What Actually Happens in Therapy

People who have never been to therapy usually have an idea of how they believe it works. For many, it involves a couch, questions being asked, and eventual revelations that should arrive after a few sessions.

That is not the whole truth about what therapy involves. The question of what actually happens in therapy is among the most common questions people have before they start, and this post is an attempt to answer it.

What Therapy Is Not

First, it might be helpful to explain what therapy is not. For example, therapy is not advice. A therapist is not a person who receives the facts of a situation and tells the patient what to do with them. There can certainly be conversation about options and how each scenario might play out in real life, but a therapist who simply tells a patient what to do is not doing therapy.

Also, therapy is not a conversation between equals. The therapeutic relationship has a specific structure and an asymmetry: one person speaks, and the other listens with a professional quality of attention, focusing on specific elements of the event or experience being described.

Finally, therapy is also not about feeling better immediately. Sessions can feel difficult, disorienting, and uncomfortable before a patient finds relief, and the process is not linear, depending on each person and what they are carrying.

What Actually Happens In Therapy

Regardless of the clinical approach, in therapy, you come in and you speak. But the presence of someone whose attention is professionally engaged and the absence of the ordinary social requirement to manage how the other person feels about what you are saying create a different kind of talk. Many times, we say things we have not said before, we notice things, we contradict ourselves and hear that contradiction, we circle around something until we can approach it more directly. The therapist listens with sustained, trained attention to what you are saying, how you are saying it, what you are not saying, where you hesitate, what you approach and then move away from. The therapist also responds, either with statements, questions, or support to deal with the practical results of what is being said.

What Changes in Therapy

People often ask when they will know therapy is working, because the changes that happen in therapy are often not the ones we were expecting, and they are not always straightforward.

Over time, a person might notice that they respond to situations differently than they did before. They might also find that a relationship that used to produce distress has changed, or they might become aware of a pattern they had been living. Many times, they find that the thing they came to therapy to fix is no longer the most interesting thing, because something underneath it has become visible.

What changes in therapy, when it goes well, is not the circumstances of life, but the person's relationship to their own experience and history.

What Therapy Looks Like at Real Talk

Our clinicians are trained to a doctoral level to listen at multiple levels, and to help patients choose the best clinical approach to what they bring. We accept major insurance plans, including BCBS, Aetna, Cigna, and United Healthcare. We offer therapy in English, Spanish, Portuguese, and Farsi, in person in Houston and via telehealth across Texas.

If you have been curious about what therapy actually is, the answer is that it is a particular kind of conversation, held under particular conditions, which allows a person to understand themselves differently. It is not magic and it is not simple, but it is, for many people, the most important thing they have ever done for themselves.

More About Real Talk

Real Talk Clinical Psychology is a doctoral-level group practice in Houston, Texas, offering psychodynamic and psychoanalytic therapy in four languages. We accept BCBS, Aetna, Cigna, and United Healthcare. Learn more at realtalkpsychology.com.