Get Off the Couch and Into Your Life: 6 Ingredients of Successful Therapy

For nearly 21 years, I have provided therapy for many individuals and couples presenting with a wide range of concerns and varying degrees of motivation. My hope is for each individual or couple to successfully achieve the changes they desire. Some come in without previous therapy experience and have no idea what to expect, while others have been to several therapists with moderate success. What are the common qualities in clients who report positive results from therapy? In this blog, I reveal the 6 ingredients of successful therapy. Incorporating some or all of these can help you get off the couch and into your life.

1. Be specific and realistic about what you want to change

A question I often ask at the first appointment is, “why did you decide to come to therapy now and what do you want to work on?”  The more specific and clear you can be, the more it will help the therapist begin to understand what path to take to assist you. An example of a specific goal might be, “I want to feel more comfortable communicating to my partner about my sexual needs, ” or, “I want to figure out why I can’t maintain an erection”. If you don’t know where to begin, or if you have trouble narrowing down your goals, your therapist can assist by asking you some specific questions.  Imagine looking into a crystal ball and seeing a positive future. Or, a magic wand is waved and the changes you’ve desired appear; what would your life be like? What would it look like if you were functioning more productively (e.g. I would be watching less porn; I would be feeling more confident)? If you are in a relationship, how would your relationship be better (e.g. argue less frequently with my partner; more sexual and emotional intimacy with my partner)? Imagine giving your therapist the pieces of the puzzle to your life. If your therapist helped you to put the pieces together, what picture would you want to see?

2. Be honest about your motivation to change

This is where “the rubber meets the road” as the proverbial saying goes. Motivation is what separates those who reported a positive therapy experience and accomplished most or all of their goals, versus those who dropped out prematurely, or reported that therapy didn’t help them. Was this your choice to come to therapy because you wanted to take some responsibility for making better decisions in your life? Or, were you urged (or maybe given an ultimatum) to attend by a partner or loved one? Are you tired of the vicious cycle of behaviors and ready to exert the energy to make some lasting changes in your life? Or, are you going through the motions to check the box to say you went? Being truly motivated means you are ready to do the hard work. It means that when things start to get tough in therapy, you hang in there instead of coming up with excuses why you’re not able to attend your appointment. Or, when you receive feedback that is hard to hear, you take time to reflect on it, ask questions for clarification, and process your feelings with your therapist. Being motivated may mean a higher level of patience and understanding that the change process is not automatic or immediate. It means you are diligent about practicing what you have learned between sessions instead of being “too busy to get to it” during the week. It also entails continued commitment to maintain the changes after treatment is terminated. It is important to note that change is not easy and can invoke fear, which may affect your overall motivation. Try bringing up any concerns or fears with your therapist, who can help you process these feelings and address any potential barriers to your treatment.

3. Do your homework between appointments and prepare for each session

Practice and preparation are key components to your therapy success. Just as you prepare for an important project or presentation for work, an exam in school, or other important event in your life, investing your time and energy into therapy can result in positive behaviors, emotions, and perspective. You can start by reflecting about your week. How was your mood? Pay attention to your thoughts and feelings throughout the week and what might have contributed to positive or negative emotions. Did you engage in any negative behaviors or negative thinking? Were you successful at practicing any new behaviors? To get the most out of therapy, understand that it does not end after your 50 minutes are up; being mindful throughout the week about what you’ve learned from each appointment is essential. During each session, it might be helpful to take some notes about the main themes. This will help you keep these themes in mind during the week when you can further reflect on them. Between sessions, notice areas in your life you’d like to explore. I suggest keeping a “therapy log” (via a ruled notebook, cool blank book that you’ve been looking for an excuse to buy, or app on your electronic device of choice). Take note of your mood, thoughts, feelings, and important events during the week to bring up at your next appointment. I’m not suggesting that you have to write a book (unless you want to), but a few words or sentences enough to recall content, themes, and processes will be extremely helpful…and don’t forget to bring your therapy log to each appointment.

4. Keep your appointments and attend regularly

Research suggests that session frequency appears to affect both the amount of recovery and the speed of recovery in psychological treatment. Clients attending weekly sessions demonstrated more clinically significant gains and tended to recover more quickly. In addition, weekly sessions can build and maintain momentum, which assists with motivation and continuity. It also allows for a thorough assessment of the history of the presenting issue, the development of the therapeutic (client and therapist) relationship, and the integration of details from the previous session. Waiting more than a week in between each appointment can result in having to spend the next session “catching up” and less time to directly address the reason you came into therapy in the first place. In addition, the greater amount of time in between appointments, the less likely you are to recall details or processes to share with your therapist. Remember, when things get more intense or tough in therapy, it is critical to resist the urge to avoid your appointments or not complete homework. It is during these periods that it is even more crucial for you to attend your appointments and when you will benefit the most from them. This is because there may be underlying issues you are not aware of and because you may be discouraged by negative emotions. Attending your appointments will allow your therapist the opportunity to help you process these issues, manage the intense emotions, intervene to prevent a crisis, and reinforce the benefits of therapy.

5. Understand that therapy is an investment

…In yourself, which may be one of the most important investments you make in your life. Keep in mind that, unlike swallowing a pill or flipping a light switch, therapy is a process and may not always render immediate results.  Several factors contribute to when you might see results (repeat 1-4 above), and a lot depends on what you do during session, in between appointments, and after you terminate treatment. I sometimes hear from clients especially early on in therapy, “I thought I was supposed to feel better in therapy, so how come I feel worse?” This is typically because you are directly addressing your concerns, talking about feelings that have been buried or that you were never aware of, and gaining insight into the areas of your life that are painful or you were avoiding. While we may consciously desire change, we often feel uncomfortable when it actually starts to happen because it is unfamiliar. Depending on how long you’ve had the problem, and how ingrained it is, the process will require a higher level of effort and persistence. Engaging fully means investing time, energy, and yes, money. Consider how much time, energy, and money you’ve already spent on your problematic sexual behaviors, substance use, or other unhealthy behaviors. What does it mean when you are hesitant to invest the necessary time, energy, money into therapy to change those problematic behaviors? Application of tools learned in therapy by practicing is critical to obtaining and sustaining the growth you desire. It is also not unusual that positive feelings take a little longer to catch up to changes in behavior. So, early on in the process, being diligent about practicing the new thoughts and behaviors even though you may experience uncomfortable feelings is essential. You should also understand that any discomfort is possibly related to the new behavior and is actually a sign of change. You must trust the process and be diligent about practicing the new thoughts and behaviors. Soon, the positive emotions will catch up and align with your behaviors. After a while, the new behaviors will become more automatic and feel as comfortable and familiar as when you resume riding a bike.

6. Take responsibility for your success

An important thing to remember is that your therapist will challenge, encourage, and teach you new cognitive and behavioral skills, but YOU need to hold yourself accountable for doing the work, in and outside of the therapy session. Your progress in therapy can be maximized when you take what you’ve learned and apply it to the rest of your week. For example, your therapist may give homework each week and there is an expectation for you to finish it. If you don’t, you may not be able to move on to the next step. Therapy is one of those, “you get out of it what you put into it” activities. If you are inconsistent, unmotivated, or reluctant to make the necessary changes, don’t be shocked if therapy doesn’t feel productive. After all, your therapist is only part of the equation, which will not equal success without your commitment. Many individuals may have tried to change on their own prior to coming to therapy. That process can be lonely and challenging without the support and knowledge of a professional. Therapy is an opportunity to work with an objective and trained clinician whose primary objective is your best interest. A key ingredient is allowing your therapist to help you by helping yourself. Together, you can work on paving a path to a healthier and more fulfilling life.