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What to Expect from Face to Face Therapy

By Caroline Kendal MBACP (Accred)

I’m going to describe what takes place in therapy so you have some idea of what to expect - from the first meeting, through the process and finally, the ending. I’ve described what happens using the traditional approach, known as psychodynamic psychotherapy.

The Beginning of Therapy

You’ve made the decision to come to therapy. It might have felt like an easy decision, something desired for a long time or it may have been a difficult decision, made after a great deal of consideration and hesitation. Even if you’re looking forward to it with excitement and relief, you may still feel apprehensive upon entering the room for the first time: The uncertainty of what to expect, what your therapist might be like, what your therapist will think of you, what to say, your hopes and fears. 
There is no good or bad way to be in the first session. Your therapist is there to welcome you, not to judge the way you present yourself. The core of the first session is about getting to know each other and establishing whether you wish to engage in a working relationship. 
At some stage during this session the therapist will wish to introduce and agree the terms upon which you will continue to meet. These include how often you meet and the length of sessions (50 minutes is the normal practice). The length of the work may also be discussed. Some therapists offer a fixed number of sessions, open to review, whereas others might offer open-ended therapy. Therapists will let you have an idea of when they take their holidays or breaks. Payment will be negotiated and agreed. Therapists will advise on their policy on missed sessions; most therapists ask to be paid for missed sessions, whether or not notice has been given. Confidentiality may be mentioned, but either way it is understood that it is at the heart of the process.
Once the agreement to meet has been made, the knowledge that there is someone there for you, at an agreed time, in the same place, every week is more than just comforting. The fact that you decided to enter therapy means that something in your life is shifting. Experiencing consistency and continuity week after week gradually enables you to feel safe. The confidentiality of the sessions also fosters the sense of safety as well as the fact that your therapist is not a part of your outside life.
Talking to your therapist is not the same as talking to a good friend. Sometimes you tell a friend something and end up regretting it – you worry they might not keep it a secret, you may fall out, it may change the nature of your relationship or your friend may end up feeling burdened by your disclosure. In therapy, the only agenda is yours. Your therapist is bound by a professional ethical framework to retain confidentiality. He or she is objective and will not retaliate. The relationship is there exclusively for you.   
As the feeling of safety and trust grows, you may feel comfortable telling your therapist more about your life. Simply telling someone whom you trust current and past events as well as your wishes and worries for the future is beneficial in its own right. We often experience a sense of release from saying aloud what has been previously left unsaid. This is not to say that it’s always easy; it may take weeks or months of deliberation and hesitation. Indeed, what prevents you from talking can be as important as what you are afraid to say; either way, the therapist’s role is to understand and empathise with your anxiety of disclosure. Building a good alliance takes time and requires patience from both you and your therapist.

The Middle of Therapy

As mentioned, therapy gives you the right setting in which you can be and explore different aspects of yourself; how you feel, behave and respond and what you create. You are given the opportunity to mourn for all that you didn’t have, all that you felt you needed but did not receive and all that you wish for but find hard to reach out and take. Mourning might not be an attractive proposition, but both the realisation and release of these feelings enables you to be lighter, open and more vibrant.
While you talk more about yourself and your life, you may make a common discovery; your tendency to experience the same feelings, often in similar situations, again and again. Therapy gives you the environment to sit, think and acknowledge what that part might be.
As you come to understand your participation, indeed, often your creation of these experiences, and perhaps even your reasons for doing so, you might feel surprise and uncertainty. Frustration too. How could you do this to yourself? How could you not have noticed what you were doing? You are no longer a passive bystander in your life story; you come to understand your part in the picture. 
There are two elements to this understanding: Intellectual and emotional. Intellectual understanding brings awareness - we come to learn why we behave as we do. This is an important milestone in therapy. Our eyes are opened; things become clearer. However, this awareness does not guarantee change. In fact, we might wonder how, despite our knowledge, we still find ourselves back in the same situation. “I know why I do it, but I don’t know how to stop doing it.” Emotional understanding, however, takes us further. By its very nature, it is difficult to give a rational explanation to emotional understanding. We often need intellectual understanding to take us there; an emotional milestone is an experience, something we feel rather than think about. It can dawn on us and we feel it deep down; we finally know. Once we have reached emotional understanding, we are unlikely to revisit old patterns of behaviour.
As well as discussing events and feelings in your life, one of the tools therapy offers towards greater understanding is using the therapeutic relationship. The way you relate to your therapist is almost certainly a pattern and a reflection of other relationships in your life. Whether we are aware of it or not, these patterns take place and account for our tendency to re-experience similar situations from the past.
The idea that your relationship with your therapist is a microcosm of your other relationships may be a difficult one to take in - we are not used to seeing ourselves in relationships in this way. Say you’ve been feeling misunderstood throughout your life, it is possible that in therapy, you might feel as if your therapist is failing to understand you. If this is the case, you have both the choice and opportunity to let your therapist know how you are feeling. This might be the first time that someone has attempted to understand the feeling of being misunderstood. It is the role of the therapist to understand and note how you are relating and feeling, reflect it back to you and possibly link feelings evoked between the two of you with those in your outside life and your past.
The connection between past and present may lead you to choose to re-examine some aspects of your history. You might establish links, discover reoccurring feelings and look at the impact it has on your present life. One of the benefits of therapy is that you do not do this alone. Your therapist is not only present to hold you emotionally through the process, but can also offer insights and observations.
Re-visiting the past can be a welcome relief. You have the time and space to voice and feel what has been unacknowledged, unknown or stored. It can also be challenging, particularly given the nature of the relationship. Putting your trust in another, sharing who you are, allowing yourself to be vulnerable and exploring your past can make you feel like a child again. This stage can feel uncomfortable. You might feel dependent and uncertain, even though reality means you still have to function as a grown-up, independent person.  
As difficult as this might sound, you will be re-experiencing these childhood feelings in a safe, nurturing, intimate, relationship. This time, you will be receiving what you might have lacked first time round. Just as when you were a child, you will once again be learning and seeing yourself and the world with new eyes. It is a long process, but it is also refreshing.
Integrating a positive experience of an intimate, dependent relationship with our therapist has a powerful impact on all areas of our lives. We can find ourselves using what we have learnt and without even realising, it becomes part of us and we apply it to other relationships.  
In order for us to understand ourselves, we need to be understood. If we have not received understanding while growing up, how could we possibly know how to provide ourselves and others with that understanding? Experiencing a relationship in which your ideas, needs or anger are acknowledged and understood, rather than ignored or retaliated against, changes you. Your old internal dialogue is gradually replaced with a new one.
As movement occurs, we are more open to receive the world from a new perspective. We also begin to come to terms with and accept things we resented or felt uncomfortable with in the past.   

The Ending of Therapy

Throughout life, we experience “endings” in different forms and situations, although we do not generally consider their impact.
As mentioned earlier, the length of therapy cannot be predicted so how do we know when we are ready to end therapy? Perhaps a good start is to think about why we want to end. We may feel ready to leave. We have learnt, experienced and achieved. Put simply, we are happier. However, we may also wish to leave to avoid discomfort arising from time to time as part of the work. Each of us is sensitive to different issues and our need to break away can be tempting. However, if we do manage to stay and talk through our desire to leave, vital progress often follows. Whatever our reason for wanting to stop, it is a good idea to discuss it with our therapist first.
In our practice, gradual endings are recommended. Like a treadmill in the gym, it is better to have a cooling down period rather than halting abruptly. In fact, endings are considered to be a valuable stage in the therapeutic work.
We face our attachment to our therapist and the difficulty of separating. We lose an environment that has become an integral part of our lives. We must say goodbye to someone we are unlikely to see again. We leave not only our trusted therapist and a special relationship, but a part of us too.
Ending with our therapist can evoke a variety of feelings and memories. It may reactivate previous losses and partings. We have the time and space to look at other endings and consider what they meant for us, perhaps discovering that there was more to them than we were aware of at the time. With that discovery, we can understand and mourn unfinished business. Endings bring to light a key part of attitude to relationships. Do we cut off? Leave early? Sabotage? Lose interest and move on? Or do we manage to separate on a positive note?
One of therapy’s aims is to work towards a good ending. This might involve reflecting back on the therapeutic relationship, the process we undertook and our achievements. We can also contemplate our disappointments. Not only that we are parting, but also what we feel we have not yet gained but hoped we would. We can acknowledge our dependence whilst striving for independence and the consequent fear of having to continue our development alone. The process doesn’t stop with the last session. 
Whilst we will inevitably still experience periods of dissatisfaction and confusion, our overall sense of fulfillment and clarity increases. We are now free to use this in whatever way we choose.

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