A Year in Therapy: A Client and Therapist Reflect Together
Have you ever wondered what goes on in therapy? Leigh Matthews and one of her clients: Micheal*, reflect on his past year in treatment. Leigh is the Founder and Director of Therapy in Barcelona and an Australian Registered Psychologist with almost two decades of experience as a therapist.
Let us start, as we do in therapy, with the client experience. Below you will find the therapist’s reflections.
The Client’s Reflections
Micheal’s Past: Social Anxiety, Depression and Low Self-Worth on the Road to Therapy
I’ve struggled with social anxiety since I was a teenager. Whenever I found myself in a social situation, a shot of adrenaline would race through my stomach like an electric current. My heart rate would increase, my palms would become sweaty and I’d become incredibly rigid—often to the point where I couldn’t speak. I felt socially awkward and experienced myself as a burden on the rest of the group, making me feel depressed. I started to make excuses to avoid socializing, and whenever I did mix, my go-to solution was alcohol, loads of alcohol. For the few hours in which its effects lasted, I’d become talkative and disinhibited. However, the next day I’d be bombarded by flashbacks of the night before and something I’d said or done would cause me even greater anxiety.
On occasions when alcohol wasn’t an option, I made excuses to leave the room—use the bathroom, make an important call, get some fresh air—anything to avoid social interaction and the accompanying anxiety.
When I couldn’t leave the room, I had no choice but to use brute force to push my anxiety down in the depths of my stomach and hold it there like sitting on a giant jack-in-the-box. I’d then do my best to put on a brave face and contribute to the conversation as best I could.
All of these techniques had one thing in common: I employed them to avoid feeling the discomfort of anxiety. After years of practice, I became so adept at avoidance that those around me never suspected I had social anxiety. But it eventually became clear to me that avoidance was not the solution.
I didn’t know at the time that my anxiety stemmed from a lack of self-worth and an endless stream of critical thoughts that played like a radio in my mind 24 hours a day. I call it Critical FM. “You’re not good enough,” it would tell me. “Nobody likes you. You’re not interesting. Why can’t you be more like them? You’re not funny. You’re doing it wrong. You’re so stupid. You’re …”
You get the point.
The lockdown exacerbated my anxiety, and I became very depressed. I found myself tuned in to Critical FM day in and day out. Then I decided to give meditation a try. Initially very sceptical, I was pleasantly surprised to find my general anxiety had reduced within a couple of weeks.
I booked myself in for my first therapy session soon after.
Starting therapy was something I’d wanted to do for a long time and although there is a stigma associated with it, this didn’t bother me. My fear was that my therapist may judge me so my main concern was finding a therapist who would understand me. After my first session, I felt accepted and safe enough to reveal things I had never revealed to anyone before. Doing this in a non-judgemental environment was a relief in itself.
Micheal’s Present: The Therapy Journey and Doing the Work
Starting my therapy journey is one of the best life decisions I’ve ever made and if you’re struggling with mental health I would definitely recommend it. You will learn that you don’t have to struggle alone and the tools you acquire will serve you for the rest of your life.
My therapist helped me identify the unhelpful thoughts and stories my mind was telling me. I remember being shocked to discover just how harsh a critic my mind is. It was also a revelation to find out I didn’t have to pay attention to it anymore.
My therapist taught me some tools to help me in my daily life. In particular, I started to use defusion, which helped me create some distance between me and my thoughts. I also learned a technique called expansion, in which one deals with uncomfortable feelings and emotions by simply sitting with, accepting and making space for them. After years of avoiding and fighting my feelings, this seemed counterintuitive and took a lot of practice.
I’ve been doing therapy for just over a year now, and I’m making good progress. But I still have a long way to go, and my progress has not been linear. I have good days and bad days, but the general trend is positive. My social anxiety is significantly reduced, and I have the tools to address it when it shows up. I am now more authentic with friends, acquaintances and colleagues, who respond with greater openness. I care slightly less about the judgement of others, although this still informs many of my thoughts and actions.
A crucial part of my progress has been taking ownership of my therapy journey. Having a good therapist has been invaluable, but just as important is the work I do outside our sessions and implementing the techniques I discuss with my therapist in the real world. I experiment with them throughout the week and see which ones help me most. Here are a few things I have done on my journey so far:
- Meditation
- Defusion
- Expansion
- Identifying and challenging unhelpful thoughts
- Positive affirmations
- Journaling
- Exposing myself to uncomfortable situations
- Trying to be present and aware during the day
- Reading books and watching self-help videos
- Practising mindful self-compassion
- Spotting when my mind is being harsh
This list is far from exhaustive, nor do I practice all of them consistently. There are days, sometimes weeks when I feel too low to do any of them. But that’s fine. It’s all part of my journey. I try not to be too hard on myself. I always get back on track eventually and thank myself when I do so.
Micheal’s Future: Using the Tools, Making Progress and Opportunities Ahead
I now find myself looking outwards at the range of opportunities that life has to offer. In the coming weeks and months, I intend to identify and connect with my values to have more fulfilling work, private and social life. Finally, I’m ready to do the things that genuinely excite me instead of the things I think others would approve of.
Exposing myself to uncomfortable social situations has undoubtedly been the most challenging part of my journey so far. Still, it’s also been the most fruitful and has given me greater social confidence. So, I intend to continue exposing myself to them despite the urge to turn and bolt in the opposite direction. Yes, there will be times when my mind tells me I’m being judged, and anxiety will rear its head, but I now feel better able to deal with it by using mindfulness or challenging my thoughts.
A year ago, I despaired at the prospect of anxiety determining the course of my life. However, thanks to my year in therapy, the future no longer looks so bleak, and although still, I have a mountain to climb, it doesn’t look so daunting.
The Therapist’s Reflections
How Real Change Happens
How many psychologists does it take to change a light bulb?
One, but the light bulb has to really want to change.
And so it is with therapy: the client has to really want to change. Micheal really wanted to change and his positive therapeutic outcomes are a result of his motivation and hard work. He eloquently underscores this when he notes: A critical part of my progress has been taking ownership of my therapy journey.
I think we therapists are less like light bulb changers and more like Sherpas, guiding you on a treacherous and rewarding trek into your past and emotions, scaling painful beliefs and memories, navigating over and beyond peaks and valleys of yourself you have not tackled before. Part of Michael’s journey required excavating past relationships and experiences that set the stage for his anxiety, depression and low self-worth. Later, he had to climb without the therapist in his daily life, applying the tools taught in session in moments of high anxiety or distress, moments when as Michael says, he would have instead previously bolted.
Doing the Heavy Lifting
You need to come to a place of motivation to create change. When you enter therapy, you take a leap of faith, especially when many people espouse the myths that treatment doesn’t work or you need to be at rock bottom to start therapy. However, for those like Michael who dare, the rewards can be great when you recruit a trained professional. A therapist can accompany you on your journey to greater self-awareness and mastery of strategies to reach your goal: managing anxiety, reducing depression, facing an existential crisis, or moving toward growth or pivoting careers. They’re just a few of the concerns therapists help navigate. In addition, therapists offer insight into those aspects of yourself, your thoughts, behaviour, lifestyle or your life that you may not be aware of. These insights can make all the difference in the velocity of your climb.
I love the words of Kami, the Sherpa with the most climbs on Everest:
“I treat every climb with the same sincerity as the first. Whenever a client is successful, it makes my day.” Indeed, starting treatment in the first place is a journey in its own right, and good therapists honour each client’s bravery with a non-judgmental, authentic presence and desire to understand where the client has come from, how they got here and where they wish to climb to. It is important to know, as Michael has found, the journey is actually ongoing. This doesn’t mean you will continue therapy forever, but self-actualization and growth will be a continuous process in your life, always requiring work and climbing beyond your comfort zones to maintain your coping skills and experience ongoing change.
How a Therapist Helps
Taking from Kami’s wisdom again: “Without a Sherpa, there is no expedition.”
You may be able to create change on your own, as Michael did to a point when he took up meditation, but generally, you’ll get longer-lasting results and the right tools from a therapist. Just talking things over in a confidential and non-judgmental space brings an intense sense of relief to many clients from the first session. Whilst therapy works around deep conversations and may seem like “just talking,” it does require much work and skill on behalf of the therapist. Here is a rough and incomplete list of what a therapist brings to therapy with you which is not always a matter of “doing” but rather a way of “being” with you.
1. Strategies
A trained therapist comes with a toolbox of strategies that can assist you to take action toward achieving a life change or goal or in changing your relationship with uncomfortable thoughts, feelings, behaviours, people or situations. After all, you cannot climb without adequate tools. Michael has outlined some of those we covered in his journey, informed primarily by the cognitive-behavioural and acceptance and commitment therapy schools. However, there are whole worlds of therapeutic tools available, dependent on the theories that guide a therapist in their work and those that seem most appropriate for an individual client. Therapy that offers you tools has great benefits but deep-diving talk therapy has its place with some clients. Regardless, a therapy tailored to fit your needs and concerns will be more likely to help you in the long term.
2. Accountability
Well, you could get tools from a self-help book, no!? Yes, but unlike a self-help book, a therapist helps you develop plans to reach your goals and commits to following up and offering support as you take action to get to them. After every week’s “climb” testing new strategies that you have learned in therapy, you will debrief with your therapist. The therapist will celebrate your wins and help you regroup when things don’t go to plan, and you are at risk of being derailed. Michael is so right when he stresses that progress is not linear. Instead, therapists help you recover your motivation and teach you an attitude of grace and compassion in response to inevitable setbacks. You eventually learn to internalize this growth mindset, accepting mistakes as part of learning and leaning into self-compassion when you go off track. Remember, not all therapies are so focused on strategies but rather on exploring your past and how it informs your current issues. Nonetheless, your therapist will still be there for accountability, supporting you to show up for sessions, face up to new insights and expose challenging and uncomfortable patterns in the service of creating new ways of being.
3. Unconditional Positive Regard
Unhelpful messages from family, media, school, peers and society in general about not being good enough, perhaps about needing to perform or be successful to be accepted are common. One of therapy’s powers is offering a relationship in which you are welcomed as you are, without conditions. A therapist is not looking for a perfect performance or entertainment. We only ask for you to be willing to show your genuine self, take risks and speak your truth. Experiencing this kind of unconditional positive regard reveals the rich rewards of risking vulnerability. It offers you a healthy template for new relationships with yourself and others in the future.
4. Modelling
In the therapeutic hour, therapists may role model kindness, supportive self-talk, grounding and breathing. Your therapist will kindly correct you when you use unhelpful language, engage in self-deprecation or get stuck in obsessing over others’ responsibilities rather than your sphere of influence. You may experience invaluable shifts in perspective prompted by your therapist’s carefully worded questions or a gentle reminder of a different way of looking at things. Michael’s experience evidences the power of this kind of re-framing, learning and unlearning, especially around his relationship to the mind, anxiety, avoidance, self-criticism and self-acceptance.
5. The Relationship
The relationship is essential to promising therapeutic outcomes. If you do not feel comfortable with your therapist, you will not disclose your deepest personal concerns, thoughts or feelings that a therapist must understand to help you. A therapist builds safety and trust with you through sincerity, kindness, encouragement, and genuine interest in your story and emotional landscape. Active listening and reflection of your story show you are indeed heard and seen. We create a safe space and help you carry your heavy emotional baggage. While this may seem easy, advanced empathy is a skill and takes a great deal of emotional energy to execute.
Collaborative, supportive and armed with years of training and experience, your therapist will assist you in navigating the mountainous landscape of emotions, history, thoughts, behaviours, and relationships like a Sherpa. Do you dare to enter a therapeutic relationship where you can discover greater self-awareness, strategies for coping and a presence and accountability unsurpassed in any other relationship?
Consider reaching out to the multicultural and English-speaking team at Therapy in Barcelona. We will personally match you to a therapist. If something doesn’t feel right in your life, it is important, whether it is a big or small concern. We’d like to accompany you on your journey; like Everest, it won’t be a simple walk in the park, it will be hard, but like Kami the Sherpa on Everest, we are trained to climb mountains and ready to be your guides.
*Name has been changed to protect privacy.
Leigh Matthews is an Australian Psychologist and Founder of Therapy in Barcelona, an international team of English speaking therapists in Barcelona and online. Leigh has been living in Barcelona for ten years and is in an intercultural family with her Catalan husband and son. Leigh can be found on LinkedIn, Instagram at @therapyinbcn and on Facebook at @therapyinbarcelona. You can join Therapy in Barcelona’s Therapist Led Peer Support Group for tips and inspiration while dealing with the pandemic.
