How to get the most out of your therapy sessions

Take notes

A lot of traditional psychotherapy is “insight-oriented” meaning, behavior change happens because new insight is gained, but what happens if you forget all the insight you painstakingly uncovered during your therapy session?

One study found that patients immediately forget between 40-80% of information shared by a healthcare provider.

You may be more likely to remember information you yourself uncover, as opposed to information your therapist shares or recommends to you, but the risk of getting fuzzy on the details in the week between appointments is higher than you think. 

At the Pomegranate Institute, we send all of our notes to our patients between sessions, so they have a written record of what was discussed. We find this enhances their recall in between sessions, and it helps make sure we’re on the same page as a treatment team.  

If your therapist isn’t sharing notes with you, you can always ask, concurrent documentation, a style of documentation where the patient and therapist collaborate on the progress note together, is becoming more and more popular. If this isn’t an option, try to carve out the fifteen minutes after your therapy session to write down the three most important things you learned in therapy. You’ll be pleasantly surprised by how much these sentences jog your memory.

Manage a realistic schedule

Maybe you agreed to meet weekly because that seemed like the classic thing to do. It’s what your friends are doing, people on TV are doing, and what your therapist’s other patients are probably doing (you assumed). But if you genuinely don’t have time to give therapy your undivided attention on a weekly basis, don’t meet weekly. We have patients that meet twice a month, or even once a month. The best frequency is the frequency you can sustain. 

The same goes for time of day. You and your therapist need to weigh the risk and benefit of the need for therapy relative to the disruption that it causes to your schedule. If you can’t realistically manage leaving work an hour early, excusing yourself for a long lunch break, getting up early, or adjusting your schedule in another way, don’t do it. You don’t want to wind up in the kind of therapy session where you need a therapy session to debrief about the stress attending your therapy session is causing you!

Pay your invoices

You want your therapy sessions to be about you and the projects that are most important to your mental health. Having to use even a few minutes to have an awkward conversation about unpaid invoices is not going to feel like a productive use of your time. It’s going to leave you and probably your therapist feeling guilty and a little embarrassed, and you don’t want to introduce those dynamics into the relationship if it can be avoided.

If money management isn’t your strong suit, ask if your therapist can set up your account on auto-pay, if they’re using any kind of electronic health record, this will be available with the click of a button. And remember, most therapists include a financial agreement in their consent paperwork in which you promised to make payment at the time services were rendered, and understood services could be terminated if you failed to do this. 

Debrief

We love the old joke about CrossFit being an inverse fight club in the sense that people who do CrossFit NEVER shut up about CrossFit (sorry to anyone that knew us circa 2011-2014). But part of the reason CrossFit is so successful as a system of exercise is that it encourages people to remain connected to their community even when they aren’t actively WODing. So be a little like Sara Sigmundsdóttir or Brooke Ence and TELL people about what you learned in therapy. 

Your brain learns best by repetition, and therapy is just one hour of about 100 waking hours a week. If you’re trying to change your life, you need to reinforce what you learned by repeating it a lot. Talking it over with people you trust is a great way to rehearse the changes you’re trying to make, and your loved ones can help hold you accountable if they see you start to slip.  

Prepare

Try to give yourself a ten-minute buffer before your therapy session starts. Go to the bathroom, grab a snack, take a few deep breaths, read your progress note from last session, review the list of things you wanted to discuss this session, and decide which is the most important to cover, and try to find a few moments of internal stillness.

Try to do something that signals to your brain that you’re switching gears to a different and important time. Whether that’s lighting a candle, dimming the lights, or listening to a specific song, the ritual will help create a climate for optimal learning.

Be honest about what homework you can do

Your therapist is probably going to give you homework, which lately our field has been rebranding as an “action plan”. This might involve reflecting on a certain topic that you’ve started to explore in session, or practicing an exercise, or committing to a particular behavior change. Set yourself up for success by being honest about what you have the time and energy to work on.

If you’re working on your sleep hygiene, and you’re trying to get up earlier in the day, and you have the end goal of getting up at 6 AM every day, but you’re currently getting up at 11 AM, don’t tell your therapist you’re suddenly going to get up at 8 AM every day when you know you’ve been feeling depressed and exhausted lately. Instead, say that you could realistically get up 15 minutes earlier three times in between now and when you see her next. 

This will save you the crummy feeling of having to say, “I didn’t do it” or “I forgot” when your therapist says “So how did it go?” at the start of your next session. A theme we’re repeating a lot here is the importance of small, sustainable changes.

HALT

An acronym we’re borrowing from our comrades in 12 step fellowship is H.A.L.T. which stands for Hungry, Angry, Lonely, Tired. As you’re getting ready to go to therapy, check in, do you need to grab a quick snack, or something to drink? Virtually every therapist I know is going to say they would rather see you eat and drink during therapy rather than be hungry and thirsty to the point of being distracted. 

If you’re feeling sleepy to the point of it negatively impacting your session, are you within the window of time where it’s ok for you to have a boost of caffeine? Will a snack help with this feeling? A couple jumping jacks? Energizing ice pack to the back of the neck? Or is this good feedback moving forward that the 8 AM session you scheduled thinking it would help kickstart your week is just going to be filled with yawns?

Be realistic about what privacy you have access to

Most therapists have encountered the unexpected session being conducted from a bathroom, car, or Starbucks parking lot, and we’re no strangers to kids popping in. This isn’t meant to call out any patients who have run into unforeseen emergencies and had to pivot at the last minute. We get it! We’re fine with it, we’ll make it work and we want to see you!

But we are curious about what the plan is for your regular, scheduled therapy session and whether this plan supports you have access to the kind of privacy you need to talk about the kinds of things you need to talk about in order to get the maximum benefit you deserve.

Be realistic about the relationship

Whether or not you like your therapist matters more than you might think it does. Countless studies have documented that the strength of what we call the “therapeutic alliance” is one of the strongest predictors for good treatment outcomes. Said another way, therapy won’t be as effective if you don’t vibe with your therapist.

If you don’t like your therapist, you should stop seeing them and find a therapist you like better. This is much easier said then done, we know, but we hate to see you waste your time, energy, and financial resources on something that isn’t working well. For tips on how to end a relationship with a therapist check out our article “Break Up With Your Therapist (But Not ‘Cause You’re Bored)” and for help finding a new therapist try “How Do I Find a Therapist”

At the end of the day

Therapy is an investment in yourself, and with a few small adjustments, the time and money you spend can be put to work working a little harder so you can live your best life. If you’re ready to work with a therapist who will work as hard as you, reach out, we’d love to meet you.