I agree with the above: what are your goals? That question in itself has often been too hard for me, and I’ll spend the odd appointment just working on that. What should my goals be? What can I improve? What am i avoiding?
My T starts each appointment the same way: how are you? She knows, by now, that’s not a particularly helpful question for me. But I also know - that’s my cue. I can go 2 ways with that question.
I can chat. About stuff. Sometimes that’s exactly what I need. Sometimes I do that because I’m just plain old avoiding the hard stuff.
The alternative, is I can use that question as a springboard for a hard work session. When she says “How are you?” My response is usually not all that much about how I am, so “I’m doing okay, so I’d like to talk about/work a bit more on...”.
I think people often misinterpret that initial opening of “How are you?” as common politeness (that’s the normal thing to say to a person you’ve just sat down with to speak to), or “My T hasn’t planned anything for today’s session. Again.”
Depending on the type of T, though? That’s absolutely not the case. Many psychotherapists deliberately let the therapy process be guided by you, at the pace you dictate. You decide what to work on, rather than them, and when that work gets done.
That is intended to build trust, but more importantly, leave control and ownership of the healing process with the client. Particularly with trauma patients, one popular theory is that the client feeling in control of the relationship, how quickly things move, what you’re prepared to talk about and when you’re ready to do that.
Trauma patients often come from a place where they have had little or no control over a significant relationship, and will naturally fall back into that dynamic. In essentially forcing the patient to take back control of their own healing, this type of approach is intended to help the patient not just gain the T’s trust, but relearn what a healthy relationship dynamic should be like.
It doesn’t work for everyone. For example, when Marsha Lineham originally coined DBT, she very deliberately forced patients to commit to a set process with fixed topics for each work, expectations about homework and preparation for the following week. That approach was because DBT recognised that, particularly for people who have BPD, they oftentimes come to therapy with a lot of resistance, and letting them control those initial skill-based parts of therapy was essential to getting anywhere.
With you? You’ve been journalling some really intense stuff, stuff that I think it would be helpful to have your T helping you process. You probably also have particular symptoms or function issues particular to you that you’d like to improve.
So, perhaps at the next appointment, you could go in ready with some notes about those things, and ask for your T’s help with (1) planning some therapy goals; (2) getting your T’s advice on the best way to prioritise and work towards those goals; (3) whether your T has their own thoughts about things they think you would benefit from working on; and then (4) coming up with a rough plan of how that’s going to work.
Your T is likely to keep starting your appointment with “How are you”, even having agreed the week before “We’re going to start processing my traumatic experiences so I can move on”, or “We’re going to discuss my children’s situation and how to manage that”. Because at each appointment, your T is likely to want to leave it up to you to take control of the process.
I hope that’s helpful. I floundered for a long time with seemingly endless, ‘wasted’ appointments where my T would ask me how I was and we’d spend the time discussing that, and ridiculously minor issues cropping up day to day, not realising they were waiting for me to stand up and say “This is what I need to work on - please help me with that, because I find it hard to just open up of my own accord”.
If it’s any consolation, some T’s take an even more rigourous approach to this. Freudian T’s are still around who will insist that any input from them is counter therapeutic. My sister spent several years with one of them, and since she didn’t want to talk? Many of those years the majority of her appointments were spent in complete silence, with her getting no feedback, inout or questions, and her (and her stubbornness!) quite happy to play the silent game! Not helpful!!
