5 Things that therapists wished their patients knew before coming to therapy

Here's what you need to know to make the most out of getting counseling

5 Things that therapists wished their patients knew before coming to therapy

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People ask me time and again what they should expect in therapy. “Will the therapist have a leather couch that I have to lie on?” “Will they give me sage advice that will change my life?” “Will they tell me that it is all my husband’s fault and I am free of all blame?” In view of questions like these, I thought it would be helpful to address five things that therapists would love for their patients to know before they decide to begin therapy.  

1. It is not my job to fix you


So often patients come into the room, tell the therapist what is bothering them, and then sit there stunned when the therapist says that it is not their job to fix the patient. The therapist is there to help guide the patient during this self-transformation and offer support throughout the process of therapy.  Coming to a therapist is radically different than going to a physician. We cannot prescribe medication that will take away all your challenges, and sometimes we are unsure of exactly what is going on that is causing the problem. Unfortunately, our culture has become programmed to expect a solution to every problem, and a quick remedy to every pain. The master therapists will tell you that they do not seek to alleviate pain immediately since sometimes there is no remedy. At that point, they try to guide their patients to better learn how to cope with situations which may have no solution.  

2. I don’t give advice


This point flows nicely with the above one. Many times individuals come into therapy and point blank ask what they should do in such-and-such situation. Patients believe that if only the therapist would just tell them what to do, then all would be well! On the contrary, all would be worse. When the patient seeks the therapist’s advice, they ultimately can wish to hide behind the therapist’s decision and thus be able to either blame the therapist for a situation’s failure or use the therapist’s advice as ammunition when their friends and family confront them about a certain behavior. In either case, the situation is lose-lose and can actually start to build co-dependency within therapy, which is counter-productive to the entire enterprise. Therefore, therapy should focus more on helping the patient see their strengths and ultimately their ability to influence their present and future.

3. Therapy will take more than a month


Yes, there are therapists who claim that they can provide you with the skills you need in a month or two months’ time, but such therapy neglects the deeper issues. In fact, research has consistently indicated that such a style of therapy actually can lead to a relapse in symptoms. Thus, you need to ask yourself just what kind of change you would like to see in your life: permanent or temporary. Research has also indicated that therapy really begins to kick in around six months and then again after a year. After that point, therapy’s effects begin to level off. Much of the length of treatment will depend on the severity of the problem combined with a commitment to change.

4. Be willing to be honest with your therapist, but most importantly with yourself   


Therapy becomes useless to patients who are unwilling to be honest with themselves about their situation and honest with the therapist about exactly what is going on in their lives. Unless therapists are able to understand the larger picture, it can be difficult to progress far in the treatment. All therapists, though, understand that it takes time to form a relationship where you feel safe enough to disclose secrets about yourself, but at some point you do need to take a chance and trust the person in front of you. Remember, we are here to help.   

5. Therapy does not really begin until you take personal responsibility


Therapists are not in the business of blaming people. I especially find blaming others counterproductive and harmful to the therapeutic process. Granted, patients need to express their anger about injustices done unto them, but that is different from blaming individuals for all of their ills. Instead, it is better to focus on how the patient has arrived here and what he can do to move toward healing. Once again, though, how patients arrived at the therapist’s doorstep is not all their responsibility (e.g. in cases of abuse), but at one point they need to take responsibility for their future along with how they interact with others in their daily lives. Without taking this step, the patient will struggle to see change.  


One of my mentors and close friends gave me this image of therapy: therapy is like a football game where I am quarterback/cheerleader and the patient is the running back. I will always call a run play and give them the ball, but then I have to get out of the way so that they can cross the goal line. Therapy is a collaborative endeavor. We as therapists lend our expertise of psychology to our patients, but it is our patient’s obligations to decide that they are willing to do whatever is necessary for them to change. Such a style of therapy is healthy and align with authentic human flourishing since it seeks to help the person realize their capacity for self-determination along with providing them a safe place where they can begin to recognize this capacity.   



William McKenna, M.S.

William T. McKenna, M.S. is a Pre-Doctoral Resident in Clinical Psychology at Catholic Charities with the Diocese of Arlington. He recently completed his coursework for his doctorate at the Institute for the Psychological Sciences, now Divine Mercy University. Divine Mercy University offers graduate programs in psychology and counseling, both online and onsite in the greater Washington, DC area. Visit for more information.