My Thoughts

Thank you for the question! One thing that I want to point out to people is what you mentioned at the start of your question, which is that sometimes you do start therapy with a session limit in mind. This could be for a variety of factors. Some people do brief therapy as a modality, so it’s within their approach to have a limited number of sessions. Other times, this is more related to the insurance you have or the agency that you are going through. They may approve a given number of sessions and then require re-evaluation or appealing to get more. It is also possible that therapy is being conducted through a grant or organization of some type that simply can’t provide open-ended free therapy, so they offer a certain number of sessions for free or at reduced cost. I wouldn’t say that session limits are the most common these days in the USA, but you do still encounter them at times.

I’m really glad that you have had a positive experience with therapy and be sure to tell your friend thanks for suggesting the podcast as an additional resource. I love that. You mentioned that you are looking for a new therapist that you can work with more long-term and that you struggle with opening up to a therapist. My instinct here would be to say that maybe it won’t be the same with the next therapist, as you have had some practice and success now, but you mentioned that this has been the case for at least two therapists, so I can understand why you would be concerned about a pattern here.

I admire that you want to make the most of therapy, but I do want to push back a little bit on you saying that it’s an obvious waste of time for you and the therapist to have a hard time opening up. I suspect that you are being pretty hard on yourself here. If I had to guess, you still had productive sessions and covered some interesting ground throughout therapy, but there were some specific topics that you had in your mind that you wanted to get to all along, but could only open up about toward the end. Totally not a waste of time, but I hear where you are coming from. As a reminder to everyone, the research is mixed on how long it takes to form a strong therapeutic alliance, but we are talking at least 4 sessions on the low end. This is obviously variable from situation to situation, but it takes time.

There are two broad phases to the therapeutic alliance. The first phase is where you are feeling out the therapist and basically becoming comfortable with one another as people. You also start to assess your feelings of trust and how competent you feel they are. In other words, do you like them as a human and do you think they could help you? The second phase is where you start to dive more into actual issues. You have to establish the first part in order to feel safe enough to take the risks that come along with participating more fully with your therapist in the second part. So, I would ask that you go easy on yourself about your previous experiences with therapy and trying to get the ball rolling. At the same time, I understand that you are ready to keep going on your mental health journey without losing too much momentum.

Let’s talk a bit about what you can do to facilitate and maybe speed up the process of being able to be open and honest about the topics that are important to you in therapy. One thing that you didn’t mention in your question that could be a good idea is trying to find a therapist with some sort of presence that you feel represents them well. This could be as simple as their website. In other cases, there are people like me that have some social media presence or content that they put out like books, blogs, or podcasts. I have found in my experience that I am able to accelerate that rapport building phase with patients of mine that find me through the content that I make because they already have a good sense of who I am and what I am all about. In a certain way, I have already earned a degree of their trust and they don’t have to tiptoe around certain topics that they already know I am totally comfortable discussing. This doesn’t necessarily mean that you have to find someone with a big body of work that you can dive deep into. But it is helpful if you can get a sense of who they are and whether they have a personality and approach that resonates with you.

I think your idea about making an important things to know document is a really interesting one. There is probably a certain version of this that could work well. A lot of people joke about making a PowerPoint or something like that to get their therapist up to speed on their life and such, which is a cute idea but potentially not the most useful thing. Most therapists send out some paperwork ahead of time or if not, they will start their treatment with an intake session where they are gathering a lot of information rather than diving straight into the more therapeutic stuff. From the therapist’s perspective, I find a lot of value in getting information verbally through a conversation rather than just reading it. However, having some background information as a jumping-off point is also super helpful. The risk that I would run in getting a lengthy document from a client with all of the need-to-know information is that I would probably have a hard time internalizing it in the way that I might in a more collaborative conversation where the information is presented.

That said… it’s f**king hard to remember every single thing about every single client. So if there is information that you feel is important to who you are and your situation, such as approximate dates of significant traumas in your life, names of relevant figures in your story like family members, etc that may not be covered during the intake session, I could totally see a document containing that info as helpful. It would likely be something that I reference from time to time so that I don’t have to ask clarifying questions.

When it comes to topics to discuss in therapy and things that you would like to dive more deeply into, I think that less is more. Rather than spelling it all out and providing a lot of your own interpretations to your therapist, you might simply have some big topics that you would love to get to at some point in a simple bullet point format. For example, I could picture a scenario where you come into the first session and explain that you have characteristically had a hard time opening up about certain things until quite late into the therapeutic relationship, so you wanted them to know some of the topics that might be on the horizon and then you hand them a piece of paper. You can explain that you don’t need to get into those right now, but you would like to at some point and this is your way of staying accountable to that. That would be really useful. I’ve mentioned before, but simply telling your therapist honestly what it is that you have tended to struggle with in therapy, whether that is lying or avoiding topics can serve as a great feedback mechanism to help the problem work itself out.

Another great thing that you could do in early sessions with a new therapist if they don’t already ask you about it is to talk about your previous experiences in therapy. You could talk about the course of it, what you focused on, what you would have liked to get to more of, what worked for you, and anything that didn’t seem to work well for you. The last piece of advice that I have about this is to simply ask the therapist. You could let them know that you have had a hard time getting in the groove and approaching important topics in therapy in the past and ask them if it would be helpful for you to provide a list of things they should know about you. Never be afraid to be honest about your experience outside and inside the therapy room with your therapist. It only serves to move things forward more effectively.

So great job continuing your journey. I think this next course of therapy is going to be really important for you. Don’t forget that it won’t always be easy and happy. When you open up boxes that you have been avoiding, there is sometimes pain or other reactions that come with that. That’s part of the process. The reason you want to take some time to allow a therapeutic alliance to form is so that you can trust in the person on the other side of the room (or screen) to stick around and work THROUGH these things with you.

You got this!