Advice columnist

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Adapted from an online discussion.

Hi, Carolyn! How do I get the "most" out of therapy? I want to start feeling and living better ASAP, and I know it's a process so I'm trying to be preemptively patient. But the two other times I've visited therapists, I feel like everything I never talked about in childhood jumped to the surface. None of it was relevant to what I was experiencing at the time.

I'm in a pretty low place right now, and I don't want to spend the first three sessions crying about my family dynamics. However, I'm not the expert! Should I just trust the therapist to navigate to the root of the problem?

— Patient


(Nick Galifianakis/The Washington Post)

Patient: Get the most out of therapy by saying stuff like this to your therapist out loud, upfront. If you get knocked off your point easily when the conversation changes direction — common problem — then either say that right away, or write it down and hand it over.

It’s okay if that feels weird. It’s therapy! It’s safe to be weird.

And, apologies for overstepping: If your past keeps resurfacing, then maybe it is connected to your present distress.

Certainly don’t “trust the therapist” to know intuitively what you need; be vocal about your treatment goals. From there, do trust the therapist to find a path for you, but speak up as needed.

Last thing, a general comment: The way to get the least from therapy is to hold back. Tell! The! Truth!

Good for you for getting the help process started. That can be the hardest step.

Re: Therapy: What do you most want your therapist to do for you? To give you practical tips? To help you recognize disordered thoughts? To simply lend a sympathetic ear? (Can you tell I've done a lot of work in therapy?) Lead with this information! When there's something I want to talk about in a session, I email my therapist ahead of time. A good, compatible therapist will be able to organize sessions around your priorities, or provide you with a good explanation for why revisiting past events will help you now.

— Done the Work

Re: Therapist: I’m a therapist. Tell them what you need. If they think the only way to deal with the present is a long psychological study of your childhood, then they are not the one for you. There are plenty of therapies that are solution-focused for the here-and-now.

— Therapist

Therapist: Yes — not every therapist is a fit, and it’s okay to change. Thanks.

Re: Therapy: I was suicidal for my entire life, until one day I suddenly realized my mother wanted me dead. As soon as that thought hit my gut, the suicidal feeling stopped. I had internalized her desire to kill me into my "desire" to kill myself. Twenty years of therapy with two highly recommended therapists didn't budge the core issue, my being suicidal, an inch. Because all the current stuff really reflected one core, deep, yet-to-be-realized issue.

If you start talking about your childhood the moment you get to the therapist's office, stop trying to force the "current" stuff. What's current is whatever is blurting out of you the moment you get to talk.

— Anonymous

Anonymous: Harrowing. Thank you for sharing your experience to help someone else.

Write to Carolyn Hax at tellme@washpost.com. Get her column delivered to your inbox each morning at wapo.st/haxpost.