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No, you are not lying on the couch. Or - what therapy is NOT.

The couch in my office

I almost always begin a first session with a client by explaining that the therapy process seen in the movies* is far from reality. In movies - the therapist is painfully passive, stands silent and cold, asks the odd question here and there, nods without showing emotion and asks about dreams; the client is lying on a couch recounting their dreams. In the films - the other extreme - there is boundaries tresspassing in the context of the therapist-client relationship and an entering into the realm of sexual fantasies. In the movies - the image of the therapist is endlessly mystical. In reality - therapy has not been a mysterious process for decades and involves the active participation of both therapist and client, and the boundaries of professional and ethical norms in this process are extremely important. And no, you don't lie down on the couch.

True: To have success, the client must be courageous in this journey. And to trust their therapist.

Here are a few myths that are good to part with:


1. Therapy focuses solely on the client's past - perhaps true to some extent for psychoanalysis, this statement is generally far from the truth. Yes, especially for family therapy, the exploration of family history is central to the therapeutic process, but it is far from all that the therapist focuses on. It is the exploration of relationship patterns, family dynamics, attachment styles that provide the basis for the problematic elements in the client's present. And it is a large part of the focus in the therapeutic process.


2. The therapist pathologizes their client - unfortunately this myth is not dictated by the movies, but by the actual experiences of quite a few clients. Many people come to me with a diagnosis from a past therapist, from a psychiatrist, or worse, from themselves, after reading possible symptoms on the internet and expecting me to confirm or reject that label. It is my professional belief that labeling, as relieving as it is, robs one of the opportunity to help. Rather, I perceive each person with their complex behaviors, attitudes, beliefs, experiences - so much richer than any diagnosis. Very often the assessment is for the convenience of the therapist or psychiatrist, but not for the good of the person seeking help. The further we can avoid the limitation of the label, the more easily we can perceive the client as a full-blooded person. In this regard, when a client comes to me saying, "I have depression, I'm sure you've read all the symptoms on the internet.", my question is, "I'm sure you've read about possible treatments as well. What are your expectations of our work together?" Answers vary according to the client's willingness to set aside preconceived notions about the process ahead for a bit.


3. Therapy is a process that takes years - Thanks to the queen of therapy, Freud's classical psychoanalysis, therapy has been placed on a high pedestal, sometimes unattainable. Yes, clients who have embarked on the path of psychoanalysis walk that walk for years. But there are many other strands and approaches in therapy that find shortcuts (solution-focused therapy, cognitive-behavioral). Exactly how many sessions are needed for a particular client is hard to predict, but sometimes it may be 5 sessions, other times 10 or more, and the frequency 1 time a week, 1 every two weeks, and diluting over time until a natural end to the process is reached.


4. Just talk, do nothing - this is usually a retorhic of life coaches who like to say that therapists focus too much on "talking" and not on "doing specific things". In fact, the therapy process uses a variety of methods - art approaches, psycho-drama, cognitive-behavioral, etc. - to help the client explore, observe, become more aware. Also, different tasks are often set for the client between sessions. Doing them helps the process of change and improvement, and not doing them gives different and also valuable information for awareness. Active participation of the client between sessions is required to have the desired outcome.


5. You will immediately feel very good after going to therapy - Unfortunately this is very often not true. I always tell clients that in order to feel better they will most likely go through a period of deterioration. Change is a difficult thing. As much as we want it, there are actually reasons to avoid it, to feel ok in our current, unhealthy reality. We keep the balance and experience some "gain" from the state we are in. Often it is in the process of real change that the client becomes frightened and retreats, dropping out of therapy because they feel something scary, uncomfortable, unfamiliar. To have success, the client must be courageous in this journey. And to trust their therapist. Very often there is a provoking, a challenge on the part of the therapist, in order to awaken different emotions, their healthy experience in the safe environment of the office, the awareness of defense mechanisms, behavior tendencies. Therapy hurts sometimes. And the results of it are sometimes felt faster, other times the client realizes after a while, in some situation, that he reacts differently than usual.

Change is a difficult thing. As much as we want it, there are actually reasons to avoid it, to feel ok in our current, unhealthy reality.

6. The therapist does not share anything personal about himself - one thing is certain - therapy should not be therapist-centered. And yes, sessions with clients are in no way and under no circumstances a space for the therapist to share about their personal adversities and life difficulties. That's what supervisors and therapists are there for, for the therapist to visit themselves. Oh, and personal life traumas should not be the basis for a person becoming a therapist. But let's get back to whether it's ok for a therapist to share something personal about themselves. Yes, of course. It's good to know that the therapist is a person just like everyone else. At specific times in the session, it can also help connect the therapist and the client. A simple example - last year I was training for a marathon and I was limping a lot, had a bandaged ankle, and felt physical pain. It's only natural to share with clients why that is - yes, I'm training for a marathon, yes, it's a challenge for me, yes, it will be my first time. Or - I'm extremely fond of candles - my clients know that the scent of a candle can be smelled from the hallway. Often the theme of scent has been an introduction in sessions - what does it remind the client of, does it take them back somewhere in the past, for me what is that scent - yes, cinnamon and apple are my Christmas scent. And many other examples can be given of such interaction without crossing boundaries.


Yes, the boundaries of personal experiences and professional ones are certainly respected. But, if I see a client in the cinema, I won't pretend not to notice. On the contrary, I'll be delighted to see it. But I will also wait for his reaction. He or she might be startled, become uncomfortable. And that's ok too. No need for ostentation, no need for fakery either. But next time you watch a movie with a therapist, keep these myths in mind as well.


*There *are* wonderful depictions of therapists and the therapeutic process, but more on those another time.

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