As a Therapist, These Are the 5 Things I Wish I'd Known Earlier About Therapy

Over the course of my lifetime, I have logged thousands of hours as a therapy client. I’ve received therapy over telehealth, in a residential treatment center, in a psych ward, on a couch.

I’ve participated in the full alphabet soup of therapy modalities, from dialectical behavioral therapy (DBT) to cognitive-behavioral therapy (CBT) to ketamine-assisted psychotherapy (KAP). I’ve done it alone, in groups, and as “family” therapy with my dad after my mom died.

Even before becoming a therapist, I read everything I could about therapy and mental health, hoping that the more I knew about the process, the more I would know about myself. But once I became a therapist, I started learning that—spoiler alert!—there’s no shortcut to actually feeling your feelings.

Some of these things I learned over the course of my own therapy, some in grad school, and some through my work with clients. I hope I can spare you some of the frustration and pain I endured in order to learn these the hard way.

You Don't Have to Be Perfect for Your Therapist

I’m embarrassed to say that it took me far too long to realize this one. I thought that if I told my therapist that I did all the things we talked about, she would be impressed. I would be her favorite client, be The Best Client Who Ever Went to Therapy, and therefore, all of my problems would be solved. (What perfectionism?!)

As someone who sits on the other side of the couch now, I genuinely consider everything “grist for the mill,” as therapist and author Irvin Yalom calls it. That means that, no, you absolutely don’t need to be the perfect therapy client, but if you’re feeling like you need to be, there’s something to that.

A client of mine, a very bright human and a high achiever, recently wanted to skip a session because she hadn’t done her therapy homework, and I encouraged her to come and let me gently unpack with her why she hadn’t done it.

Frankly, I didn’t care at all that she didn’t do the homework; it was valuable for both of us to look at possible reasons she hadn’t, as well as the discomfort around showing up to therapy “imperfectly.” My hunch was that this wasn’t the only place this theme was showing up in her life. Unpacking that was just as helpful—if not more so!—than whatever activity I’d asked her to try.

“Intellectualizing” Doesn't Mean You're Just Really Smart (Sorry!)

I’ve been writing about mental health and reading studies for fun since long before I became a therapist. 

Part of this is a natural curiosity and a desire to better understand myself; impressing my therapist with how smart I am is perhaps another part of it. When a PhD-from-an-Ivy-League-school previous therapist of mine told me I was intellectualizing my feelings, I preened, feeling proud that she thought I was smart. 

It wasn’t until grad school that I learned that “intellectualization” is actually a defense mechanism, just like denial. That is, all trying to “outsmart” my therapist—as one of my besties called it—did was move me farther away from my emotions. Intellectualizing keeps you in your head, not your heart.

The annoying truth is that emotions are actually far simpler than we give them credit for. Not only that but when you give yourself permission to just experience an emotion, it also passes much faster than if you spend time trying to outsmart it. 

They're Not Judging You

As a client, I lived in fear for so long of my therapist judging me the way I judged myself. I feared telling therapists about things I felt that sounded petty or immature. I was so used to invalidating my own feelings and having my feelings invalidated by others that I couldn’t even fathom a world in which my emotions wouldn’t be shot down.

Because of this, I spent my first six years of therapy never saying a word about a relatively small thing that happened to me in high school with a guy, even though it had affected my view of my self-worth as a partner for the next 20 years. I was so ashamed that she’d say, “THAT’S what’s been holding you back?” 

When I told her about the shame and fear of judgment, she asked what I thought she was thinking about me then.

“I don’t know—pathetic?”

“No,” she said. “The only thing I’m thinking right now is that I’m feeling sad that not only did this thing happen that affected you so deeply, but that you’ve had to carry it for so long because you thought it shouldn’t be affecting you.” 

Sometimes They're Talking About the Subconscious

I don’t know if this is a me problem or a therapy problem, but it took me way too long to realize that people—myself included—weren’t always doing things consciously. 

My therapist and I once did a walk-and-talk session. As we neared where we would part ways, my pulse raced, seemingly out of nowhere. “Maybe you’re feeling anxious about us ending?” she posited.

“Um, NO,” I said very indignantly. I was an adult who had been in therapy for years and knew that although our session was coming to an end, she wasn’t abandoning me. That was just how therapy worked; it was 50 minutes, and then it ended.

That is, that’s what I felt on a conscious level. At that time, I was mostly seeing my therapist via telehealth with occasional in-person appointments outside. Being able to spend time with her IRL, only for that time to end, was triggering all of those deeper, unconscious feelings about abandonment.

From the way I’ve heard friends and clients talk about other therapists, I know I’m not alone in this desire for more clarity when something might be happening subconsciously versus consciously. 

I think this lack of explanation actually hurts both clients and therapists. Without my therapist pointing it out to me, for example, I just thought she saw me as really clingy and childish; without me knowing she meant unconsciously, she probably saw me resisting her explanation. 

Sometimes therapists can just straight up be really wrong, but I do think a lack of understanding about what’s subconscious and what’s not can be the cause of many ruptures in therapy.

It's OK to Tell Them You're Mad at Them

And speaking of therapists being wrong, we are only human and will be wrong sometimes. Although I have training and education, that only makes me an expert in psychology. You’re the expert of your own life.

I might have too blindly trusted some therapists. I don’t want to say I saw them as infallible…but I did. I assumed if they said something that hurt or stung, it was something I needed to hear. 

I often tell clients that the therapy room is a microcosm of the “real world,” and the therapeutic relationship is a chance to “practice” uncomfortable conversations before having them in the “real world.”

In my family of origin, my dad often encouraged me to apologize to my mom when we fought—whether I was wrong or not. “It’s easier that way,” he would say, exasperated by watching us fight.

From that, came a deeply internalized belief that I don’t get to tell people when I’m upset with them because I’m always the one in the wrong anyway. 

The first time I learned it was safe to be upset was when my therapist had delivered a truth bomb, and I was pissed. No amount of Botox will ever be able to hide my incredibly expressive face.

“Wow, you look like you really want to tell me to f— off right now,” she said.

“No, I don’t…” I started weakly protesting, once again intellectualizing. “I understand why you were saying that, but…”

“I can see it all over your face, Theodora—you’re pissed at me. And that’s OK. I can take it, and I will still be here and won’t hold it against you.” 

“OK, fine. Yes. I’m really pissed that you just hit so squarely on something I thought I was doing such a good job hiding. I feel so uncomfortable feeling so seen.”

This example was an instance where I was annoyed because she’d exposed an area of mine I hadn’t really wanted her (or anyone!!) to see, but that I knew needed to be seen. 

But there will also be times when a therapist might say something wildly off base. Although a misguided comment hopefully had good intent behind it, the impact is what matters more in therapy. 

Addressing comments like this with your therapist can be more “grist for the mill” too. Their response will hopefully show you a safe way to handle conflict so you can practice it with them, but a therapist reacting poorly to something that upset you can also give you the information you need to end that relationship.