3 Therapists Describe WTF Therapy Is Actually Like

Like, "What the fuck they are writing about me?!" for example.

We recently asked members of the BuzzFeed Community to tell us everything they wanted to know about therapy.

We boiled down everything you asked into key questions that came up again and again, and then we reached out to three mental health professionals to get some answers. Here's who we talked to:

• Ryan Howes, PhD, clinical psychologist and professor at Fuller Graduate School of Psychology

• Loren Soeiro, PhD, licensed clinical psychologist

• Dr. Barbara Nosal, chief clinical officer at Newport Academy, treatment centers for teens struggling with mental health issues, eating disorders, and substance abuse

Keep in mind that these are the professional opinions and observations of three practicing therapists, and while their opinions are definitely informed by their experience, they don't speak for all therapists.

1. Is therapy like it is in the movies?

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Soeiro: "Hmm... Do you mean, are therapists geniuses, fuzzy-sweater-wearing wimps, or master manipulators? No. Is it just two people talking privately in a comfortable, quiet, confidential setting? Yes."

Howes: "There are very few movies that really do depict a therapist accurately, one of them being Ordinary People. For the most part, movies and TV are there for entertainment value. The therapist is often shown as either goofy or sadistic, or actually an object of love and desire, which makes for great storytelling but is really not accurate. Therapy is going to look much less dramatic and wacky than you see onscreen."

2. What the fuck they are writing about me?! I've always wanted to know what they're hiding!

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Howes: “I should point that not all therapists take notes during session. I never have, and never will, because I don’t want this question to be in the client’s mind and I don’t want that to get in the way of what we’re doing. But if they are writing some notes down, they’re writing down little details of the session that will help them write their case notes after the session.”

Soeiro: “I personally am not hiding very much. I make notes so I can remember what was said in the session, and sometimes I jot down ideas that help me formulate the case. These ideas might sound something like, ‘Feels distant from friends and colleagues but anxiety prevents him from reaching out,’ or, ‘Traits of obsessive-compulsive personality vs. OCD?’ In general, I always explain my thinking to the patient.”

3. What does a typical first session look like?

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Soeiro: “All therapists are different from one another, and that goes for first sessions, too. Sometimes the therapist will ask you questions; sometimes you’ll have filled out a form. Sometimes you’ll be able to just start talking about whatever’s on your mind. And sometimes there will be a clear structure and plan to the session. It depends on what type of therapist you’re talking to. Psychodynamic (or psychoanalytic) therapists are more likely to talk in an open fashion, or just to sit back and listen to you; cognitive-behavioral therapists will often closely regulate the session.”

4. What can a therapist do about anxiety? How are they supposed to rid me of my fear of people?

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Howes: “There are a few things. Therapy works as kind of a laboratory. If you have anxiety in the room, or have a social anxiety, well, the relationship with the therapist is a social relationship. Maybe you start working on it there — what's it like to be here in this room with me? Maybe we do some relaxation around that and figuring out the root causes of that anxiety, and then we start to take that out of the room and say ‘let's gradually work on moving into different social circles and new environments — go to the the coffee shop and see how you interact with people there, here are some tools to help you feel calm and relaxed while you're interacting with new people,’ and then it just expands from there.”

5. How do therapists cope with all the heavy information they hear day after day?

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Howes: “We cope with it in a few ways. Number one, we have gone through 2 to 6 years of graduate school to learn how to understand problems and how to work with our clients. A major part of our training is to learn how to handle problems. The second thing is that most of us are either in (or have been in) a lot of our own therapy to learn how to cope with stress, to learn good boundaries, to learn how to manage work-life balance. Third, a lot of us have been in consultation groups or have people we can consult with. If I have a rough day, or a rough case, I have people I call to talk about how I should handle this issue (without compromising confidentiality). We kind of bond together a little bit and help each other out."

Soeiro: “I can’t speak for other therapists, but as for me, I don’t feel burdened. I feel a sense of privilege because I’ve been entrusted with other people’s secrets and feelings. It makes me want to help and encourages me to live up to the responsibility, which I try to do by working harder — listening better, attending more closely to what each of my patients needs from me and from therapy.”

6. How long do I have to be in therapy?

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Soeiro: “Therapy can last as long as you and the therapist continue to agree that it is helpful. Sometimes this just means a short course of four or six sessions. Sometimes therapy takes years.”

7. Do I have to talk the whole time? What if I just want to cry?

AMC

Howes: “Typically, no, the person doesn't have to talk the whole time. This is something you work out with your therapist. If you want to cry the whole time, that’s something you can talk about with your therapist, by saying, 'I feel like I need a safe place to be sad,' and I don't think therapists would stand in the way of that.”

Soeiro: "When you’re in therapy, you don’t have to talk the whole time. You don’t have to talk at all, if you’re not up for it. It’s your time. And yes, if you need to, you can just come in to cry, or to let it out somehow."

8. Can someone without a mental illness still benefit from therapy?

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Howes: “Hell yes. We know more and more that you don’t need to have a mental illness or diagnosis to come to therapy. Someone who comes to me who isn’t sure what they want to be when they grow up — that’s not a mental illness. They’re just trying to figure out their life. Or someone who comes to me who has recently lost a loved one — grief isn’t a mental illness. So, absolutely people do that all the time. Even if they did have bad things happen to them in the past and they’re trying to figure out what impact that had, it doesn’t necessarily mean they have PTSD or mental illness, they just want to figure out, ‘Who am I, what am I all about?’”

Soeiro: “Yes. Therapy can help people understand themselves better, link the past to the present, make hard decisions, or get through difficult times.”

9. How do you know if you should start seeing a therapist? Are there any strong signs that indicate that therapy would be a good idea?

Twitter: @tbhgohome

Soeiro: “This is a hard question. In some cases, I would say if you find yourself doing the same thing over and over again, and disappointing yourself by not being able to change, then perhaps you could benefit from some help. I’d also recommend therapy to people who feel isolated, or who have a sense of internal confusion — of things they need to understand about themselves.

There’s no hard and fast rule. If you feel a kind of internal emotional pressure that won’t go away, and you don’t feel better after talking to your friends or practicing self-care in other ways (exercise, sleep, good nutrition), you might benefit from talking it out with a therapist."

10. As a therapist, how do you not pass judgment on your patients?

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Soeiro: “My job is to express empathy for the people who choose to talk to me. Luckily, it’s also just the way I am built. When someone trusts me with his or her feelings, it’s not hard for me to empathize, almost automatically. I don’t have to work too hard to avoid passing judgment because that’s usually just not the way I think.”

11. How do you know if a therapist is a good fit for you?

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Howes: “A therapist is a good fit for you if you feel like you can be open and if you feel comfortable enough to share the deep things in your life — or that you may be able to do that eventually. If there’s anything about that therapist that feels like you’re on guard with that person, they might not be the best fit. If you’re on guard with everybody, take that into account. But you don’t want to feel more on guard with this person than you do with other people.”

Soeiro: “You should pay attention to your feelings when you’re with your therapist. If you don’t feel comfortable, or feel judged, you may need to find someone else. Of course, it is usually a good idea to mention these feelings to your therapist. Discussing the here-and-now experience in the therapy room can provide valuable information about the relationship between therapist and patient. At the very least, your therapist may be able to tell you how he or she is reacting to you, which might disconfirm your fears. And talking about feelings of discomfort can also help your therapist do better in making you feel safe.”

12. Does the therapist usually offer a prompt or am I supposed to come in knowing what I want to talk about?

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Howes: “I can tell if someone has something they want to talk about, but oftentimes the therapist does offer a prompt. My favorite prompt to give clients is, ‘What have you been noticing about yourself this week?’ It might be something a potential client can think about in the waiting room.”

Soeiro: “It’s hard to say, because every therapist is different. I sometimes joke with my patients that they shouldn’t come in and say they have nothing to talk about, because when people do, serious or emotional topics tend to come up. Some therapists (such as those who practice cognitive-behavioral therapy) will want to review your therapy ‘homework,’ and others may bring up a remark you made at the last session in order to explore it more deeply. If you do have a topic you’d like to discuss, you should certainly bring it up at the beginning of a session. And if you’re just starting therapy, it does help the therapist if you explain what brings you in. Most therapists will ask you about that, regardless.”

13. What could therapy do for me that I don't get out of talking with friends and family?

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Soeiro: “It’s very important to depend on friends and family supports at times like that — I can’t emphasize that enough. Psychotherapy is not like talking to friends, though. You can’t overburden your therapist, and your therapist will not change the subject, run out of time, or suddenly start talking about him- or herself when you need to get something out. You won’t have to worry about alienating your therapist by telling him or her how much it hurts. You can see your therapist regularly too — quite often, even more than you see your friends. For issues like traumatic grief, where powerful feelings of loss will come back over and over again, a psychotherapist might actually be a better person to talk to than a friend.”

14. How will we know if a therapist actually cares about you?

Twitter: @aparnapkin

Soeiro: "You may or may not be able to feel that your therapist cares about you personally. Even if you’re not certain about this, you should get the sense that he or she can feel what you feel, and understands what it’s like to be you. If you don’t experience this feeling of acceptance, you may want to bring it up with your therapist."

15. Is there such a thing as full recovery for eating disorders? I feel like every time I make any progress I lapse. And I can never imagine a life without it.

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Nosal: "Yes, it is possible to make a full recovery from an eating disorder (ED). There are a variety of approaches to treating eating disorders. You might not have found the right method or therapist who can help you confront the root causes that are leading to this behavior. If you are only addressing the ED behaviors, without looking at the underlying core issues and related traumas, you are dealing with the symptoms, rather than the cause, and you will continue to relapse.

With eating disorders, as with all recovery, it’s not unusual to take several steps forward and then a step back. It may feel impossible at this point to picture yourself without the eating disorder. I promise you that with hard work and the support of professionals, you can find your way back to a version of yourself that is happier, healthier, and more whole."

16. What happens if you say you've thought about suicide? Can you have a reasonable talk about it or do they report you immediately? And who do you get reported to?

Charlotte Gomez / Via buzzfeed.com

Soeiro: "Although most therapists are obligated to report patients who present a genuine, immediate, and realistic risk to themselves (or to others), this doesn’t mean patients who discuss suicidal thoughts get reported immediately. Your psychologist will want to know the extent of your suicidal thoughts to see whether they are vague or specific, distant or urgent, recurrent or unusual, harmless or lethal.

Therapists are trained to talk about suicide at length, both to keep their patients safe and to gain deeper insights into them by talking about it. Making a telephone call to a patient’s family, for example, to let them know that the patient is in danger, usually comes only after a thorough and thoughtful evaluation."

17. If I freak out (pull my hair and hit my head and pace around) in front of my therapist, could I get thrown in the hospital for inpatient?

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Soeiro: "Only if you present a real danger to yourself (or to others) at that specific time. If you hit yourself in the head in front of me, I’d probably want you to stop as soon as possible, and I’d want you to have the appropriate services — but I wouldn’t necessarily call 911."

Nosal: "Your therapist’s primary consideration is your safety. If the symptoms you mentioned continue, they may require containment and stabilization. Depending upon the severity of the symptoms and your emotional state, your therapist may determine that you are threat to yourself or others, and ask you to go to the hospital to be evaluated by a psychiatrist. If you refuse to go to the hospital, the therapist, or local law enforcement, may place you on what’s called an 'involuntary hold' to transport you to the local hospital. This is not to say that you will be 'thrown in the hospital'; however, if the attending psychiatrist feels that you are at risk, they may admit you to the inpatient unit for observation and stabilization for up to 72 hours. After that time, if you remain at risk based on their ongoing assessments, they may extend your stay. On the other hand, if you are doing better, the psychiatrist may feel that admitting you to inpatient is not warranted."

18. OK, but will therapy actually help?

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Howes: “Yeah, mostly! The research shows that therapy is effective for the majority of people. It depends on what you’re working on and how engaged you are; it's like a lot of things — you get out what you put into it, and the goodness of fit between you and therapist matters as well.”

Soeiro: “The research says that therapy generally helps, and that it doesn’t matter what modality you choose. The most important factor is the relationship with your therapist, so it really does matter to find someone you can trust and rely on, who makes you feel safe enough to get better.”

Responses have been edited for length and clarity.

By the way, if you’re feeling curious about therapy yourself, you can learn more about how to start here, since pretty much everyone can benefit from talking to a professional. For more information on free and affordable mental health care options, check out this guide.

Follow along at BuzzFeed.com/MentalHealthWeek from Oct. 2 to Oct. 8, 2017.

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