Counseling can be very intimidating for people, so in the next few paragraphs we will take a look at what happens in the therapy room.
Okay, so first, there may be a couch, but that is usually to provide seating for multiple people (i.e. your spouse or family) if they come for a group session. Most therapists these days do not expect you to lie down, nor talk about your mother. Counseling in the 21st century usually involves one of two broad approaches. The Rogerian approach is what most people think of when they envision counseling. The thought is that if people are provided with a safe, nonjudgmental environment in which to explore their feelings, they will be able to identify and resolve their own issues. This process takes more or less time depending on how long it takes to create that safety and how directive your therapist is.
The second approach is cognitive behavioral or CBT. CBT is focused on 1) What is going well and not so well in the present, 2) What does the resolution to the problem look like, and 3) What steps need to be taken to get there. While people’s past is important, because it has shaped who they are and how they view the world, the focus is on identifying (and maybe changing) how the past is impacting the person in the present. CBT deals in facts, evidence and rational thought. Many of the things we tell ourselves we must, should or can never do are good life lessons that have morphed into something irrational. To top it off, most people are depleting the energy needed for dealing with stress by not sleeping well, eating poorly and not exercising. In most cases, the first steps are the most basic. People need to start taking care of themselves and making one or two small changes in their attitude.
For example, Tom comes to counseling because he is totally stressed out and feels like he cannot do anything right. Tom’s therapist might ask him what it is he hopes would be different if he were doing *everything* right. She might point out that he seems to be holding himself to an unreasonably high standard, and would he hold his son to that same standard? What would happen if his son failed to meet that standard? Would it impact their relationship? She might also ask him to identify one or two things that he feels he must be good at, and focus on doing those things right. (Once that happens he loses the argument that he cannot do *anything* right). She will probably also ask him to start trying to get at least 7 hours of sleep each night and walking his dog for 20 minutes each night after dinner.
Okay, so you get the idea, Rogerian tends to be more conversational and free flowing, CBT is much more directive, active and problem focused. So why use one over the other? Different people process things in different ways. I am a therapist’s worst nightmare, because I need both. When I am struggling with something, I want my feelings acknowledged, then I can go about the business of problem solving. My husband, on the other hand, just wants to get down to business. He figures the sooner the problem is solved, the sooner he will feel better. Meanwhile, my best friend is one of those people who needs to talk about her feelings and use a therapist (or me) as a sounding board.
But is that all there is? No, after all the talking comes the case notes. You know, the secret stuff doctors write in people’s medical record that they do not think they are supposed to see. Let me be the first to tell you that you have every right to see those. I usually spend the last 10 minutes of the session writing them together with my patient. Why? Because it serves as a good summation of what we talked about, and then there is no mystery. My job is to help people learn why they may be feeling or reacting in a certain way, provide them the tools to better understand themselves and help them fix negative reactions/behaviors. It is not magic. Just like a mechanic can hear an engine hum and tell you volumes, so can a therapist hear what you are saying. I could learn to be a mechanic, but I don’t really want to. You could learn to be a therapist, but let’s start with listening to yourself first.