I’ll go ahead and admit up front that today’s post involves recycling some content from my website.  There, I said it.  Hopefully you’re not judging me right now.

The truth is, I’m in the process of restructuring my site, and I’m loathe to part with portions that I worked so hard on just a few months ago.  My “therapy topics” page was one such page.

But, as I was preparing to take it off of the site, I realized that there was a blog post in there somewhere that could be useful.  Many folks want to know what people talk about in therapy.  This is especially true of folks who haven’t been in therapy before, though many avid therapy-goers are also curious to know how other people spend their hour.

Obviously, confidentiality precludes me from answering this question with any serious specificity, but I think people should know about the breadth of topics and all manner of process that a single hour can hold.  Therapy hours are neat in how flexible they are.

When I’m sitting with someone new in therapy and we’ve concluded the history-taking portion of the session, there is always the time when I set aside my yellow legal pad, and we look for a way to begin the work that’s been outlined for us.  There are a few ways this can happen.

The strangeness of getting started

I sometimes get a look from the person sitting across from me, like we’re on stage and they’re like, “What’s my line?”  Sometimes, after going over so much detailed history, it can feel a bit disorienting and also confusing to come back to the pressing question of, “So, what do I do with all of this?  How can I make it better?”  Other times, people are unsure about how to start a long conversation about their life.

This is normal.  After all, where else do you get to practice that sort of intimacy?  Social niceties generally preclude you from talking exclusively about yourself and the minutiae of your life for an hour without pause.  (And, if I’m wrong about this, you have friends for therapists, or perhaps some very unique and giving friends, or perhaps some very frustrated and alienated friends.)

Think about it:  therapy is a strange enterprise.  It happens in private, so you don’t really know what’s expected of you until you show up.  And, different therapists work in different ways.  Most TV shows and movies make it the butt of a million jokes and layer all kinds of  interesting misconceptions and myths on top of one another.

Many people are unsettled by the “rules” and process of therapy: the strange rhythm of the hour that always starts and ends on time, 60 minutes that are paid for every week, and the mysteriousness of the therapist who is neither friend nor family member nor boss nor coach yet asks after deeply intimate aspects of your life, who doesn’t expect inquiries after their health or holidays and who may or may not answer personal questions.

And, some people simply don’t know how to climb into an hour that is all about them.

So, it’s no wonder so many people get that deer in headlights look when the first session begins.

Plenty of times, though, people plunge right in.  They’ve been immersed with their struggles for so long, they just want to let someone else shoulder the burden for a bit.  They just want someone to know, really know, what it has been like for the past few weeks, months, years.  They’re full of words and feelings that need to be held and heard.

Perhaps you’ve been in treatment before and you know first-hand what therapy is like.  But the neat thing is that even seasoned therapy-goers still have no idea what someone else’s therapy looks like.  They only have a sense of their own work, and how it may evolve or change in the hands of different therapists, or in different phases of life as new challenges and problems are introduced into the hour.

Going it alone, going together

Since the work of therapy is inherently a private enterprise, most people don’t have the opportunity to bounce their struggles and feelings off of multiple people.  Many times people feel embarrassed or ashamed of what they are going through, or they manage their image closely, or they have few friends with whom they can talk honestly and openly, and so they keep their struggles to themselves.  This gives them a sense of control over something very personal, and I certainly understand that inclination.  But, it also robs them of the opportunity to seek counsel and support in others.

One of the most healing and powerful experiences for some of my clients comes from the understanding of universality, that is, the sense that what they are experiencing is, in some ways, common to many, many people.

“You mean I’m not the only one that feels this way/struggles with this/ worries about that?”

These days, I am stumbling across a sense of alienation and aloneness in the therapy room that can feel quite staggering.  So, I like to remind people that they are part of the human tribe, even if that connection feels remote.  I truly love bearing this message because it feels good to let people know that they are, at core, really okay.  And that they’re not alone.  That fact, by itself, can be deeply healing.

The corollary to this whole universality thing is the idea that we are all unique and that the same theme, struggle, or feeling can be experienced quite differently by each of us.  And, that’s the quandary of therapy—to listen to people discuss universal, human concerns, and then, for one hour, to climb into that one particular person’s experience of that concern and to feel that deeply with them.

Sometimes people need to hear they are a part of something bigger, that there are phases and tides to life that have a rhythm to them, even if that rhythm feels painful or seems meaningless.  And other times, people need know that their life, as it is, has never happened before and never will again—and what will they do with all of that possibility?  And, how must it feel for them, to be in that life, in that body, experiencing those things in that moment?

I am constantly fiddling with the zoom function in the therapy room, trying to find the proper lens for each client in each moment, so that I may see them as they are asking to be seen.

Therapy for all

I’m out to explode the myth that therapy is just for folks with a diagnosable mental illness, or “people with problems” or this or that.  Therapy is for you and me.  And, just as there are some common topics, struggles of life that we all deal with—being born, dying, and all the things that come in between those two bookends—we none of us experience the same thing.

So, I may be sitting with two people who both say they are depressed, but that looks different.  It feels different in the room, even as those people’s lives may be hallmarked by similar features or symptoms.

Having said all that, I’m going to fly in the face of my previous message and try to condense all the amazing diversity of therapy clients and identify some of the common themes or problems that bring folks into therapy.  I hope you’ll read this knowing that one size does not fit all, and that there are numerous things not included on this list.  This is just a short list of topics that people commonly bring into my practice.  Without further ado…

What people want help with

Here are just a few examples of topics and tasks we might explore together in therapy.

Burn out

Overextended in your commitments and underwhelmed by what you’re (not) getting out of it all…

You’ve given everything you have and then some—to a job, a relationship, a family, or a way of life.  Now, you have nothing left to give to anyone—including yourself.  If it’s been a while since you felt the spark of life in you, you may be suffering from burnout.  Therapy can help you escape burn out and help immunize you against future episodes by teaching you how to protect and care for yourself in an increasingly demanding world.

Trauma recovery

Old wounds that need healing, or something fresh that you need help with…

I help people heal from all types of trauma. I  also work with developmental trauma by helping you discuss and dismantle toxic messages and experiences from your childhood. People often take these messages in while growing up in their family and culture. These messages can have a profoundly negative impact on how you view yourself and the world.  Many times, people who have suffered this type of trauma don’t even know what to call it.

Relationship troubles

Commitments and breakups; negotiating boundaries; learning how to have a relationship with yourself before inviting others in…

Everyone has been hurt in a relationship. For those of us who have been badly wounded, the risks can seem to outweigh the benefits.  Closeness with another can feel like a crisis, an intolerable vulnerability, or an invitation to disaster. We can work together to see relationships as a pathway to nourishing intimacy. I can help you learn to better discern who is worthy of your trust, so you can feel more comfortable opening up and making a commitment to yourself and another.  You can get what you want out of relationships with others.

The big questions

Meaning making and other Big Stuff, grief and loss, life, and personal freedom…

An unexpected loss or crisis in a life can bring up all sorts of profound questions: “Why do bad things happen to good people?” “What is my purpose? Why am I here?” “What is it all for?” These questions can feel overwhelming and bottomless when you are facing them alone– that’s why we sit with them together.  Having a therapist with you as you face down these concerns and questions can be deeply healing.

Self-discovery

Also known as, “Why did I do that… again?”

Everyone has parts of themselves that they don’t understand fully. In therapy, you can learn to better understand your needs and motivations so you can make the best choices to meet your needs. This understanding gives you more freedom in your choices, and it often helps you to incorporate your feelings and experiences into your life story in a way that feels healing and makes sense to you.

The bad bedfellows

Depression, worry, and unease… like unwanted houseguests, one arrives and his friends soon follow…

Sometimes the feeling is tied to an event. Sometimes it is a habit. Sometimes it appears to be a fragment with no discernible cause or anchor.  Together, we might explore the questions “Why is that coming up now? What can do you to feel better in the moment? Is it ok for you to feel better?” We work to create space for the feeling and when you’re ready, we examine what brought it around and how to usher it out to make room for hope and happiness.

Feeling stuck or frozen

Paralyzed in the face of too many choices. Writer’s block. Learning how to get unstuck…

I often work with creative types who need help focusing their potential so they can move forward on a project.  The people I see who struggle with this task often overthink a situation and need to listen to their intuition. Or, sometimes they need some practical help in developing skills to better organize their efforts. Sometimes, they have to learn how to give themselves permission to create in a judging world that commonly prizes production over process.