The demand for mental health services like therapy, psychology and psychiatry is at an all-time high, according to recent data from the U.S. Health Resources & Services Administration.
However, the path towards better emotional wellbeing isn't usually as straightforward as "take this pill" or "open wide" — which may be difficult and discouraging for those seeking treatment for the first time or the skeptic who may have tried therapy in the past but with no successful outcome.
So what's the "secret sauce" then to successful therapy? Research suggests the success (or failure) of therapy largely hinges on one thing: the therapeutic alliance — that is, the strength of the relationship between you and your therapist.
"There's a line of research in therapy called common factors, and it's very clear that the quality of the therapeutic alliance is probably the biggest factor in whether a therapy goes well or not," says Dr. William Orme, a psychologist at Houston Methodist. "What makes the therapeutic alliance strong is composed of several factors, one of which is whether the therapist and the client can arrive at mutually agreed upon goals."
Dr. Orme adds: "Are you on the same page? Can the therapist help you understand how the type of therapy and techniques used will relate to the shared goal? If the therapist can help the client understand that shared alignment, then you're off to a good start."
Therapy is a highly individualized experience, and no two treatments look the same. Whether you're new to therapy or have undergone many sessions (successful or not), Dr. Orme shares his tips on how you might approach therapy with fresh eyes and get the most out of your time.
Consider what you want out of therapy
"If someone is new to therapy, it's a good idea to think about what you want to get out of the experience," says Dr. Orme. "It may be able to offer you that — it might not."
"If not, it might be able to offer you something different that's also very helpful," he adds. "That's why collaborating with the therapist is the more important point based on what we know from research."
For example, if a client comes to therapy seeking to rid themselves of social anxiety, Dr. Orme says that most therapists aren't going to focus on eliminating anxiety.
Most therapists are going to see anxiety as just a normal part of life, he says. But what the therapist can offer are ways to change their relationship with anxiety so that it doesn't prevent them being engaged in meaningful things like socializing with others. The client, however, might not understand that.
"The client may insist upon the therapist to get rid of their anxiety, in which case the therapist and client aren't going to be on the same page, so the therapy's not really going to take off," Dr. Orme says. "But if the therapist and the client can collaborate on what they want from therapy and what the therapist can offer that they think can help, then that's a really good goal."
(Related: Coping with Anxiety: How Do You Know if You're Doing It Well?)
It's also OK not to know what you want from therapy but still have a vague sense that something is off in your life, says Dr. Orme.
"A lot of people come to therapy, and they don't really understand what's happening in their lives or why, but an insight like that is not a prerequisite for therapy," he says. "Oftentimes, that's the outcome of therapy, when people start to feel unstuck, see new possibilities in their lives and take action."
Ultimately, Dr. Orme encourages clients to articulate what they want out of the experience and hear what the therapist has to say.
Find a therapist that you 'click' with
Like friendships, it's important you click with your therapist. But unlike clicking with friends, finding a therapist that you can connect with may have less to do with their personality or background and more to do with their capacity for empathy and genuineness, according to Dr. Orme.
"Most people feel like they click with their therapist when the therapist can see them for who they are and can understand the world through their lens," he says. "Even if the therapist views things differently, if the therapist can effectively put themselves in their clients' shoes, then their clients will feel like they now have something to offer them."
When you cultivate that trusting professional relationship, Dr. Orme says that's when new possibilities start to emerge.
Don't be afraid to say what's on your mind
"One of the goals of therapy is to create an environment in which people aren't afraid to open up and share freely what's going on inside them without judgement," says Dr. Orme. "That's a pretty rare thing out in the world, and because of that, people can start to understand what's really going on inside and why."
Even comments such as "I don't see any progress" or "I don't think this is working" can be helpful information. Such admissions may lead patients to address why things aren't moving forward and help them begin to face those obstacles, he adds.
Be patient with broader, deeper goals
All good things must come to an end — even therapy. But how do you know which issues only require a few sessions, while others can take weeks, months or potentially even years to resolve? It's going to depend on your goals and what you're trying to get out of therapy, says Dr. Orme.
"If you have a very defined problem like how to handle a situation with an in-law, a few sessions may be all that you need, whereas persistent problems like anxiety or depression may benefit from 10 or more sessions," he says. "However, if you're goals are broader than that and have to do with deeper paradigms of how you relate with yourself and others or the sense of fulfillment and vitality in your life, those tend to be the longest courses because they have to do with patterns developed over the course of a lifetime."
"It's going to take time to understand how those patterns came into being, become aware of how they're affecting your life, think about the different ways you can shift those behaviors and then take action," he adds.
However, Dr. Orme acknowledges that there are practical limitations that may hinder these types of sessions, including time, effort and budget. Ultimately, he says, it's going to be up to the client and therapist to define what that treatment plan looks like together.
(Related: Do You Know the Signs of Depression?)
Don't dismiss the idea of medication if you need it
"When somebody comes to therapy, the therapist is going to do an initial assessment, and often times that will include a referral to a psychiatrist to consider whether medications can be helpful," says Dr. Orme. "Some clients are not interested in meeting with a psychiatrist, and the therapist isn't going to force that on them, but often a therapist will talk with them about it and potentially consult a psychiatrist just to see if medication could help."
Choosing the right treatment for you can be complicated, since everyone responds to treatments differently. However, research has shown that for many mental health conditions, medication can be helpful, and therapy can be helpful, but the combined effect of those two is the most helpful.
"Medications can give certain clients more emotional bandwidth to do the work in therapy, creating a virtuous cycle where one good leads to another and another," says Dr. Orme.
(Related: 8 Ways to Boost Your Mental Health)
