The View from This Side of the Couch

Posted on: November 26th, 2019 by Lindsey Rogers, LCPC

“How do you do this job? I’d get so sick of listening to other people’s problems all day.” As a psychotherapist, I have heard this comment numerous times in the 14 years I have been working. Providing counseling is a tough job, sure, but it is interesting and rewarding. We get to be your secret keepers. We get to hear the good stuff: “I am pregnant.” “I am going to propose.” “I just got a promotion.” And we also get to hear the hard stuff: “I am cheating on him.” “I hate her.” “I hate myself.” “Life would be better without me in it.” And as we are guiding, challenging, listening, and supporting our clients, we have the utmost respect for the struggles and challenges that our clients and everyone face. According to the National Alliance on Mental Health (NAMI), 43.3% of American adults received treatment for mental health issues in 2018. Thank goodness there is less and less stigma about therapy these days. Companies are supportive of their workers taking time for therapy. Partners can see couples counseling as an opportunity to work on communication and trust versus the last stop on the way to a divorce. Yet despite all the understanding and positive messaging about the benefits of therapy out there, it still can be a bit confusing. Here are some common questions and answers to help you understand the perspective we have sitting across from you.

“What is a psychotherapist versus a psychologist versus a psychiatrist?”
It can be really confusing with all these titles and letters after our names. At Tobin Counseling Group, we are all considered psychotherapists and none of us prescribe medication. Some of us have master’s degrees in psychology or social work. We may have a LCSW or LCPC or LMFT after our names, which means we are licensed in Illinois as (respectively) a clinical social worker, professional counselor, or a marriage and family therapist. Other psychotherapists here have a doctorate in psychology or a PsyD, which means they are psychologists. A PhD or a PsyD in psychology confers the title of psychologist, which equates to being able to do psychological testing as well as psychotherapy. A psychiatrist is a medical doctor who prescribes medication. A psychiatrist can also provide psychotherapy.

“What are you writing?”
Don’t worry, we aren’t writing down our grocery list or working on the Times’ Saturday crossword over here (plus let’s be real, we’d need more than your session to tackle that). When we sit across from you, especially in the first session, we are writing down notes and your answers to assessment questions. We want to make sure we have a good understanding of your symptoms, history, and goals so we write down things you say or themes or patterns we are hearing. After that initial session, some therapists take notes and some do not. These are our process notes and often include key words to help us remember things you have said or themes we want to come back to later in the session. Some therapists write down names of family members they want to remember or other important things you reference. If we are asking you to do homework assignments, we may also jot this down to make sure to check in with you later.

“Why do I always cry when I sit down on the couch?”
Well, let’s be honest, you don’t always cry. But yes, there is a fair amount of crying that we see happening on our couch. But guess what, the therapy couch is the absolute best place to do it. We are always fully stocked on Kleenex. And here’s the thing: Crying is not a bad thing. We are so programmed to avoid negative emotions—there are few places where it feels safe to cry, especially in front of another person. So crying happens because it is okay to allow yourself to cry and we are often talking about difficult issues, sometimes sad issues. It is also okay to laugh and feel good during therapy. We get to feel the whole range of emotions and that happens during therapy sessions. Which is a good, positive thing, tears included.

“Why does therapy work?”
Therapy is a different way of talking. We are listening in a way that is likely different than what typically happens for you in your everyday life. A lot of times people reference feeling heard in therapy or feeling much lighter after going. There are few interruptions in our room. We are not staring at our devices or distracted by other people when you are speaking. Our main job is to show up for you in a therapeutic way to listen to what you are saying and help you. We are nonjudgmental and are in your lives only in the therapy room. So we are safe. With some exceptions to confidentiality, what happens in the therapy room stays in the therapy room. (There is a reason that was such a good advertising slogan for Vegas!) It feels good to know you can express a thought or feeling and it doesn’t leave our office. Keep in mind, we can’t tell you what to do (this is another question we often get!). But we can challenge your thoughts or help change your behaviors. We try to validate and encourage your emotional expression. We also explore ways to cope better than perhaps the current choices you are making. We are also not “just listening.” We are trained professionals who are using skills and techniques, like cognitive behavioral therapy, to help you.

“Can we be friends?”
Our relationship might feel pretty intimate; as we said before, we get to hear all your deepest secrets and inner thoughts. But therapy—and specifically this therapeutic relationship—works because of boundaries. We are professionals and this is a service we are providing to you that you are paying for. It is different than a personal relationship. We aren’t nor can we be friends with you, but at the same time, we do like you and care about you. We see your strengths and likely have a far more balanced perspective of you and your circumstances than you do of yourself. We cannot be friends with you on social media or connect with you on LinkedIn. We don’t Google you or try to find out more about you and you should do the same with your therapist. Our relationship has to exist in a professional way for therapy to work and feel safe for you and us as your provider. If we see you in public, we will wait for you to acknowledge us first. This is not a harsh social move or a matter of us snubbing you. We simply want to protect your confidentiality; if you wave or say hello to us, we will respond, but it is up to you to make the first move. Chicago is a small world so it is possible we will run into each other, but just as we have agreed to keep your secrets, how we know each other stays between us.

“What do you really think of me?”
We are all clients. Any therapist should have been in therapy during their training or may currently be in therapy. Remember that part above about this being a hard job? We couldn’t help and support you if we did not have support ourselves. So we can relate to and understand you. What we really think of you is that you are a dynamic, interesting person who we are invested in learning about and understanding as deeply as we can. We may get frustrated with you sometimes and we have to be patient. You probably make us laugh sometimes in session as well as cry along with you. We have so much respect for you and your story and we are trying to help you in the ways we know how to help. We want to do right by you.

Whether you are new to therapy or not, it is okay to have questions. It is even more okay to ask your therapist your questions. We will uphold boundaries and yet do our best to give you answers. A good fit matters when it comes to relationships but especially in the therapy office. If you don’t feel like your therapist understands you or your expectations are not being met, talk about it. And know there are a lot of sources of support out there so you don’t need to feel stuck if the relationship with your therapist is not working for you. The biggest question to ask yourself when you go to therapy is if you feel heard and understood. If we are doing that, we can make progress. And with that, we will look forward to seeing you at your next session.

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