What do therapists wish their clients knew about the therapy process?

by Nick Wignall, PhD
author of Find Your Therapy

Unfortunately there are a lot of misconceptions about therapy—what it is, how it works, what the goals are, etc. Below I list a handful of ideas that I wish people knew when it comes to therapy.

Therapy is hard work.

Changing our lives for the better in a meaningful way usually takes a lot of work. And only rarely is that work glamorous, exciting, or pretty. In fact, much of it is nose-to-the-grindstone, sweat-it-out, hard work. If you’ve ever tried to learn to play a musical instrument or lose 20 pounds, you can relate. How much of that process was fun and exciting? Five, maybe ten percent? The rest was probably just a lot of hard work.

I don’t think therapy is all that different. While therapy can be relieving, comforting, and calming to a certain extent, a productive and beneficial outcome in therapy requires a good deal of discomfort and frustration. A good therapist will always be challenging clients to work hard in addition to being supportive and comforting.

Therapy can be expensive. But not always.

Therapy is fundamentally expensive. The actual value of an hour of therapy is about $75 on the low end, easily getting close to $150 on average, with a ceiling that I’ve seen exceed $400.

Of course, most people don’t pay the entire cost of therapy themselves—although more people than you’d probably imagine do. Most of the time, a good-sized portion of the cost of therapy is covered by insurance, in which case the client may end up paying a relatively low percentage of the cost of each session, say 20%, or even just a flat co-pay of $20 or $25 per session.

Additionally, many therapists offer a sliding scale fee structure where the cost of therapy depends on how able the client is to pay, while some therapists provide explicitly low-fee and sometimes even completely pro-bono services.

A therapist is more coach than doctor.

One of the reasons people are disappointed by therapy or stop going early on is because their expectations are unrealistic as to how change occurs. Increasingly, we are able to outsource many difficult activities or problems in our lives: taxes, heart surgery, cooking dinner, even brushing our teeth can in many respects be accomplished by someone (or something) else.

Because many healthcare changes are like this, we assume therapy will be too. When we have a cold or an infection, we go to the doctor, they tell us what’s wrong, and they prescribe a pill to fix it. And it feels like therapy should be similar—that is, outsourceable. But it isn’t. Like a personal trainer, a therapist can guide their clients, offer suggestions, and provide motivation, but fundamentally they can’t do any of the work for them.

You can end therapy whenever you want.

A really big looming fear that many clients have is that once they start therapy they are somehow locked-in or committed for some undetermined but probably vast stretch of time. And even if they know technically that they can end therapy, they feel uncomfortable doing so, as if it’s not their place to decide when therapy is over.

At the end of the day, the client is always in the driver’s seat. Ideally the client and their therapist would collaboratively decide when it was time to end therapy, but ultimately that decision is always with the client.

The term ‘therapist’ can mean all sorts of things.

The terms “therapy” and “therapist” are extremely broad. Although most states require that you be licensed in order to practice as a mental health professional, there’s huge variety in terms of what therapy looks like with different types of therapists.

To make things more confusing, the “type of therapist” a person is does not necessarily correspond to the “type of therapy” they do or the way they practice. If you want cognitive behavioral therapy (a specific type of therapy) for depression, any type of therapist may be able to provide it, from psychologists to social workers.

It’s also important to realize that anyone can call themselves a “therapist,” “counselor,” or “psychotherapist.” What someone can’t claim without serious legal repercussions are educational credentials, a license issued by the state they’re practicing in, or formal training.

Therapy is not about advice.

One of the things people expect when they start therapy is that their therapist will immediately start dishing out life-changing, profound, borderline magical advice about how to live their lives better. Sorry, doesn’t happen. There are no silver-bullets in mental health because every person, and by extension their particular struggles, are unique.

But even if there were, giving them in the form of advice would probably not be productive. Simply taking advice often fosters dependence, and a major goal of therapy is to foster independence and self-confidence. Therapists help their clients to achieve their goals themselves. Like a teacher trying to stuff facts into their pupils’ heads, therapists who give advice in therapy often find the endeavor unproductive at best.

Therapy is about growth not comfort.

It’s tempting when you begin therapy to see a reduction in “bad things” (pain, symptoms, frustration, etc.) as the goal. “Once I start therapy, my anxiety will go down.” While this is true in a sense, symptom reduction is always a side effect of the more general task of correcting an underlying cognitive or behavioral dysfunction and establishing healthier habits of thought and behavior. For example, learning to approach rather than avoid uncomfortable situations and changing the way you think about your anxiety are the true positive changes that will result in—among other things—a reduction in your overall levels of anxiety.

The danger in making symptom reduction a goal rather than growth is that you reinforce the idea that your symptom is the problem rather than the problem itself. Deep breathing may temporarily make you feel less anxious, but it’s not going to correct the catastrophic thinking style that lead to panic in the first place.

Good therapists think functionally not morally.

Many clients come into therapy expecting that their therapist is going to tell them what the right thing to do is or give them some sort of secret insight into the way the mind really works (or that their therapist will think they’re a terrible person). Again, sorry to disappoint, but most therapists are actually not that concerned with what is right or wrong. Instead, therapists are trained to look for what works and doesn’t work. A good therapist is unlikely to tell you that continuing to avoid that situation that makes you anxious is wrong, instead, they’ll likely try to help you understand why it is unhelpful and not working for you given your personal values.

In other words, therapists tend to look at things from a functional rather than a moral perspective, and they may encourage you to practice doing the same. Not that there’s anything wrong with looking at things from the standpoint of ethics or morality, it’s just that that’s not the only way to look at things. And if it is the only way you’re able to look at things, that may be part of why you’re stuck.

Therapists get nervous about therapy.

Most clients—especially new clients—are very aware of their own anxiety about therapy. They’re anxious about what the therapist will think of them and their issues, whether therapy will work, whether their problems are “real” or “important enough,” etc. What many clients don’t realize is that therapists get anxious about clients. Will they be frustrated if we don’t make progress quickly enough? Will I be able to connect with this client? Can I actually help this person?

Therapy is an inherently anxiety-inducing activity, at least some of the time. It’s a hard, messy, intensely personal, and generally difficult endeavor. And that means that to some extent a degree of stress, discomfort, and nervousness for both therapist and client is natural. That’s okay.

There are very few truly excellent therapists out there.

For some reason people seem tend to assume that if someone is a healthcare professional they must be good at what they do. As a psychologist, I’m tempted to chalk this up to wish-fulfillment, but regardless of why we do it, the fact is, it’s just not true.

Sure, I can hear you say, not every hospital tech and clerical worker is the Michael Jordan of healthcare, but surely all those doctors and psychologists who spend years in school and have a passion for helping people, they’re all pretty good, right?

The only thing an MD, PhD, or any other set of letters after a therapist’s name means is that they got their MD or PhD. To be sure, educational credentials can be one of many indicators of competence and quality, but it is by no means a guarantee in and of itself.

While this is a difficult thing to quantify precisely, my own experience suggests that there are a lot of mediocre therapists out there, some pretty good ones, and only a few truly excellent ones. And unfortunately, there are also some really bad ones.

I say all this not to be negative, but to encourage people to go into the process of finding a therapist with their eyes as wide open as possible. In my opinion, the majority of therapists out there are okay at best. That means if you leave choosing a therapist up to chance, your odds of getting even a good one are low.

You can find more articles about therapy and finding a therapist at my website: https://findyourtherapy.com

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More info by therapists about therapy:

“We work mostly on the level of individual change. But it is impossible to solve the ills of capitalism, racism, transphobia, or other systemic issues from the consultation room. You can only help patients find their own paths to desire, creativity, activism, or other forms of liberation.”

— Courtney Douds, LCSW


Jessica Tappana, Licensed Clinical Social Worker, wants you to know that counseling really does work: “People get better. You may feel like you are alone or that you’ll never get better. However, the majority of clients I see do get better. Things like anxiety, depression, feeling stuck, relationship troubles, feeling overwhelmed, self-hatred, grief, and even suicidal thoughts can all get better. You can find healing. Counseling can help. Adding structure to your life can help. Learning to think differently can help. I simply want people to know that the depressed teen who never gets better portrayed in movies or the person you’ve seen look miserable for years are not representative of how mental health has to be. It’s okay to reach out and to believe that you can find healing.”