Put into words, the stuff of psychotherapy can seem hopelessly obvious. One thinks: Of course your depressed friend has nothing to be depressed about; why can’t he see it? Why can’t you just tell him so, give him some books about depression and how to overcome it, and end the problem that way? Of course the overly timid, cautious, and withdrawn man became that way because he grew up with an intolerant, volatile parent; everyone else who knows the family can see that, and they can see that this man has no reason anymore to be so scared. If they can see all this, why can’t he do the same and get moving with his life? Of course the arrogant, know-it-all only irritates the very people he’s trying so hard to impress? Why can’t he keep quiet a bit, so that he doesn’t end up jobless, friendless, and solitary?

The short answer is that it’s too painful. Your depressed friend is stuck in this depression partly because, believe it or not, it is easier to feel depressed than to face what really hurts. It is easier for him to believe that everything about him is worthless, however much this flies in the face of all the data, than it is to cope with whatever else is going on. That is why his depression seems so irrational to us — because it’s a distraction from something else. Meanwhile we can only drop our jaws in disbelief as this handsome, talented, successful man mopes that he has nothing and is worthless. The bright and attractive woman who attaches herself to one unreliable and dishonest man after another prefers — at an unconscious level — to cry or rage over the current man’s behavior rather than to feel and acknowledge more pervasive and unweildy dissatisfaction with herself and her life. Even the timid soul finds it more comfortable to flinch his way through life than to face all the rage, despair, and fear involved in questioning his habitual view of himself and the world. [Greg, Ed – II]

Important: These irrational patterns of feeling, perception, and behavior are not chosen or established on a conscious level! Clearly most of us would not engage in such silly behavior on purpose. But these habits develop outside of awareness (and nonverbally) where we can’t get at them. Why this is so, and how it happens, was explained in previous three sections. (See also Ed – II, Bully, Ron]

It is this unconsciousness that is key to understanding “Why psychotherapy” (as opposed to other kinds of help). For just as the problems are established somewhere outside your awareness, so too must the cure reach into this area. Otherwise the treatment won’t work. Learning on an intellectual level is rarely sufficient. Take a look at these case examples [Evan, Ed – II, George, George – II, Ron II, Evan – II] to see the difference between intellectual learning and the kind of personal insight that is the goal, and the great gift, of psychotherapy.

Unfortunately this kind of learning is difficult, which is one reason psychotherapy usually takes more than a few sessions. Put simply, in psychotherapy we resist most strongly the things we most need to learn, once again because they are painful [Greg]. It’s only later, when you try to put your experience and insight into words, that it all sounds so obvious. This is such a common phenomenon in psychotherapy psychoanalysts are fond of saying, “Trite is right”. So when you discover something you are sure is profoundly important and which you can feel deeply, yet saying it makes you feel foolish and even sickeningly touchy-feely, you are probably on the right track.

Why a Psychotherapist?

Treatment is a process of becoming aware of your own particular personality processes, of the parts of you that need or want things that make the rest of you miserable, and of how they all fit together. This is your story, your unique path into and out of psychological difficulty. It will not be the same as anyone else’s. While it will of course have similarities with others’ paths, you can only go so far on someone else’s story. Books, lectures, and other forms of treatment that are not individual to you are generalizations, composed of common elements from many or most people. Valuable as these are, they are like statistics. They tell you what goes on with most people, but in any individual case the answer could be different, even vastly so. [Compare Patrick and Mike.]

Moreover, if you do find your answers, you are likely to resist them (see Why psychotherapy, Greg). We are dealing in therapy with the most inaccessible and heavily guarded aspects of you. That is simply the nature of the beast and it’s why, there are so many self-help books. Generally, they cannot accomodate to your unique personality style, difficulties, and interests, nor can they usually overcome resistance

 What does a Session look like?

You were probably informed about financial arrangements when you made the appointment. When you arrive, you will be asked for any financial documentation that was requested, such as insurance cards, who is responsible for payments, etc. There will be some paperwork to fill out.

Your first session with the therapist will be different from future visits. The initial visit is a period for you and your therapist to get to know each other and get an idea where to proceed. Future visits will be more therapeutic in nature.

Keep in mind that psychotherapy is a long-term process so don’t expect any instant solutions to your problems the first day. Therapy is about equipping you with life-long solutions rather than a quick fix.

During the first session, you will be asked about what brings you to therapy. You will be asked what you feel is wrong in your life, any symptoms you are experiencing and your history. History-taking may cover such things as your childhood, education, relationships (family, romantic, friends), your current living situation and your career. You may discuss the length of your treatment, the methods to be employed and patient confidentiality as well. When the therapist finishes, you may be asked if you have any questions.

 Top Ten Questions to Ask a Psychotherapist

According to the Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists, the following are the top ten questions you will want to ask during your first visit. Use this as a check list of what goals you should achieve during the session. Many of these will probably be covered without your asking; but, if not, don’t be afraid to ask.

  1. What is your academic background and what has your training been to prepare you to practice as a therapist?
  2. What specialized training and/or experience have you had in working with the issue I am dealing with?
  3. What professional associations do you belong to?
  4. What are your fees? How will my insurance claim be handled? (preferably fees and potential insurance coverage should be discussed on the phone prior to making the first appointment)
  5. What type of therapy do you do? (mostly talking, role-playing, visualizing, hypnosis, artwork, “body -work”)
  6. What are your office protocols? ( booking appointments, payment for missed appointments, emergencies, building access after hours, etc.)
  7. I would like a brief explanation as to what I can expect to happen in my sessions.
  8. How long will each session last?
  9. How many sessions will it take to resolve my issue?
  10. How will my confidentiality be assured?

You’re In a Boatload of Anxiety

It’s not like anybody wants to go see a therapist or psychiatrist. It’s not the type of thing someone wakes up in the morning and says, “Wow, I’ve been missing something in my life. I’d love to chat to a stranger about my innermost personal fears, thoughts, and feelings and see exactly how screwed up I really am.” In fact, most people think just the opposite about almost any health or mental health appointment. Most people avoid them like the plague. Or avian bird flu. It’s just not something you want to deal with.

There are no easy ways to “get over” this fear and anxiety. Such anxiety is a normal part of our lives, and lets us know that what we’re about to embark on is indeed a scary journey of self-discovery. Learning things about oneself and bringing the light of day to shine on them is not always all joy and butterflies. Sometimes our demons need to come out as well, or those behaviors we almost wish nobody in the world knew about.

So instead of fighting these feelings, its best to just accept them as a part of the process. That acceptance becomes one of the very first steps of not only getting help, but also the psycho therapeutic process of change. Because without making changes in your life, you’re just going to keep on feeling bad.

Make the appointment you’ll feel better!