Q&A with a Therapist Part II: It's a Process

Starting therapy is more than just logistics. 

In my last post I attempted to answer some nitty gritty therapy-related questions like “what is therapy?”, “what is a therapist?”, and “how do I find one?” Here in part two we’ll explore questions related to the process of therapy, and what happens in the background once you and your shiny new therapist are sitting in a room together. 

Whereas describing the logistics of therapy is relatively straightforward, talking about the process of therapy might get a little…vague. This is in part because different therapists each have their own view of how therapy works, and bring their unique style and perspective to their work. As you read this, please remember I am answering questions through my lens as a therapist; other professionals might see these concepts very differently.

In the questions below, I’m going to try to put logistics aside and instead focus on the more “meta” part of therapy. The process of therapy is inherently ambiguous because it is not anything you can see or touch…it’s all stuff that is happening in the background. It’s energetic, relational, nervous system, and attachment-based stuff. It can all start to sound a little weird and woo-woo. And, healing happens in relationships, so all the juicy interpersonal stuff is a big part of the magic of therapy. 

1. I just walked in the room for my first appointment. What happens now? 
In my first post I described how I approach a first session logistically; the sort of broad data collection that helps me and the person I’m working with begin to envision how therapy might move forward. But there’s a lot of other stuff happening in that moment, too. 

For one, you are meeting an entirely new person, an essential stranger, with whom you will begin sharing intimate details of your life. From an emotional, relational, and nervous system perspective, this is an understandably stressful scenario. 

My hope in this challenging moment is to be able to calm my own nervous system so that the person entering my office picks up on a sense of regulation from me. This is similar to what happens in healthy attachment between parents and children; ideally, parents show children how to take care of themselves when distressed by reacting in a grounded, calm manner. 

Of course, you’re new to me just like I’m new to you, so this process works both ways. We’re both learning how the other person’s system operates and feels to be around. I know my system can get a little keyed up when I meet a new person, and that's something you might pick up on. It's also something I've been working on since my baby days as a therapist, and I know I'm a lot more skilled at my own regulation than I was when I first started this work. 

This is part of the reason therapy takes time as attachment and nervous-system healing is not a short process. Think about the years and years of growing up and relating with attachment figures that takes place before you gain independence and leave the home, and all the stuff that happens between you and those attachment figures during that time. 

Attachment patterns take time to build, and if they're harmful or unhealthy in any way they take time to change. If, like most people seeking therapy, you experienced any attachment wounding—childhood abuse, neglect, or trauma, or even just being missed, unseen, or invalidated in your family—this process of regulation is likely going to be a little more challenging and muddy for both of us.

So, while one goal of the first session is to absorb all the information you're sharing with me, another more "meta" goal is to just give our systems some time to settle together. 

2. This new person is asking me a bunch of questions! What is going on? 
Talking doesn’t HAVE to be a huge part of therapy…and as language-based creatures, there is generally language-based communication involved in the process of healing and changing. So, there's probably going to be some talking and some question-asking. 

When I meet someone in a first session, there are quite a few things going on inside of me:

• Curiosity: I’m just generally curious about the person I’m talking to, thus...questions. Some of my values as a therapist are to approach people with kindness, curiosity, flexibility, and openness. When I put these values into practice in our first session, I genuinely just want to know about you, and I don’t have much of an agenda. One exception is if something dangerous is happening such as you wanting to hurt yourself or someone else; I would then have an agenda around safety. 
  
  
• Theory: All therapists have a core theoretical orientation—a way we view human suffering and healing. I see my theoretical orientation (Acceptance and Commitment Therapy, abbreviated ACT) as the foundation and framing of my therapy “house.” This foundation and framing gives me a sense of solidity as a therapist. I know I can rely on ACT’s theoretical underpinnings to process people’s pain and triumphs. 
  
  Theory can also help guide us if therapy is feeling stuck in some way (more on that in a future post). So, when I’m working with someone, I'm always holding ACT theory in the background, just like when you’re sitting in your house and the foundation and framing are doing their job without you seeing them in action. 
  
  
• Nervous system and attachment: As I mentioned earlier, it takes a while for two people’s nervous systems to acclimate to each other. In our sessions I’m doing a lot of tracking of what’s happening with my system and with yours. I try to notice when I’m feeling nervous system dysregulation. Because of exciting things like mirror neurons, it can sometimes be hard to know what’s mine and what's yours from an energetic lens. So, usually I’ll just ask. 
  
  If I become aware of a floaty or lightheaded feeling that might indicate your nervous system is shutting down, I’ll pause to see what you’re noticing. I might ask you to check in with your awareness of the present moment, or we'll practice coming back to the here and now together. It could be something is stressing your system, or it could just be that I’m hungry and haven’t had enough water. (Gotta say, usually it’s the first one). 

Those are just a few of the processes going on behind the question asking of a first session. Values, theory, and nervous system attunement are all chugging along in the background while we're using language to interact. 

3. Is my therapist judging me?
This is such a common idea/question, I can’t even tell you how many times I’ve heard it. So, I’m going to answer this understandable worry on a couple of different levels.

On the most basic level…in all likelihood no, your therapist is not judging you. We see and hear A LOT of stuff as therapists. While I’m sure there are things I’ve heard and will continue to hear that might surprise me, my first reaction is unlikely to be judgment. And if it is, that's my stuff to deal with, not yours. 

On another level and leaning in to my ACT therapist self, all humans have judgmental thoughts. They are a normal and natural part of our mind's chatter. In ACT, we talk a lot about not believing everything we think, and I try to live this tenant of ACT both in my work and in my day-to-day life. 

So yes, it is possible a judgmental thought might go through my head at some point or another during a session. If it did, I would likely notice it and be able to see it as words and pictures in my head rather than an indictment of the person I’m working with. If I'm fused with a judgmental thought, I have some work to do in the moment and after session is over. 

On a third level, when someone feels judgment from their therapist, there's a chance transference is happening—the person is transferring their own feelings of judgment, or the judgment they have received from a parent or partner, onto the therapist. This is a very normal part of therapy, and something that any therapist worth their salt will be able to work through with you in the moment. 

If you are feeling judged in a therapy session I would highly recommend you bring it up with your therapist. You might say “I’m worried you’re judging me” or "you look judgmental right now." Ninety-nine percent of the time, in a moment when a client is feeling a lot of judgment, there has not been an even remotely judgmental thought in my head.  

(Turns out, this Q&A is going to be a three-parter! I sort of love it when that happens. I have a couple more questions I'd like to answer, like "what if my therapist pisses me off?" and "what if therapy's not working?" I'll be back in two weeks for those hot potatoes.)

My excitement about a three-part blog aside, you've probably learned through these last two posts that there is A LOT going on in therapy, both logistically and energetically. If there's something happening in therapy that you don't understand, please ask. I know it can be scary, but most of us are very open to answering questions in the moment. If I decide not to answer a question, it's usually for a therapeutic reason and I'll try to communicate that reason directly.  

Have more questions? You're welcome to schedule a complimentary 15 minute call with me to ask them, or send me a message. I'd love to hear from you!