Starting and pursuing a process of psychotherapy is not an easy endeavour! It takes honesty to admit that you are facing some problems, courage to ask for the support of an unknown person, and time, and money to sustain the process itself. Sometimes, despite all of these things, the client does not get out of therapy what they hoped for.
The outcome of psychotherapy depends on many factors, the therapeutic relationship, the complexity of the problem, the association with personality disorders, the experience and the personality of the therapist, the therapeutic techniques, the resources of the client and many others. Another, sometimes overlooked, factor is the client’s expectation of therapy. This can take many forms, starting with what the therapy can do, what the therapist “should” do, what role the client will play in the process, how long the therapy will last, and how the progression should feel.
If the expectations are not realistic, there is a high risk that the therapy will not be effective, even if the other factors are favourable.
In the following, I will address the main areas in which unrealistic expectations may affect the result of psychotherapy and the questions that You, as a client, might find it beneficial to ask.
How long should therapy last?
The exact length of therapy will depend on a number of factors, including what types of problems you are experiencing, how long the problems have been present, and what type of treatment approach you and your therapist are using. In all cases, however, it is good to keep in mind that therapy does not provide an overnight fix—change takes time! Many clients come with the expectation that they will get better after 4-5 sessions, and when this does not happen, they abandon the therapy and moreover, lose hope that their problem will ever get solved.
An extensive body of research looking at psychotherapy outcomes indicates that, on average, it takes approximately 4 to 5 months of weekly sessions for 50% of patients to experience substantial improvement and up to 50 sessions for 75% of patients to fully recover. Some patients may get better in a shorter amount of time and other patients may take much longer.
Not only is the number of sessions important, but also attending them regularly. In the first 4-6 months, weekly or twice a week is recommended. Therapy is like a new habit to be learned, and we know that the human mind likes consistency and patterns. Without consistency, therapy can still bring some value, but far from achieving the long term-goal of creating a new solid, sustainable, healthy way of living life.
How soon will I start to notice things getting better?
Although it will probably take a little while for you to experience recovery from the problems that led you to seek out treatment, you will likely notice some improvements early on. Many patients will notice some gains in their general sense of well-being after just a few sessions. These early improvements may include increased hope and optimism or the relief that comes from sharing your problems with someone, knowing he or she understands, and that there is a way to overcome them. Although these early gains are a good sign, they do not always signify lasting change. There is more work to be done! It typically takes continued sessions and effort to notice a more enduring reduction in your symptoms and for things to get back to normal in your life (i.e., at work or school, with family and friends).
What if I feel worse?
Change doesn’t always come easily! In therapy you may be asked to face some of your fears and pains. Although you should notice a general progression over time, there may be some ups and downs. Experiencing the downs or setbacks need not always be taken as a sign that therapy is failing. Instead, it may be a sign that you are doing some very difficult work. At the same time, the setbacks should not be all that you experience. When you do notice some setbacks, talk to your therapist and see if together a plan can be developed to get you through them as quickly as possible.
What is expected of me as a client in therapy?
As a client, you are expected to take an active part in this process, not just to assist to it. You are doing the therapy, and therapy is not something being done to you. If you do not contribute to this process, there may still be some changes, but minimal.
Maintaining regular attendance, preferably weekly, is another key to a successful endpoint. Many insights happen in between the sessions, and, if the interval between the sessions is too long, you may lose the opportunity to process them with your therapist at the appropriate time.
This is especially true for the Cognitive Behavioural Therapy (CBT) approach. In CBT, we discuss what is going on in your life right now, what the problems are in real time, and what you implement from what we discuss in therapy in real-life scenarios. If we process the events weeks after they occur, we may miss relevant information, and the result is altered.
Being open and providing regular feedback to your therapist about what works or does not work for you in therapy is essential during the therapeutic process. Your relationship with your therapist is not only professional, but also interpersonal. What happens in the client-therapist interaction often reflects real-life client dynamics, and, if providing feedback in real life is not something comfortable for the client, it will likely be the same in the therapist’s office. Remember that the therapist needs your feedback to be able to help you and will be grateful for it.
What shall I expect/ not expect from my therapist?
You can expect your therapist to listen to you in a non-judgemental way, to try to understand the world through your eyes, to be empathic and supportive, but also to confront you when needed.
The therapist is not a magician that can change your life or the people in your world. The therapist is not expected to give you advice, solve problems or take decisions for you. The therapist guides you in the exploration of your experiences, thoughts and feelings and can assist you in the journey of finding solutions. You can expect your therapist to see you as the expert in your own life and, above all, as a valuable human being, worthy of love and respect.
The facts provided in this article are based on empirical research and refer to averages for patients of all types. Your individual pattern of change may differ somewhat from what is described here. You are encouraged to discuss your own changed expectations with your therapist as well as any differences that you notice in your own pattern of change as therapy progresses.
In conclusion, having realistic expectations is pivotal in achieving a successful outcome in therapy, but also in avoiding the frustration and confusion that come from investing time and money in a process that does not bring what you had hoped for.