Therapy is expensive — here’s how to make the most of your sessions

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Private therapy in Canada isn’t cheap — fees can range anywhere between $50 to $240 per hour — so it’s important that you get your money’s worth.

According to Dr. Lynda Ashbourne, associate professor at the University of Guelph, feeling heard is a telltale sign of a good therapy session.

“You should feel as if… the therapist heard and understood what you’ve talked about, what is important to you, who you are and something of your current situation — either what’s working or what’s troubling,” she said.

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By the end of your first session with a new therapist, you should also have a solid grasp on “how they work and what to expect.”

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“The questions that your therapist asks should be helpful to you in thinking about yourself, the broader picture of your life as well as the specifics of your concern,” said Ashbourne.

Don’t expect to have all of your problems resolved after one hour, but you should leave your initial appointment feeling like you have a clearer understanding of what you want to work on.

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“How it’s affecting you, how it’s affecting others, what has worked for you in the past or in other contexts of your life that you might be able to learn from and apply… and how the therapist could be helpful to you” are all things you should feel good about when you finish your first session, said Ashbourne.

She defines a “good” therapy session as one which involves your therapist taking time to ask about and listen to “the unique context in which you live.” This includes what you understand to be your culture, age, gender identity and sexual orientation, spiritual or religious beliefs, values and priorities, life experience, ethnicity and class roots.

This is what a therapist should do, said Ashbourne — not “provide you with suggestions or prescriptions that seem oriented to a generic person or relationship.”

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All your subsequent sessions should give you both insight and action items that you can start working on as soon as you leave the room.

“[They] should leave you feeling that you have some new ideas and new insight into what’s going on for you and how you can address that,” she said. “[You should have] steps you can take [and tips for] how you can continue self-reflection in a constructive manner between sessions.”

Here are some things you can do to ensure you’re making the best of your next therapy session.

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Before your first appointment…

Why are you going to therapy? Asking yourself that question (and answering it) will ensure your first session is productive, Ashbourne said.

“How do you understand the ‘problem’? What do you call it? How does it affect you? Who else does it affect? How will you know if it’s getting better or worse?” he said. “How will you know if therapy is helping? What are your expectations of therapy?”

She would also recommend keeping a list of all the questions you immediately have for your therapist, so you don’t get flustered and miss something.

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“That can include what training they have, what experience informs their work, what… they think is most helpful about therapy, how they work, the number of sessions” and more, said Ashbourne.

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While there is some preparation necessary on your end, Ashbourne also recommends that you try to stay open-minded.

“Let the therapist do their job in understanding your current situation and inviting you to reflect on this differently or try something new in response,” she said.

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It’s important to remember that what you’ve tried before wasn’t working, and that’s why you decided to go to therapy.

If your therapist attempts to use an unorthodox method, try it out before shutting it down — it could be the angle you’ve been missing.

“Sometimes the therapist might ask you about something that seems unrelated… it’s a good idea to let that conversation unfold for a bit as there may be ideas there that are linked to how you are seeing or responding to the current dilemma, or where you might be getting stuck,” said Ashbourne.

Use your time wisely, be nonjudgmental

Not only does an agenda keep a session on track, but it offers transparency and stability to both patient and clinician.

Dr. Christine Korol of the Vancouver Anxiety Centre always uses an agenda, and she likes it because it ensures that nothing is missed or skipped.

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“It doesn’t feel good when you wanted to talk about something in particular and you don’t get to it by the end of the session,” Korol said.

“[An agenda] makes sure that you’ve covered everything… and if there is too much to talk about in one session, you know that you can prioritize at the beginning.”

In a typical session, Korol allows a few minutes at the beginning for client and patient to “go over how the last week went.” Then, together, they make a plan for the rest of the session.

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“[For example,] 10 minutes on homework, 15 minutes on a work situation, 15 minutes on an upcoming visit home, 10 minutes to review the session and make a plan for the next week,” she said.

It’s also a better use of your time if you’re completely honest and vulnerable from the outset.

“[Therapy] is where you can explore exactly how you have been feeling. This is especially important for those who are learning to set boundaries or set limits with others,” said Korol. “Telling yourself that something you’re feeling is bad or wrong will slow you down from exploring those feelings… [feelings which] may not be bad or wrong.”

Use a journal to track your thoughts and feelings

A therapist can start to feel like a friend after a few sessions, but talking about your day or your social outings are not an effective use of time.

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“[Journals] can help you collect data and keep you on track in between sessions,” Korol said.

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Ashbourne agrees — writing down how you felt at the end of the last session will allow you to pick up where you left off with ease.

Use journal prompts like “what stuck with you from last time? What happened this week with regard to your problem that was different? What did you try that worked or didn’t work, and what do you think that tells you?” said Ashbourne.

If you’re still not getting what you want…

According to Ashbourne, you should feel like there have been some “beginning shifts” in how you are dealing with your concerns after three to four sessions.

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If you don’t feel anything after that amount of time, it might be time to have an honest conversation with your therapist.

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“They may have ideas for doing something different, or they may suggest another therapist who might be a better fit for who you are,” said Ashbourne.

“Neither of these are indications that you or the therapist is flawed in some way… they simply reflect that we’re not all the same.”

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