What makes for good therapy?

Eliza Wells, MS, LMFT

Pronouns: she/her, they/them

Staff Psychotherapist

Sometimes people come to therapy because they feel like they’re “supposed” to, but they can’t quite articulate what it is they’re looking for. Maybe something is feeling off in their life or they aren’t meeting the goals and expectations they have for themselves. 

They don’t have a specific problem to solve, but they’re looking for direction from an “expert” and have this idea of a therapist as someone who is supposed to “fix” this feeling of lackluster or discontent. The therapist is going to “do” something “to” them that’s going to change them, like a doctor treating a patient or a stylist performing a makeover. 

It doesn’t help that we have so many platitudes cropping up related to mental health in the last decade. Open ended, vague encouragements to “work on yourself”, “do the work”, and “work on your mental health” make many of us feel that there’s definitely something we’re supposed to be doing with a therapist that’s going to improve our everyday life, but we don’t actually know what that thing is. And therapy is something that takes place behind closed doors more so than a personal training session or a new diet–it's cloaked in mystery, which can make it a bit intimidating.

Of course we have media representations of what therapy looks like. But honestly, the majority of them are terrible. Therapists you see on television and in movies are hoaky and stilted at best, and fiercely unethical at worst. They often have no boundaries, crafting quasi-friendships with their would be clients and sharing too much about their personal lives, or they hardly even act human, simply playing a figure-head that nods emphatically mumbling “mhm” and “how does that make you feel” while adjusting their glasses and clutching at their cardigan.

So what actually is good therapy then? 

Good therapy can look so different that it can be challenging to really define it objectively–which is why it’s often easier to talk about bad therapy.

There are countless different models for conducting therapy as well as several different “types” of licenses that allow a person to conduct themselves as a therapist. For example, in Illinois, there are Licensed Clinical Social Workers (LCSWs), Licensed Clinical Professional Counselors (LCPCs), Psychologists,  Doctors of Psychology (PsyD), and Licensed Marriage and Family Therapists (LMFTs), just to name a few. These all carry with them some form of education, internship, and test-taking that then holds that person accountable to a professional board with its own ethics and legalities. 

And as a practicing therapist, one might utilize something like Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Emotionally Focused Therapy (EFT), Action and Commitment Therapy (ACT) (and the list goes on and on and on…)

But research has shown time and time again that it’s not the type of training a therapist received or the type of therapy they practice that decides whether or not clients rate therapy as effective: It’s something called “common factors”. Ironically, there isn’t a shared definition of what specifically these encompass, but they usually include the sort of human characteristics that make up a trusting and healthy relationship, such as empathy, unconditional positive regard, and genuineness. 

Another major factor in whether therapy is experienced as successful is goal alignment: are the therapist and the client in alignment on the goals of therapy. 

This doesn’t mean that the type of therapy is completely irrelevant, though. What it means is that having what we call a strong therapeutic alliance and shared expectations for the process of therapy creates the pathway through which therapy can be effective. 

Therapy Is A Relationship 

I believe this is often why the start of therapy can be the bumpiest part. Most clients who are going to drop out of therapy do so after the first session, and after the second and third session there is another drop off. Finding a good fit in a therapist is crucial to therapy working for you–so this dropout is to be expected, and it doesn’t mean that a client is not committed to therapy. However, if one goes into therapy expecting therapeutic change to occur in the first few sessions, they may need to adjust their expectations of how the process works. 

Therapists are taught to stay primarily in relationship-building and assessment mode in the first five sessions or so. This means that we may not be offering you much in terms of concrete skills, advice, or insightful sage-like wisdom. Because realistically, what would any of that mean coming from a complete stranger? You know your experience and your needs much better than a therapist who is only just meeting you. This isn’t to say that we can’t offer something concrete initially if that’s what you need–but it’s important to be mindful of whether you’re actually willing or able to make any use of that when you first begin therapy. 

Therapy is a process that can break a life-long cycle of someone else making choices for us and telling us what we should value and how we should be. For some of us, therapy is the first experience we have where there aren't expectations for us other than to be ourselves. And this can be very intimidating.

Sometimes it's all too much to have a human on the other end to meet you just where you're at and to ask you what your goals and expectations are. We want to be led, "fixed", or directed in how to heal our wounded parts. But if a therapist was to take the lead and do this "to" you, rather than with you, at best it may not truly be what you would have wanted for yourself, and at worst, it would reaffirm structures that created that wounding in the first place. In fact, you may not even be wounded at all-only you can decide what you want to change and what you want to keep, and we cannot make that choice for you.

Therapy Can Be What You Need It To Be

Therapy really is a combination of whatever you put into it and the quality of the relationship between therapist and client. So if it's not feeling good to you, consider whether you're really showing up in a genuine way, and whether you feel you're being welcomed to do that by the therapist.

Figuring out what it is that you need and how to express it clearly in some ways is the entire goal of therapy for many people–and sometimes starting there is already incredibly difficult. It can be uncomfortable to sit with someone who is in some ways an authority figure but who is not directing you in how you should be using your time with them.

There may be a lot of awkward silences. There may be small-talk that feels strangely deafening and excruciatingly empty at the same time. You may have a lot of feelings about paying someone to simply exist in a space with you as a human and not give you specific directions on how to best get your money’s worth. 

But we’re not just someone that you’re paying to share a space with. We are specifically trained to show up with you in the most non judgemental, empathic, accepting way that a person can. And this in itself is often the therapy. 

How does it feel to simply be with someone else, without all of the expectations to impress them or take care of them? Are you even able to put all of those expectations for yourself down, or do you struggle to just be?

Are you frustrated that your therapist isn’t somehow reading your mind and digging your deepest darkest secrets out of you? Or maybe you have discussed your goals and needs from therapy with your therapist, yet you find yourself each session talking about the weather or your favorite sports team, internally screaming and begging for them to stop you and say “hey wait a minute, I thought you were here to talk about how your relationship with your mom makes you feel like you take up too much space in the world?” 

It is your job as the client to communicate to your therapist your goals and what you want to get out of therapy.

And this includes telling your therapist directly what might not be working about the structure or content of sessions.

What’s getting in the way of bringing up what feels important to you to talk about? Is a part of you relieved if it doesn’t get talked about?

Good Therapy Is Talking About Therapy

Consider if you have built a relationship with your therapist that feels secure enough to work what you actually want to work through. This can take time, and that’s ok.

This is why finding a good fit and proper pacing is so important. Timing and context in your life also plays an important role.

Sometimes good therapy is talking to your therapist about what’s getting in the way of you working on what you actually want to work on. Is now the right time to be doing this work? Do you really feel ready to do it? Do you actually want to do it, or do you feel like you’re supposed to do it? 

And finally, do you trust this therapist to meet you in whatever way you show up? Or are you perhaps struggling with some of your own protectors (for example, engaging in “people pleasing” and trying to get the therapist to have a certain view of you). 

These are the things that show up the therapeutic relationship because it is a real relationship, but what makes therapy different is that a therapist is trained specifically to help you work through these dynamics. They are the right person to name these experiences to, because while they are in relationship with you, they are doing it in favor of your goals and growth, not their own. 

Your therapist is there to talk about whatever you want to talk about, so they are usually going to follow your lead. But they should be willing to follow that wherever you need it to go.

Part of the experience of good therapy is trusting yourself to take the lead and communicate what you want out of the experience, with the expectation that the therapist will meet you there.

You Don’t Need Therapy

If you’re hesitant to engage in therapy but you feel like you’re “supposed” to or that you “should”, I want you to know that it’s ok not to go to therapy. I firmly believe that nobody needs therapy, but that anyone who wants therapy deserves to have access to it. 

Therapy can be wonderful when it’s the right fit for you and something that you want–but if you feel pressured or guilted into it, or it’s just another routine you feel the need to complete for total “wellness”, then it’s probably not going to be very helpful to you. And this type of belief is actually what can get in the way of good therapy working for you. 

Therapy is not an activity you complete or a task that you cross off your list–and if you stop seeing it this way, you may get a better sense of what you would actually like to do with the space that it offers. The space is yours, but only if you want to claim it. 

Contact us today if you’d like to learn more about our services and how we can support you on your journey towards healing and recovery. You deserve validation, understanding, and compassionate care.

At Sage Stone Counseling, we hold that everyone should have the right to mental health care. We focus on providing affirming and safe therapeutic space to marginalized groups of all kinds, and are here to help. If you or a loved one is seeking support from a therapist, consider contacting us today.