‘I love my therapist’ – but are you getting better?

Let’s say one had a sister who lived in a distant land. Let’s say that sister broke her leg so dramatically the doctors told her it would take eight months to heal. Let’s say it was October.

What that says is such a sister could not possibly make it home for Christmas.

My sister couldn’t possibly make it home for Christmas.

My sister made it home for Christmas.

With blinkered commitment, she focused on an improbable rehab that saw her go from bed-bound to Piarco-bound in fewer than eight weeks. Her daily routine was to test the limits of her tolerance for pain, as directed by a physiotherapist. She had a goal and she had a therapist who helped her stay on track.

This is how we talk about physical therapy. We go to physical therapy with the expectation of getting some physical ailment fixed or at least mitigated. You signed up for it in the first place to fix your leg, neck pain, back injury.

There should be no mystery to the goal of any therapy. To be receiving therapy is to be seeking to have something made better – which generally entails knowing that something isn’t working as well as it should.

When the thing that isn’t working as it should is your mental health, however, somehow the goals of therapy can get a little out of focus.

It’s not uncommon for people in psychotherapy to lose confidence in their therapy in a way that simply wouldn’t make any sense if they were being treated for a physical ailment. If you’re not making any headway with your depression/anxiety/obsessions or whatever ails you, you need to find out why.

Situation the first: Therapist or tell-a-friend?

The worst of all the in-treatment failures. You love your therapist. So caring and understanding. Why, it’s just like talking to a friend. When you leave the office you feel uplifted. When you get home and your down-spiral resumes, you wonder what happened.

Here’s what happened: you have fallen into the habit of treating your therapist like a friend (a friend you pay). You talk. You both talk. You share. You laugh. You have so much in common. This scenario is not uncommon, but it’s not terribly helpful. It’s great that you get on well, but if the conversation does not come back around to what you need help with, you have a problem.

You can try to talk about getting back on track or – and this is going to hurt – you may have to break up and find someone else.

Situation the second: Yes, there are boundaries

There are guidelines governing the patient-therapist relationship, and there is simply good sense. I think any professional acting in your best interest should be aware of when you or they or both of you have crossed a line.

This bleeds into the first situation quite a bit, but is still worth a separate space. To put it plainly, you are there to fix you, not to talk about how much you both enjoy floral arranging.

It’s nice that you can empathise with your therapist’s problems but, I say again, and I say sharply, this is about fixing you.

If you find yourself making plans to go to Panorama together when next there is one, you’re in trouble.

Situation the third: It takes work to make this thing go right

Psychotherapy takes work. And even homework. Do the work. In spite of what you may have seen on sitcoms and other high artforms, it’s not only about talking.

When my sister was rehabbing her leg, there were good days and bad days. She had days she thought she wasn’t getting any better and days she felt like she’d made great progress.

What she never had was a day when she was confused about what she was doing in therapy at all. She wanted her leg to work properly again. When she felt like something wasn’t working for her, she made changes.

All that is to say: it’s important to be clear on what results you’re seeking. You may need to spend some time in psychotherapy simply to clarify the mental health problems you’re experiencing.

Still, you should also expect psychotherapy to have the same objective as any other therapy: to relieve or heal a disorder.

That process can start with setting therapy goals for yourself, in agreement with your therapist. And it continues with working toward those goals, or revising them when it becomes clear they aren’t going to be met.

Remember to talk to your doctor or therapist if you want to know more about what you read here. In many cases, there’s no single solution or diagnosis to a mental health concern. Many people suffer from more than one condition.