The first time I went to therapy, I was a teenager, and I lasted only a few sessions. I don’t remember much about the therapist or even what we talked about, which is probably telling in itself. What I do remember is how strange the whole thing felt. I had no idea what I was supposed to talk about or what was supposed to happen while I was there. Therapy wasn’t something my friends were doing, or at least not something anyone was talking about (especially in a Hispanic culture but thank god for an evolved mother), and I certainly didn’t have any frame of reference for what it was supposed to be like. So I stopped going.
I think about that now when I meet young adults or even folks that are new to therapy. They come into my office with a completely different understanding of therapy than I had when I first went. Many of them have friends, colleagues or family members who are in therapy. They may already know something about anxiety, trauma, attachment or boundaries. Some have an idea of what they want to work on before I ever meet them. Therapy itself isn’t particularly mysterious to them.
Even much later there was still a different feeling around admitting that you went to therapy yourself. When I moved to Nashville about sixteen years ago, I was working at a university and mentioned to a colleague one day that I was leaving for a therapy appointment. I wasn’t making some big disclosure. I was just saying where I was going.
I still remember the way she looked at me.
It wasn’t judgment exactly, and she didn’t say anything inappropriate. It was more that I could immediately tell I had shared something she considered very private or perhaps even strange. I remember being surprised by her reaction. Going to therapy seemed like a fairly normal thing to me. Apparently, it didn’t seem quite as normal to everyone else.
Now people talk about their therapists all the time. They mention something their therapist said at dinner (sometimes I do wonder about what my clients are actually hearing me say, lol). They tell a friend they need to discuss something in therapy. People who have never been in therapy know the language of therapy because they hear it on podcasts and social media and in everyday conversation.
For the most part, I think this is a very good thing. I would much rather have someone feel comfortable saying they see a therapist than feel as though they have disclosed something embarrassing or shameful. But the normalization of therapy has also changed what people expect when they come to see us, and I’ve been thinking about that part more lately.
When I began practicing, clients generally came in because something wasn’t going well. They were anxious or depressed, and many had been through severe trauma. Most weren’t asking for a particular modality. They weren’t interviewing me about whether I practiced EMDR or IFS or somatic therapy. They were looking for a therapist and, to a large extent, trusting that the therapist would know what to do. That is very different now.
Clients are much more informed now. They read therapist websites carefully, and ask about trainings and certifications. They may specifically seek out EMDR or SE because they’ve already read about it (even if we end up deciding later that that modality is not a fit). They are more likely to ask what we’re doing and why I think it might help.
I actually like that. I don’t think therapy needs to be mysterious in order to be meaningful, and I don’t think the therapist needs to be the unquestioned expert in the room. In fact, I really avoid being the expert, as weird as that might sound. In fact, I just told a client this week that “therapists don’t fix people, they help folks find what they have within to heal”. I know things because of my training and experience, but the person sitting across from me knows things about themselves that I don’t. Good therapy has to make room for both.
I also think clients expect more interaction from therapists than they once did. There was a time when the image of a good therapist was someone fairly neutral who revealed very little (a blank slate), listened carefully and offered an occasional interpretation. There are therapists who still work that way, and there are clients who prefer it. But that isn’t what most people who come into my office seem to be looking for and it is isn’t the way I practice.
They want to know me enough to know that I’m there with them. They want a response. They want me to tell them when I notice something. They may want me to challenge them, although perhaps not always at the exact moment I decide to do it. They want warmth and humor and a relationship that feels real while still being very clearly a therapeutic relationship. In fact, I love ending my session with a client who is a fellow story lover, talking about an amazing show or book.
I think expectations about progress have changed too. People are less willing to spend months coming to therapy without having some sense of what they’re working toward. That doesn’t mean every session needs to produce an insight or a strategy, and I would be wary of therapy that feels as though it has to demonstrate its value every fifty minutes. Some sessions are quiet. Some feel incredibly productive while you’re in them and turn out not to be nearly as important as the session that seemed to go nowhere. Therapy doesn’t move in a straight line.
But I do think clients are entitled to understand what we are doing together. If someone has been seeing me for months and has no idea what we’re working on or whether anything is changing, that’s worth talking about.
Virtual therapy has changed expectations as well, probably permanently. Before the pandemic, I was skeptical about it. I assumed too much would be lost if the therapist and client weren’t physically in the same room. Then, like most therapists, I had to start doing it, and I was surprised by how well it could work. There are still things I prefer about being together in person, but I no longer see virtual therapy as simply a substitute for the real thing. For many people it has made therapy possible in a way that it wasn’t before, particularly when work, parenting, transportation or geography would otherwise make a weekly appointment difficult.
There are parts of the current therapy culture that give me pause. Psychological language is everywhere now, and not all of it is used particularly carefully. Ordinary conflict can become “toxicity.” Discomfort can become “feeling unsafe.” A difficult person becomes a narcissist. There are times when those descriptions are accurate, of course, but there are also times when we’re using clinical language to describe experiences that are painful, frustrating or complicated because relationships are painful, frustrating and complicated.
That creates a different job for therapists than the one we had when clients arrived knowing almost nothing about psychology. Sometimes we’re introducing a new way of understanding an experience. Other times we’re helping someone sort through all the explanations they’ve already collected and figure out which of them actually fit.
I don’t know that therapy was better when fewer people understood it. I don’t think it was. There was too much shame around getting help, too much mystery, and in some cases, too much authority given to therapists simply because they were therapists.
But I also don’t think every change in therapy culture has necessarily made therapy better. Greater openness has brought greater expectations, and greater access to psychological information has brought a lot of misinformation along with it.
Still, when I think back to being a teenager and walking into a therapist’s office without any idea of what I was doing there, and then to being a grown woman who still got a strange look for mentioning a therapy appointment, I realize how much has changed in a relatively short period of time. If I told that same colleague today that I had to leave for therapy, she might not even look up.