Your Therapist Can’t Read Your Mind
When therapy is going well, it can sometimes feel like our therapist has just read our mind- “How did they know exactly how I was feeling?” But, of course, therapists aren’t psychic; we’re following what you’re communicating to us.
This means that when therapy isn’t working as well, the therapist might not know exactly what’s going wrong. While some therapists use very standardized treatment protocols, most of us create our own style based on our personalities, theoretical background, training, and experience. We then tailor that style to the client sitting in front of us. Ideally, expectations will be discussed during the intake, but you may not know much about the different kinds of therapy or what techniques will work best for you going in. Your therapist will be doing some experimentation, especially early in the therapeutic relationship, to see what clicks for you.
To show how this can sometimes break down, let’s look at two hypothetical sessions. In both examples, the clients are dealing with similar issues. During the intake, the client talked about a difficult relationship with her mother, and identified this as her reason for seeking therapy. However, since then, all she’s talked about is work. She’s a chatty person, and the therapist has a hard time getting a word in edgewise.
Strategy A:
The therapist thinks, “Work stress is clearly what’s important right now, so I’ll hold space for her to talk through her experience. I’m respecting her right to choose how to use this time. She doesn’t seem to want much input from me, so I’ll focus on listening attentively and showing compassion. Maybe later we can discuss some coping strategies for her to use at work.” Great!
Client A thinks, “All my therapist does is sit there and listen. If I just wanted to vent, I’d talk to my best friend. Why am I paying for this?”
But what if, in a similar session with a similar client, the therapist tries this:
Strategy B:
The therapist thinks, “Work is on her mind because she just clocked out a couple hours before this. I’m going to jump in and remind her that she’s here to talk about her mother- she even mentioned they had a fight at the start of the session. I’ll guide her to stay focused on her goals and the session will be more effective and productive.” Great!
Client B thinks, “Wow, did my therapist just interrupt me? That’s exactly what my mom does whenever I try to tell her about this stuff, and my best friend hardly has any time to talk these days. It feels like my problems aren’t important to anyone.”
Yikes! Neither of the strategies the therapist tried were “incorrect.” We can imagine Client B feeling heard and supported with Strategy A, which may empower her to recognize that her emotions matter, even if her mother doesn’t listen. We can imagine Client A feeling excited with Strategy B- finally, she’ll get to the root of her perfectionism!
A 2020 qualitative study of client/therapist agreement on the helpful aspects of therapy found that clients and therapists often have different perspectives about what’s helpful, for example: “The majority of clients but fewer therapists noted that therapist support, validation, and affirmation was a helpful component of psychotherapy” (Chui et al., 2020). Since we can’t read minds, we rely on our clients to give us feedback about what’s working and what’s not. According to the same study, both clients and therapists felt open discussion of the therapeutic relationship was helpful to the process.
Giving criticism can be difficult. You may worry about seeming rude, ungrateful, or like a know-it-all. To make things harder, you may not be able to pinpoint what didn’t work, only that you left feeling worse than when you came in. These conversations can become especially fraught when there are racial, gender, or cultural differences between therapist and client. Remember that this is your treatment, and you have a right to speak up for your needs. Your therapist wants to know what you’re thinking and feeling, and they don’t expect you to have everything figured out.
Here are some examples for how you might phrase feedback:
- “I really wanted to discuss [X] last session, but you seemed more focused on [Y.] Can we address [X] this session?”
- “The comment you made about my partner really bothered me. It made me feel like you’re judging me for dating them.”
- “I can see how the homework you assigned could have been helpful, but I was stressed about it all week.”
- “I feel like we’ve been going in circles on [X]. Can you explain the kind of therapy we’ve been doing? Is there something new we could try?”
- “I appreciate your recommendation, but I’m not interested in that. What are some other options?”
- “I think we’re coming to this issue from different backgrounds. For me, [X] is very important, and I want to know that you respect that.”
- “I’d like you to take the lead in setting the agenda for the session and keeping me on track.”
- “You’ve been really pushing me to do [X], but I don’t feel ready for that yet.”
- “I’ve felt icky since our session last week, but I don’t know why. Can we talk about it?”
- “I’d like more suggestions from you on things I could try doing differently.”
A good therapist will welcome your feedback. They may explain their rationale for the strategies they are using, and ask you some follow up questions. This is not defensiveness, but an effort to clear up misunderstandings and explore your preferences. You can expect your therapist to either adjust their strategies to you; explain why your request is infeasible or inappropriate; or assist in transferring you to another therapist who may better fit what you’re looking for. Your therapist should not become openly angry or belittle your needs. While therapists, like everyone else, experience anxiety and frustration in our work, it is our job to manage our emotions to support your wellbeing.
Therapy is an ongoing collaboration between therapist and client. You can help your therapist do their job effectively, and get more out of therapy, by speaking up when something feels off- or when something is particularly helpful!
References:
Chui, H., Palma, B., Jackson, J. L., & Hill, C. E. (2020). Therapist–client agreement on helpful and wished-for experiences in psychotherapy: Associations with outcome. Journal of Counseling Psychology, 67(3), 349–360.
