How Do I Do Therapy “Right?”

And what do “cows” have to do with it?

I got asked this question earlier in the week and it was such a good one that I thought it should be it’s own article.

I’ve had a lot of people tell me that they’ve had therapy experiences where they really felt like they wasted time, and whether that’s true for you, you feel it might be, or you just in general want to make sure you’re getting the most from your experience, that’s a good question to pay attention to.

Some therapeutic modalities are VERY strict on session structure. In CBT, for example, you get 5 minutes for general check in and 5 minutes to review homework then it’s delve back into the work.

This is designed to make sure every session for weeks on end doesn’t devolve into COW-chasing (COW, in this case means “crisis of the week”)…which is a common way of avoiding dealing with the past issues what brought you there.

I’m not that strict for a few reasons. Knowing about what’s going on in my clients’ lives, what’s important to them, and even the COWs mooing about is a big part of our work . I get a better sense of issues in context and can help them make connections that they hadn’t picked up on (the kind of bigger picture things that are really difficult to see when you’re in the thick of it).

I also love seeing their skills in action over time. To be able to point out how well they handled a particular COW in their path that would have thrown them for a loop months ago. Again, when you’re plodding along you may not see the huge progress your therapist sees and we love being able to say “Look at you, setting boundaries like a badass!”

And sometimes the COW is enough of an asshole that it needs to be reckoned with for an entire session or sessions. Maybe the COW needs is own treatment goal. It’s ok to pivot when life happens.

But, even in dealing with present issues, I’d attend to how past issues are influencing them. A lot of trauma work is about how the present is being influenced by past shit…which is where those bigger picture connections come in handy.

And if someone started therapy with an eye toward doing some difficult trauma work, there’s time in each session for both. Maybe we herd COWs for awhile and then spend 20 minutes using a Brainspotting intervention for their trauma work. And the Brainspotting focuses on finding connections between their trauma histories and present experiences. Another layer of insight, damn therapists!

And it’s also OK, if someone comes in overwhelmed and doesn’t know where to start. I’ve asked many people “would it be helpful if I start telling you everything I know about [topic that brought you here]? I can talk my ass off and you can ask questions and talk back whenever your ready.” Which is to say, getting a lot of psychoeducation is still a good use of therapy, if your using the intel I took on a lot of student loan debt to share!

My go-to question isn’t “how are you today?” but is “what are we working on today?” which is designed to set the stage that (a) I value my clients time and (b) I want to help them make the most of it.

A lot of clients come in with their work lists because they’re so used to that question. Even if your therapist doesn’t come at you hard like that, you can still ask yourself that question.

And if you’ve been working together awhile ask THEM where they see your progress, what they’re noticing about your work, your goal achievement, and what they see y’all working on next. If they can’t answer that, or if y’all can’t answer it together? Then yeah, maybe that particular therapeutic relationship isn’t the best one for you.

You and your cow deserve a good home.

— Faith