Things your therapist may do (that are not explicit)
Let's talk about therapy.
How to better understand your therapist
Your therapist is there to help you, but are you interested to know more about how they do it? Read this and more of my upcoming hubs for topics related to therapy. Trust is a big part of the counseling process. While it is important to trust in the knowledge and skill of your therapist, being aware of some key things about therapy can make it more successful. The more you know the better you can evaluate your experience and the better you can work with the process.
So, let's look at three things therapists do which they might not always make explicit.
1) They operate from a theoretical orientation. Or at least they should.
What is a theoretical orientation? A theoretical orientation is a school of thought that dictates how a therapist approaches case conceptualization and treatment planning, and informs what kind of interventions they use.
Why is having a theoretical orientation important? Because no other human being can or should tell you what to do; you're expert on your own life and autonomous to make your own decisions. Therapists are there to learn the various theories, specialize in one, or develop their own eclectic style, but even this eclectic approach is based on a combining aspects of various theories. A good therapist is not there to create a philosophy or religion or to sell you their own worldview. A therapist's worldview is important, and it often aligns with their particular approach to therapy (existential/humanistic, for example), but treatment with a therapist still involves implementing evidence based-interventions based on well-known and researched schools of theory. How much you learn about the different ones is up to you, but it helps to at least know about them. Then you can make your mind up about how important it is that your therapist operates from one to you. Some psychologists operate from an orientation that might not appeal to you, so knowing some things about them can help you avoid a poor match. While there are hundreds of theoretical orientations that your counselor could ascribe to, most operate from one of four schools of theory and therapy that include Psychodynamic (and psychoanalytic), Cognitive-behavioral (and behavioral), Humanistic (and existential), and eclectic.
How can you tell if your therapist uses a theoretical orientation? It is not as easy to tell whether your therapist is operating from a theoretical orientation than it is to identify the next two therapeutic tendencies, but at the very least if you ask, your therapist should be able to identify their orientation and explain it to you. Some counselors do not do this because they feel clients might think it's too technical or are not interested. Some therapists go into a lot of detail with their clients about the theoretical orientation they practice from, and make every step of the process really clear. For example, an existential psychotherapist may disclose that they will explore your problems in the context of the four existential "givens of existence," death, freedom, isolation, and meaninglessness right away, while some will wait to see which of these is more salient in your life. They might assess how you talk about abstract ideas, and if you don't handle these well they might switch to a cognitive-behavioral model or another form of therapy. Some therapists introduce the concepts and explore them with you slowly as you progress through therapy, which is fine, but it can help you to know at least that theoretical orientations exist. If you do care and want to know more then you can ask your therapist. If any theoretical orientation is okay with you, or you are not that interested which they use as long as you feel your therapist is competent, then chances for success are good. But if time for therapy is short, which is often the case with insurance, you might want to know. The risk of not checking is in the possibility that the therapist either has not learned or learned to integrate theories, or has abandoned using any theory to guide their work (for whatever reason, but it happens). One indicator of a lack of theoretical guidance is little consistency or common terminology or continuity from your therapist, but the best way to know if and what theory they use is to just ask. Therapists who are not well established in a theory or skilled at integrating and implementing interventions based on them may seem personable but may provide little help beyond lay-person level assistance. Of course, there is also the risk they will not have an ethical decision model integrated as well. So, don't hesitate to ask your therapist about how they conceptualize the change process and what criteria they use to track progress. You might think this is weird, because, after all, your friends who go to therapy might not talk about theoretical orientation, but don't let this dissuade you. Therapists know about theoretical orientations and should be really used to and comfortable about people asking.
2) They respect the parallel process.
What is the parallel process? The parallel process is what you don't see in therapy but is key and there always: it's the world about which you came to therapy for. Your are not in therapy to work out anything between you and the therapist. You two hopefully never even met. But you are there to work out things in the outside world, and that world enters into therapy more than you might think. Therapy is not necessarily about what happens in the room - sure that is important, but its ultimate value is in how well what goes on in that room applies to your life outside it. So a therapist always keeps your other people in mind, these other places and experience you encounter, because when you're in therapy, "where you come from" in your conversation is based on these contexts. Parallel process is a form of transference so you might hear your therapist use that word, but essentially it is the enactment with a third party like your therapist of certain dynamics which originally arose in a separate context.
Why is the parallel process important? It is important because how you come across to the therapist is very much like how you come across to other people, and the feedback your therapist will give you about this can translate in you interacting with others differently. The chance for the therapist to observe how you might act and react in the real world is based on how you act or react in therapy. Paying attention to how what happens in therapy relates to your world outside is important, because if the therapist does not explore how what you do in therapy relates to your issues outside in the world, then all they accomplish is getting you to come to therapy. It's all well and good if you've finally learned to talk about or be a certain way with your therapist, but a good therapist should not stop there (unless your goal was to learn to be a certain way with them only, which is unlikely). How it unfolds in parallel to what is going on in your life is what's important. The reason I mention this as important is because therapists are people too; they may be flattered and love to hear about the progress you make in the room. You might even tell them how wonderful they are for allowing you to talk about something you can't talk to anyone else about. But if they don't help you talk to others in your life about things that are important to you then the therapeutic relationship is at risk of becoming too isolated and ineffective in what it's actually meant to do. Good therapists care more about you dealing with things well on the outside, and that is why they may seem to be too subtle or hesitate to challenge too soon. It's not revealing your secrets to us as soon as possible that we want, it's that you understand your feelings, motivations, and learn how to discuss things appropriately with people who matter to you in your life that you care about in a way that respects your boundaries.
How can you tell if your therapist respects the parallel process? One way to tell if your therapist minds the parallel process is simply by referencing important people in your life that you interact with. The therapist does do not make the entirety of therapy about what goes in in the room between themselves and you. They ask how others responded to you when you said/asked something in the same manner you just did in therapy, or they may even invite you to pretend someone is sitting in the "empty chair" beside you. Therapists who respect the parallel process recognize progress is not just about gaining comfort and skill to talk about something with the therapist but about you gaining skills in therapy you can actually apply to help you with others. Yes, therapists often do also focus on the "here and now" and process what goes on in the moment, but look for that key piece where your therapist also actually helps you transfer gains to the real world. This includes discussing how you can be a certain way with others in your life once you're able to be a certain way with the therapist. One way therapists demonstrate regard for the parallel process is when clients lie and the therapist doesn't call them out on it. The counselor may prioritize a goal to no confront or prove a particular point while helping the client get to a point where they can talk to them, and then others, more openly and honestly. This can take time, but when the client does reveal a "truth" or insight, the therapist who respects the parallel process may explore not just why, but why now, and whether this is indicative that the client is ready to be more open and honest with other people in their life. It's not just about what happened in the therapist's office, but about what whatever happened signifies for the client's world outside of counseling. So, one way to tell if your therapist is minding the parallel process is if they actually don't challenge you much. Or at least, if it doesn't feel like it. They may still be challenging you, but not as directly as you might like. This is because they know that you telling them something personal isn't the final prize; it's you being able to tell other people who matter in a way that respects your boundaries that they are working on.
3) More and more therapists integrate positive psychology and use positive emotions therapeutically.
What is positive psychology? Psychology Today defines positive psychology as the study of happiness, but it is a lot more than that. It shifts the focus from asking "what's wrong with people?" to "what is well-being?" and "how do people live well?"
Why is it important to use positive emotions in therapy? Growth can begin once a problem or issue is identified, but psychology has traditionally been more fixated on pathology than on identifying people's strength and leveraging them toward progress. We simply do not learn well when put down, criticized, or told what our problem is, over and over and over again, but traditional therapy could be a lot like that. After a while the point is to do something about whatever bothers one, and positive emotions help facilitate change in a way that is less painful. Positive psychology integration can also be a breath of fresh air to therapists who struggled with some of the more negative and punitive aspects of therapy. It can also be perceived as much more dignifying and respectful to clients. The focus of the entire therapy session is no longer to dissect problems in great detail but to understand, in an emotionally positive environment, how one's strengths can be leveraged, and to identify sources of resilience. I used to be really skeptical of using positive emotions in therapy, perhaps from my existential/humanistic background where much of the writing and discussion is so serious. I was worried that forays into lighter topics might not be as meaningful or therapeutic, but the more I read about the benefits of positive emotions in therapy and the more I integrated them cautiously, the more I came to respect their usefulness.
How can you tell your therapist integrates positive psychology? They don’t focus on problems all the time but also on strengths and on what is going well in your life, and they are not apologetic about it! They help you identify and label positive emotions as well as negative ones, and they work to actually create positive emotions in therapy. They will not shy away from celebrating progress or noting improvements and they will not brush off accomplishments. They will help you survive another devastating success with grace and a smile. While it is not unusual to see clients be self-deprecating, success can be uncomfortable for some therapists too. It helps, though, that if clients are to learn to recognize and celebrate the positives in themselves and situations they encounter, the therapist take the time to point them out too. Of course, it is really important not to avoid negative emotions in favor of facilitating just positive ones. Positive emotions in therapy can be beneficial, though. If you're one of those tortured souls who barely dragged yourself into therapy, only to be aghast it's not as horrible as you thought, don't despair. Rest assured, even if it's actually amusing, you can survive a devastating success. It might actually help you survive next ones.
I hope learning about theoretical orientations, the parallel process, and positive psychology has helped you better understand some basic aspects of therapy that you might experience in therapy but may not be outright discussed by therapists.