5 Ways To Ensure A Productive Therapy Appointment

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I have been in therapy or counselling for more than half of my life. I won’t go into the long and short of it but I know a lot about what happens on the other side of closed doors. I spent most of my years in therapy either being intentionally hard to read or challenging the person in the arm chair across the room from me.

I would either not talk at all, talk about things that didn’t matter like the weather or the birds in my backyard, or display all the wrong emotions. I was once told in a treatment program that they were having trouble gauging how to help me because I displayed opposite affect – in other words I would smile when talking about difficult or upsetting things. I later learned that this is a coping mechanism, my face smiles so that my body and mind don’t experience the depth of the emotion I am trying to avoid. It is a form of dissociation and that is how I survived for years.

I spent years challenging the people who were trying to help me, people who spent hours across from me and only wanted me to figure out my crap so I could actually live my life. I was convinced I was un-helpable and I let them know it. No strategy they tried worked, no theraputic approach, no medication, I would tell those wonderful caring men and women about just how hard it was to be me (most of it anyway, there were a lot of things that I kept closely guarded).

A few years ago I decided that there were things I wanted in this world other than the prestige of being the toughest egg to crack or the impossible puzzle. I started actually showing up in the room with the therapist, sharing what was really going on and allowing them to help me. It took a strange combination of age, realizations about my health and future, health complications, relationship breakdowns, finding the right therapist and pure exhaustion but I got there.

Since making the decision to be an active participant in my therapy appointments I have made leaps and bounds in my recovery from various mental health ailments. I have watched my life turn a complete 180 degree turn, my body heal and my mind sharpen. There are still a few roadblocks on the path to whole healing for me but I am firmly on the path and doing everything I can to heal from my wounds.

I am writing this today because I have an appointment with my therapist tonight and I am preparing for it so that I can get the most out of my time with her and quite honestly my money spent. SO how do you get the most out of an appointment with a therapist? THese are the 5 things that I find really help me feel fulfilled with my appointments, I can walk away to think about our talk but still have a sense of closure.


Instead of just showing up at your appointment to talk about whatever happens to come up, go in with a game plan. When there’s no plan, it’s easy to fall into talking about the weather, the drive, work, your dog, how your mother pissed you off at lunch the other day, leaving only a few minutes left to actually get down to the issues at hand. If you are looking to avoid your issues this is actually an ingenious strategy that I used for WAY too long, everything seemed important so I talked about it and in the last 10 minutes of the appointment I would drop a pretty major bomb about what was really going on. Once we spent 45 minutes talking about my upcoming wedding, all the intricate details and then I told her that I didn’t know if I could get married, marriage required recovery in my mind and I couldn’t guarantee that for my future husband feeling that it wasn’t fair for me to marry him. Obviously I didn’t plan to do this but it appeared to be an unconscious game plan for me to fill the time with crap and then get to the meat and potatoes when there wasn’t enough time to actually talk about the problems I was facing.

Before my appointments I sit down and write a list of what the issues I am facing are. There are no limits here but whatever comes to my mind first goes to the top of the list. Under each item I write a short synopsis of what is on my mind and what my thoughts are, enough to remind me what the heck I’m talking about. It’s incredibly difficult to remember these things or come up with the courage to actually say them once you are sitting in the room with your therapist and I found writing it down helped me stay on track. I take my list with me and read it shortly before I head into my appointment, then stick it in my pocket for reference later if I need it.

We spend enough time on each point until I feel complete with it and we move on! Whatever didn’t get covered I put a star beside and it might make it onto the list for the next appointment.


Recapping the appointment later is very important to the process for me. Instead of letting all the words that were said and thoughts that were sparked drift off into the ether I make note of them so that we can continue to move forward in therapy, not rehashing the same issues because I forgot what she said last time. I go over what was said, what I wish I had said or new thoughts that have been sparked by the conversation. My therapist is a 1 hour drive from my house which I actually really like. I am the type of person that needs to think about things before I can put them into words so the time spent on the drive home helps me to process the conversation and analyze the session.

When I get home, I revisit the list and write notes about the different points, starring anything that didn’t get covered and scratching out things that didn’t really matter. I write a little paragraph of notes about each thing we talked about, going over my thoughts, revelations or further questions. These can either be good for me to revisit later or reference when making my list the next time.

Be Real!

When you walk into a room of your friends I can guarantee that you smile when you get in there even if you have just had the worst day of your life. Walk into school or around the mall and bump into someone you know and you will likely smile, saying “I’m great thanks and you?” even if in truth you are anything but great. We all have a tonne of masks we wear, whether it’s the “daughter” mask, the “mother” mask, the “good student” mask, the “best friend” mask or the “employee of the month” mask.

It’s not that your therapist doesn’t want to see these masks you put on but it’s helpful to the process if you take those masks off at the door so your therapist doesn’t have to fight through them. Every appointment still starts with the pleasantries; how was the drive, how’s the baby, is my husband enjoying his job but it’s limited to only a few minutes before I set the cordial social mask aside and we get down to business. If I kept up the “I’m fine” mask throughout the appointment we would literally get nowhere because she would have to prod and poke through all the “I’m fine” I was projecting in order to get any work done. Again, if you’re being forced to sit in therapy and actually don’t want to get anywhere this is a great strategy! But if that was the case I’m guessing you wouldn’t be reading this ;)

It took a long time for me to learn that I was wearing masks and how to set them aside but it’s important to figure this out. Learn what it feels like physically when you are wearing a mask and what ot feels like when you are just being real. For me, I can tell that I’m wearing a mask of some sort when I feel super fake, I’m all smiles and feel a little bit like I’m floating. My feet don’t really exist and it’s as if I’m literally viewing the world through only my eyes. Sometimes a mask feels like a shield of armour around my body helping to steel me for whatever is coming. Sometimes It’s feigning calm while my son is climbing on the furniture and is about to fall because I know if I shouted out he would get scared and actually fall.

Whatever your masks are and whatever they feel like it’ll take time to recognize them. When you do, it will be easier to set them aside. Think about how you feel, both emotionally and physically, when you are sitting by yourself. Currently I am sitting at my dining room table with music in the background while my son is napping. I am not aware of my breath being either fast or slow, I am not aware of any tightness in my chest or facial muscles, I’m wiggling my toes a bit because I like the way they feel in my soft squishy socks. There is no tension, no shaking, no heart beat that is discernible, my face is lax with neither a smile nor a frown. This is me being real. When I sit by myself and think about the things I want to talk about in my therapy session tonight I feel a weight come over me. I feel tension in my chest and the muscles around my eyes feel tighter somehow. The muscles in my legs and abdomen tense and it’s hard to breathe. It is an incredibly uncomfortable sensation but this is me being real and experiencing what it’s like to be in my shit. Later in my appointment I will try to find this discomfort again. If the movements in my body are more twitching and less fluid or I am fighting the weight of the conversation, if I am trying to feel any different than I am when thinking about the appointment sitting by myself in my dining room I know I am wearing a mask. I can continue to wear that mask or I can try to find this real sensation again, only when you are being real about your emotions can you make progress in overcoming whatever brings you to therapy in the first place.

Tell The Truth!

When talking about uncomfortable things it is our first instinct to lie. Not big outlandish lies but tiny little lies that discount your emotions or problems. Personally I would test my therapists to see how much they could handle of what was really going on in my mind, if I sensed any kind of perceived judgement or really any other reaction coming from them I would back off and know that’s as far as I could go with them. This happened with my eating disorder a lot. I would embellish my food intake for the last few days and see how they reacted. If they were shocked, worried or seemed upset with that I would embellish it more. If they displayed no reaction I would tell them something little closer to the truth next time. I was worried that if they knew what I was really eating, or in my early teenage years how often I was really cutting, they would say I was too broken to see them, suggest that I go to a more intensive treatment program or be put on a closer watch by my friends and family. I most often lied about my weight, saying that it was higher than it really was so I would be allowed to go home and continue to lose more weight. If I was weighed in the office I would take measure to ensure that I weighed more than I actually did and wouldn’t set off any red flags.

Any lies no matter how big or small, either outright or by exclusion will get in the way of your recovery. Lying about my intake, my weight and my self-harming habits kept me out of more therapy and allowed me to continue destroying myself, which might have been what I wanted but it was really undermining the whole process of therapy and recovery. Therapy at that point in my life was basically just so that professionals could keep an eye on me through regular check-ins and make sure nothing went too awry. There was no progress being made and I wasn’t ready to make progress. But once you are ready to make progress towards healing and recovery from whatever brings you to therapy in the first place, telling the whole truth and dealing with the consequences are paramount to the process.

Know What You Want!

What do you want from your therapy appointments? Do you need a friend to talk to, someone to vent to, a professional’s opinion, a sounding board for thoughts and ideas, a cheerleader, a safety net, a person who will justify your feelings, someone who will push you or challenge your beliefs?

Before your appointment revisit what you are looking for in your therapist and what you are looking to get out of this particular appointment. Keep this as your focus or intention for the whole hour. You can even write it on your hand to remind you to stay on target.

So, what do you think ?