John's Blog

The Blog of John Gibson, PhD

Second Therapy Session: "What should I talk about?"

Maybe you’ve had your first session. You’ve explained your problem or concern to your therapist, and you felt like he understood you. Moreover, you feel comfortable talking to him, and you’ve decided that therapy is right for you. Things are looking up, and maybe, just maybe, you are starting to feel better already.

But when the next session rolls around and you think, “Now what? What do I talk about?”

Here are some ideas to stimulate your thinking.

  • When you reflect on the week, what were the key events, problematic areas, or stresses?
  • What thoughts came to you since we last me? Did our prior session prompt any new reflections?
  • Take a moment and go inside yourself. Let your “mud settle,” as a Taoist might say. What are aware of right now? What do you feel? What’s on the top of your mind? Dive deep into your immediate experience.
  • What is the status of the problem that brought you here? Is it the same? Different? Better? Worse?
  • Did you try anything different? Did you take an actions that might improve your life? What were they? Evaluate them. Think of them as mini-experiments in how to live. What steps might you take?
  • If you took steps but they didn’t work, what got in the way? What blocked your progress?
  • Did your psyche present you with any dreams?
  • Likewise, are you a daydreamer? Where do your daydreams take you? Do you see any themes?
  • What things in your life are you avoiding? Avoidance and anxiety go together like hand and glove. Where are your deepest anxieties?
  • Relationships matter –– a lot. Relationships have the power to hurt us, help us, and heal us. Relationships also provide a context for learning something about ourselves. We discover who we are in relation to other people. How have your relationships influenced you?

These are just some ideas for getting started, for getting more deeply acquainted with your own psychology.

Don’t worry. I promise you, we’ll have something to talk about.

Are "Counseling" and "Therapy" the Same Thing?

Technically speaking, no. But in everyday language these words have become interchangeable.

Consider an example. If you’re looking to make a career change, you can seek out “career counseling” (which I sometimes do, by the way), but no one would mistake this service for psychotherapy. It simply does not have the psychological depth that true psychotherapy does. “Counseling” is a broad term. (An attorney will give you legal “counsel,” for instance.)

Admittedly, the line between “personal” counseling and psychotherapy can be so thin as be appear invisible. Which is probably why these words have come to be used as synonyms for each other. But ideally, therapy should deal with your inner life, your relationships to self, others, and world, and your behavior patterns. “Personal” counseling is concerned with these same processes, though some practitioners shy away from using the counseling label because they think it does not imply the depth that the psychotherapy label does.

Unfortunately, all of this can be a little confusing if you are the person who is trying to get help. Psychotherapy is a pie that’s divided among psychiatrists, psychologists, social workers, and counselors. (There are also pastoral counselors and nurses with graduate degrees in mental health.) These days, most psychiatrists specialize in treating mental disorders with medications, leaving the other occupational groups to duke it out for a piece of the psychotherapy/counseling pie.

Unless you need medication, don’t get too caught up in the title or degree when you’re looking for a mental health practitioner. What you want is the
right practitioner, one who has experience with your type of concern. You also want to feel comfortable with that person. As it turns out, the fit between client and therapist is a bit mysterious. It’s not always clear why one pair clicks and another doesn’t. What we do know, however, is that this bond or connection is crucial to establishing a good working relationship. Indeed, a good relationship is a much stronger predictor of therapeutic success than the title or degree held by the practitioner.

In sum: I don’t care if you call me a psychologist, psychotherapist, therapist, or counselor. Frankly, I am all of these things. What I do care about, however, is whether you and I can establish a productive relationship that is useful to you. The stakes of your emotional life are just too high for it to be otherwise.