A peek inside the mind of a therapist

Behind the scenes of the therapy hour

Morning sunlight streaming into my therapy room in Auckland

Visiting a therapist for the first time can be a daunting experience. It’s a curious situation where you meet a complete stranger and tell them about the most intimate, vulnerable details of your life, the shortcomings and struggles that you spend the rest of your life (and your carefully curated social media feed) trying to hide. To say that it’s exposing is an understatement. To get the most out of the session there is no way around having to dish the dirt on yourself. The truth, the whole truth and nothing but the truth.

Perhaps it helps to know that most therapists have also done their own therapy. We have sat in that uncomfortable seat, squirming and riddled with self-doubt, hoping we will not be seen as too messed up. And I can tell you, there’s an added layer of self-judgement when you’re a therapist, that goes something along the lines of ‘after all this training and knowledge, I really should have my shit together by now’. We fear being judged by our peers. The reality is, we are all a work in progress, the learning is life-long and often we teach best what we most needed to learn ourselves. We did not arrive at this profession by accident.

Your therapist is not looking through the lens of fault, but more likely compassion, shared humanity, and a desire to understand. They will be recognising themselves in the struggles you’re experiencing more times than they may care to admit.

While some people imagine that a therapist’s job is unfathomably tough (‘I don’t know how you cope with listening to so many heartbreaking stories’), others imagine it’s a walk in the park and anyone can do it (‘you just sit and listen to people all day long, right?’). The reality is somewhere in between.

Listening is just one part of the role of course, but even that part is multi-layered.

As you tell your story, your therapist is most likely listening to:

• The words and story itself

• The parts of the story you’re not telling. The so-called elephants in the room.

• Recurring themes and aspects of your story that may link together

• Non-verbals such as when you say something is fine and your foot is tapping away furiously

• What is happening in the room. Therapists emphasise this to varying degrees, but there is a general understanding that what happens in the therapy room is a microcosm of what happens elsewhere in life, in relational situations, and we might learn something about how you show up in the world from how you show up in the room.

• What is happening in the therapist’s own body. We have a tendency to mirror each other and co-regulate our nervous systems, so we can learn about the other person by noticing our own internal experience as we sit with them - such as how much activation (or dissociation) is present in the nervous system.

We’re listening to all these layers in part to offer warmth, acceptance, and validation, as well as to gain understanding and a platform from which to navigate a way forwards. In psychology, this is known as formulation.

I can’t speak for all therapists, but as a psychologist, formulation is central to our work. It aims to conceptualise what set of life circumstances, coping styles, and background factors shaped this particular issue arising, in this way, at this time. In what way does it somehow make sense? Many of the behaviours and traits that are causing us problems once came into being as a way to help us cope with something, as a survival strategy. Possibly at a tender age when we had few other options available. It’s crucial to understand what function and purpose something has served in our lives. If we try to wrestle a behaviour away before we have fully understood this, we are very likely going to be met with internal resistance.

Without a formulation, we would just be blindly throwing a bunch of coping strategies at someone and then wondering why many of them don’t stick. Let’s face it, most of us have read and researched a lot by the time we reach a therapist’s door and if it were as simple as applying a bunch of tools, we’d have done it already. Formulation allows us to go deeper and understand potential roadblocks and reasons why a coping strategy may be unsuccessful for a particular individual, or why they may not yet be ready to let go of a seemingly problematic behaviour. The internal system may have been using it as a crutch, and will likely need some other scaffolding in place before it’s ready for something new.

The formulation sets the scene for where to intervene, why, and how. It generates a map of the terrain for our work together. We’ll return to it throughout the work, particularly when we hit up against inevitable stumbling blocks.

Alongside a formulation, we’re also aiming to build the compassionate container of a therapeutic relationship. We need to establish a sense of safety and trust, to create an environment where defensive walls can be lowered, and new discoveries and transformations can emerge.

Of course, safety is relative, but what helps the therapy room to become a safe place is multi-fold. There are obvious protections such as clear boundaries, consistency, and confidentiality, but more than that, I believe what makes it a safe place is that the therapist’s sole purpose in the interaction is to help you. They are going to endeavour to see things from your point of view, to understand why you think and feel and act the way you do, and to really inhabit your world. It’s rare elsewhere in life that someone will offer that level of empathic understanding and curiosity.

When you hear someone’s deepest vulnerabilities, struggles, and dark nights of the soul, judgement tends to dissolve. It’s hard not to find some loving, compassionate feelings towards them. Your therapist will be firmly rooted on your side, even as they may need to share some confronting truths at times.

Of course, this is only the beginning of the work, but it sets the scene and establishes the unique container for further explorations.

It’s an encounter unlike any other, and I often feel like the most real, raw, and intimate conversations in my week happen within that room.

A lot is going on in a therapy session, even in moments where it may appear not much is happening.

I’d love to hear your thoughts, whether as a therapist yourself, a client, or just a curious onlooker. I’m sure the therapists in the house may have interesting perspectives to add on what is happening in the room for them during the therapy hour. And I’d love to hear observations from the non-therapists’ perspective too. My own experiences come from many years on both sides of the therapy room.

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