If your partner, family member or friend is about to start therapy or is having therapy you may be wondering how best to support them. If that is the case, they are very lucky to have you in their life! Therapy is hard and having the support of the people who care about you is hugely valuable. At the same, if you haven't had therapy yourself, it can be hard to understand what therapy is like within the session and how it impacts on someone after the session and between sessions. I hope that this post will give you some insights. Naturally, every one has a different experience of therapy and therapists deliver therapy in different ways, so these are just some general ideas and are not meant to be exhaustive. I have identified some common threads that are particularly relevant to EMDR and the various cognitive behavioural therapies that I use. I hope they will help you and the person you care about.
What is therapy like? What does it involve?
The first thing to say is that therapy is a journey with peaks and troughs, some weeks will be hard and other weeks will (hopefully) be enlightening and lead to significant positive change and new perspectives. Speaking with a stranger about the things that we most dislike about ourselves, our unhelpful behaviours and the most difficult experiences we have had in our life takes a lot of courage. Having therapy involves speaking openly about very difficult or upsetting things, and this means being and feeling; it takes a lot of strength. It's one of the reasons why it is really important that anyone seeking therapy takes time to find a therapist that they feel comfortable with. It is much easier to speak honestly and openly when we feel a sense of safety and connection.
Different therapies are very different in terms of what happens in the room. For example, CBT often involves talking together about experiences in order to understand how a problem is being maintained and draw out unhelpful patterns, so that the therapist and client can work together to plan experiments to test out new ideas and strategies. DBT involves learning and practicing skills to regulate emotions and be more effective in interpersonal situations. ACT involves finding ways to be more accepting of our internal experiences so that we can unhook from difficult thoughts and feelings, live according to our values and and do the things that matter to us. EMDR, in contrast, involves less talking, it largely involves processing disturbing memories or feared future events with a particular focus on the feelings that these experiences create in the body. For all of these therapies the therapy sessions have a beginning (a quick review of the time between sessions and agreeing a plan for the session), a middle (where the active therapeutic work is done) and an end (a closing down of the session and a reflection on what has been helpful or learned). Through out all of these sessions the therapist and client work together at a pace that feels right for the individual client.
How do people feel after a therapy session?
This really depends on the type of therapy and the stage of therapy or content of the session. I predominantly work with people who are experiencing trauma symptoms using EMDR. After an EMDR session my clients often tell me that they feel exhausted, which is in contrast to people I see for other types of therapy. I think EMDR is particularly tiring due to the concentration involved (thinking about an experience whilst moving one's eyes and possibly also tapping one's thighs or arms) and the full body experiencing that occurs in the session. My clients also often report a feeling of relief at the end of the session; they are usually relieved that they have been able to work on the memory and experience some changes, even if these are small at first. If we have made good progress on a trauma memory, then clients often leave feeling optimistic and hopeful and with a sense of curiosity ("Has it really worked?"). When processing is slower, for example at the start of working on a very disturbing memory, then people may leave feeling some of the feelings that came up in the session. Whilst the early sessions focus on developing skills to reduce any significant disturbance at the end of the session, it would be unrealistic to expect this to completely disappear before the end of the session. Other therapies, such as CBT, DBT and ACT, can also leave clients with a mix of emotions. For example, they may leave feeling energised if there has been a new discovery in the session, or they may leave feeling sadness if they have been discussing losses. It depends very much on the content of the session. Therapy sessions are a place to open up to, or make space for, difficult emotional experiences, so it is natural that people may sometimes leave feeling similar or even worse than when they walked in (e.g. if the person has been avoiding thinking about the difficulty they wish to address). However, over time they are likely to leave feeling lighter and better able to tackle their difficulties and pursue their goals.
It is important to recognise that when starting a course of therapy, particularly trauma-focused therapy, it not unusual for people to feel worse before they feel better. It's a bit like running, when you first try to run 5k it will feel hard and you will be out of breath and at the same time it is making you fitter and stronger, so that in time you will be able to run 5k faster and more easily. Research shows that people who feel worse in the early phase of therapy have similar outcomes to those who do not, so it is important to keep going, whilst also thinking about any extra support that might make things a bit easier.
What can I do to support my loved one whilst they have therapy?
Offer compassion and support for the fact that they have decided to start something that they know will not be easy. Be encouraging; they have made a decision to make some changes in their life and that is a very brave thing to do. They are likely to feel nervous before the first session and may even start to think about cancelling the session. This is completely normal. You could ask them what they are worried about. It can be helpful to normalise or validate their experiences, it's very common to feel this way before therapy. In fact, I don't think I've ever seen a client who didn't feel nervous about starting therapy. You could also encourage them to go and try it out and see how it feels. After all, if they don't like it they don't need to return. If you know their reasons for starting therapy you could gently remind them of them. For example, "Imagine how you will feel if therapy helps you to stop having flashbacks and nightmares/ improve your confidence/ start doing the things that are important to you". You can also encourage them to talk to their therapist about any fears they might have about therapy. Most therapists will ask new clients how they felt about coming to the first session.
As therapy progresses there might be times when your loved one doesn't feel like attending a session. Maybe they felt worse after the last session or feel very anxious or are worried that the next session will be hard or upsetting. These are the times when they will really benefit from attending their therapy session - so that they can discuss how they are feeling with their therapist and make some adjustments and have some help. It is good to encourage them to attend if they can. However, if they feel physically unwell, then they should make a judgement on whether they are too ill to attend.
As therapy progresses you will notice your loved one making some changes in the way they do things, respond to situations or think about things. This can sometimes feel a bit uncomfortable, as you will have been used to them being how they have been. A bit like when you trade in your old comfy shoes for a new pair that pinch a little bit. It can take some time for you both to adapt to these changes. Try to be supportive of positive change and at the same time be kind to yourself if it creates some discomfort for you; it is not unusual to find it hard when others make changes. For example, if your partner has been coping with stress by drinking wine and watching television and as a result of attending therapy sessions decides to experiment with going to the gym instead twice a week, this might feel uncomfortable for you. You may be happy that they are being more healthy and at the same time you might miss watching television together.
Should I ask my loved one about their therapy session?
I think it is usually helpful to ask how things went, if this is done in a casual way without any expectations of what will be shared. I think most of us like it when the people we care about show an interest in the things we are doing, the challenges we are facing and the progress we are making. At the same time, therapy is very personal and your loved one may not wish to say very much about what was discussed, particularly straight after the session, when they may still be making sense of things and reflecting on what was covered. Tune in to their cues about how much or how little they wish to discuss.
What can I do to support my loved one after a therapy session?
It can be helpful to plan a bit of downtime after a therapy session. Going for a walk, spending some time outside, doing something soothing or something that involves movement can be helpful. Not expecting too much of your loved one in the hour or two after a therapy session will also be helpful if they are covering difficult material in their therapy sessions. It's always a good idea to think about when would be a good time in the week to attend therapy sessions, choosing a day and time when there won't be many demands in the hour or two after the session (particularly for trauma-focused therapies).
Generally though, I think the best approach is to ask your loved one how they would like you to support them and what you can do that would be helpful. Different people need different types of support and what you might naturally offer may not be what they most need. For example, some people may enjoy someone running a bath for them, going on a walk with them, or making them a cup of tea, whilst others might prefer a hug, or discussing what happened and what they discovered. Some people might prefer having some alone time to go on a bike ride, do some gardening or just do whatever feels relaxing and soothing. We are all different, so it's always a good idea to ask what will best support your partner, friend or family member. Just letting them know that you care about how things are going and are supportive of their therapy will be hugely valuable.
I hope you find some of these ideas helpful.
Dr Rachel Lee
Chartered Clinical Psychologist
www.northstarpsychology.co.uk
