Venting
Many people who have never been in therapy before think that their therapy sessions will be a place for them to vent about their problems and nothing more.

They think that they can use their therapy sessions to just release whatever is on their mind, so they can empty themselves of what's bothering them.

While venting is an important part of therapy, it's only one part.  If therapy were solely about venting, it would be of limited value since you can vent with a friend, family member or a spouse.  Why pay a psychotherapist if you're only going to vent?

Understanding the Importance of Balancing Content and Process in Therapy
Psychoeducation is an important part of therapy, especially for people who haven't been in therapy before.

Understanding the difference between content and process in therapy is important, and it's essential to balance both in order to have a successful therapy.

Content is just what you would think it is--you talk about what's on your mind: What happened during the week and other things that are on your mind.

Many people who begin therapy only focus on content.

Often, people provide so much content in therapy sessions that there's little time for processing, which is another very important part of therapy.

Processing in therapy is stepping back from the content, experiencing your feelings about what you're talking about, and telling your therapist about your feelings.  For example:

• What is it like on an emotional level for you to talk about these issues with your therapist?
• How is the content that you shared with your therapist meaningful to you?  
• How does it relate to your past, present or wished for future?  
• How does it relate to other things that you and your therapist are working on?  

and so on.

Let's take a look at a fictionalized scenario that illustrates the importance of balancing process and content in psychotherapy sessions:

Ida
Ida started therapy after her breakup with Sam.

She had never been in therapy before, and she started therapy because she was afraid that she would alienate her friends if she kept talking on and on about the breakup.

After the consultation with her therapist, Ida had her first therapy session.  During that session, Ida started venting non-stop about what happened in the relationship.

Since it was Ida's first therapy session, her therapist realized that Ida needed to vent and allowed her to talk.

During the next session, Ida was talking non-stop again about the relationship, but she wasn't talking about her feelings.

When Ida stopped to take a breath, her therapist gently and tactfully pointed out to Ida that she was providing a lot of information about the relationship and the breakup, but she wasn't talking about how she was feeling.

Her therapist explained to Ida why it's important to not only relay information in therapy but also to talk about her feelings--in other words, to balance content and process.

Her therapist asked Ida to slow down rather than try to get in as much information as possible in their hour together.  She told her that by slowing down, Ida would be able to sense into her feelings and process them.

Ida wasn't sure she understood, but she knew how to slow down.  So, rather than racing ahead to her next thought, she focused on what she had just said, which was that she felt betrayed by Sam, her ex.

At first, Ida didn't feel any particular emotions.  Then, her therapist asked Ida to focus on her body and sense if she was holding onto any emotions (see my article: The Body Offers a Window Into the Unconscious Mind).

Ida felt a tightness in her throat and, as she focused on that tightness, she began to cry.

After she cried for a few minutes, Ida felt an emotional release and she realized that she had been holding onto this sadness in her throat.

From that session on, Ida was much more mindful of the importance of both process and content.  Rather than speaking quickly to vent, she slowed down and allowed herself to feel her emotions.

Ida realized that she had been speaking quickly as a way to not feel her emotions.  She was racing from one thought to the next because, without realizing it, she thought it was just a matter of purging herself of these thoughts so she could let them go.

But as she took the time to process her thoughts and emotions, she began to feel more emotionally integrated.

Psychotherapy: Understanding the Importance of Balancing Content and Process in Your Therapy Sessions

Conclusion
A common misconception about psychotherapy is that therapy is just about venting, but this is only a part of what therapy is about (see my articles about other common myths about therapy: Common Myths About Psychotherapy: Therapy Takes a Long Time and Common Myths About Psychotherapy: Going to Therapy Means You're Weak).

Many clients who are new to therapy think that they will use their psychotherapy sessions to just talk and purge themselves of their thoughts.

Psychoeducation is an important part of psychotherapy, especially for people who are new to therapy.

When therapists provide clients with psychoeducation about the importance of balancing content and process in their therapy sessions, clients usually realize how essential this combination is to their healing process.

Rather than just venting about what happened, they're also taking the time to feel how they are affected and make connections to the past, present and their wishes for the future.

The emotional integration of balancing content and process is an important part of what is healing in therapy.

Getting Help in Therapy
A skilled psychotherapist knows how to provide psychoeducation to assist clients to use both content and process in therapy (see my article: How to Choose a Psychotherapist).

Like any other skill, it can take clients time to develop these skills.

As a psychotherapy client, with the help of your psychotherapist, you learn as you become more experienced in therapy.

Although it might seem contradictory, going slower to process thoughts and feelings moves the therapeutic work along faster than just venting.

Venting without any processing is a superficial way of talking about  "the story" of what happened and not about your related emotional experience.

If you're feeling stuck or you're having difficulty overcoming your problems, you could benefit from attending therapy with a skilled psychotherapist.

You're not alone.  Help is available to you.

After you've worked through your problems in therapy, you'll have an opportunity to live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during regular business hours or email me.