Therapy can be mysterious and intimidating, especially if you don’t know what to expect. So Casey Green, who is a staff member of BuzzFeed Health, spoke with three psychologists who all have extensive experience with psychotherapy: Stephanie Smith, Ph.D., clinical psychologist in Colorado; Ryan Howes, Ph.D., clinical psychologist and professor at Fuller Graduate School of Psychology; and Lynn Bufka, Ph.D., associate executive director of Practice Research and Policy at the American Psychological Association. Here’s what they wish people knew about therapy:
1. It’s not really a therapist’s job to give you advice.
They’re not here to tell you if you should call off your marriage or quit your job. “The real job of therapy is to get to know yourself better and change the way you’re thinking, the way you’re behaving, or the way you’re understanding the world,” says Smith. “The process of therapy is not to give good give advice.”
Sure, they might tell you about strategies to cope with a mental illness like depression, anxiety, or bipolar disorder, but when it comes to your personal life decisions, they’re more of a facilitator. “Do you really want to come to therapy to give your power away to someone else or do you want to learn to have that power on your own?” says Howes.
2. They probably see a therapist, too.
“I would never trust a therapist who hadn’t been to therapy,” says Howes. And according to these experts, most psychologists do see their own therapists — maybe not all the time, but at least at some point in their careers. Most graduate psychology programs even require that candidates participate in therapy, says Smith.
3. Most therapists don’t prescribe medication.
That’s typically the job of a psychiatrist or a primary care provider — not a psychologist or social worker, says Bufka. However, your therapist can coordinate with another provider to help you start or end a medication, if that’s something you’re interested in.
4. You don’t have to be diagnosed with a mental illness to go to therapy.
One common misconception: “That you have to be ‘crazy’ to go to therapy,” says Howes. “There are a lot of reasons why people go to therapy that have nothing to do with disorders. And when people do go because they have a disorder, that’s nothing to be ashamed of. You’re going to get help and speak to an expert just like you would seeking help for any other medical condition.”
It’s usually this in between area — when you’re struggling but not completely debilitated — that people hesitate to go to therapy because they feel like they don’t need it. “But if you’re feeling stuck or overwhelmed or not able to function as you’d like to, that’s a sign you do need to talk to somebody,” says Bufka.
5. Your therapist isn’t talking about you with their friends at the bar.
“Rule number one is confidentiality,” says Howes. “I would quickly lose my license if I talked about my clients with my friends or family.” However, they may discuss certain cases or broader themes with a small group of trusted colleagues. “We have groups that meet every other week or monthly to discuss difficult cases and get feedback from peers,” says Smith. “We talk about cases, but it’s a stripped-down version with no identifying information.”
6. And they probably aren’t Googling you.
“My understanding is that it is an overstepping of bounds and almost a breach of confidentiality in some ways to Google a client without their permission,” says Smith.
Plus, they’d rather talk about things as you bring them up, not force you to explain That Picture they saw on Facebook over the weekend. “I don’t Google my clients because I’m of the philosophy that I want everything to happen in the room,” says Howes.
7. Your therapist probably won’t acknowledge you in public unless you do first.
Don’t worry about running into them at a restaurant and hearing “Hey, glad to see you out and about!” while you’re on a date. The general consensus is that therapists won’t acknowledge you in public unless the client initiates it, and even then, they won’t acknowledge that they are your therapist unless you do first, says Bufka.
So feel free to say hi and introduce them as your therapist/yoga teacher/neighbor, or ignore them entirely. It’s your call, and it’s something you can talk to them about ahead of time if you’re worried about it.
8. Just going to therapy won’t necessarily help — you have to participate.
Therapy isn’t like going to your primary care doctor for a sinus infection and leaving with antibiotics. It takes collaboration — not just passively sitting back and waiting for results. “It’s pretty disappointing for clients when they think that’s the way it works,” says Howes. “They want the therapist to ask them a bunch of questions and it’s like a treasure hunt.”
But if a client is prepared and willing to talk about what brought them in and what they’d like to work on, it can make the whole process more collaborative and efficient.
9. Therapy doesn’t have to be a long-term commitment.
“Sometimes I think people hesitate to embark on therapy because they feel like ‘If I go once I’m going to be sucked in for 10 years, three times a week,’ and it feels like this huge decision,” says Smith. But the length and frequency of therapy is very individual. It can be a one-time deal, a few months of sessions, or longer depending on what you’re going through and what you’re looking to accomplish.
It’s perfectly reasonable to ask questions about a therapist’s approach in the first session or two, says Bufka. Things like: What would treatment look like? How long are we going to be working together? How will I know when we’re finished?
10. The right “fit” is the most important factor when it comes to finding a therapist.
“You could be seeing the best, most qualified therapist in the whole world, but if the fit isn’t good, its not going to be as effective,” says Smith. “What research tells us is that of all the different variables in therapy — types of treatment, education of the provider, length of treatment, all that stuff — one of the biggest factors in therapy success is fit.”
What does that look like? Feeling heard, understood, and respected. “The experience of therapy itself isn’t always going to be fun or enjoyable,” says Bufka. “But in the context of that, you should feel safe, accepted, and heard, and at times challenged.”
11. And stopping therapy doesn’t mean you can never go back.
“As a therapist, what I’m hoping is that by the end they feel like they’ve improved their functioning, whether in their relationships or their job or as a student,” says Bufka. “That they’re feeling like they’re contributing to whatever is of value of them and not distressed by the symptoms they were experiencing.”
Of course, life happens and things change, and just because you felt better for years doesn’t mean you won’t necessarily need help again in the future. “It doesn’t mean that you’ll never need a booster session, just like you see a primary care provider,” says Bufka.
12. If you’re worried that something might be inappropriate — like hugging them or asking about their personal life — just talk about it.
Not every therapist will be open to hugging their clients, but if you really feel compelled to, don’t be embarrassed to bring it up. “The client should feel free to say anything or ask anything,” says Howes. “Ask it if it’s on your mind and then let the therapist decide whether or not they’re going to answer that. Try not to filter yourself or censor yourself.”
13. They don’t have all the answers.
“Sometimes people think therapists have a special ability to see inside you but we really don’t,” says Bufka. “We have a particular training and understanding of how humans are, how humans behave, how emotions work, and we’re able to use that to understand the specific situation someone is in. We don’t have these magical skills that we’re instantly going to read into you — it’s a process.”
14. Being a therapist can be hard work.
Between juggling several clients every day and helping patients through particularly traumatic events, it can be an incredibly daunting profession. “Obviously it can be hard to hear difficult stories hour after hour, day after day and then still have enough energy for your own family at night,” says Smith. “That can be a challenge, but it’s certainly manageable.”
“We’re professional secret keepers,” says Howes. “That takes a toll after a while. It’s really important for us to have our own confidants and our own people we can talk to about things.”
15. But chances are, they also find what they do incredibly rewarding.
“When therapy works, and it does, you’re going to walk out of there with a new understanding and new ways of doing things. You own it. It’s yours. It goes with you for the rest of your life,” says Bufka.
“I just love people,” says Smith. “I love to get to know people, and it’s really as simple as that. I find people endlessly interesting.”
“Whenever I’m able to see someone’s growth process taking place, I’m delighted,” says Howes. “And I spend much more time laughing than I ever thought I would.”