Is therapy just talking?

If you are new to therapy, talking with a therapist feels a lot like talking with a friend or advisor: therapist and patient take turns talking, listening, and responding and the flow of the conversation feels natural and easy. It feels a lot like talking to a friend that is in a good place: someone dependable, empathetic, accepting, and understanding. But there is a lot of work going on from the therapist’s side. Like a professional athlete, the more experienced the therapist, the more effortless the work appears. Here is a behind the scenes look at what a therapist is tending to during a session:

1. A therapist follows a few preferred modalities and will implement techniques that fit with the direction of the conversation. For example, when a patient is feeling stuck, a therapist might ask what would get you a half step better. This is an intervention from solution focused brief therapy approach. The therapist will sometimes explain the intervention but most of the time it would be like breaking the fourth wall (where an actor talks to the camera).
2. A therapist is working on helping the patient feel emotions. If a patient is too repressed, the therapist will focus on reading between the lines to help the patient start noticing feelings. If a patient gets flooded with feelings, the therapist stays on the feeling while comforting. Feeling feelings makes us human and so many people struggle with feeling the “just right” amount at a time. I tell my patients that you can feel as much or as little as you can handle — a few drops or a whole cup. But being completely dry or drinking from a firehouse does not serve us and a therapist helps us regulate the feelings up or down as needed.
3. A therapist assesses continuously a long list of patient attributes — from attention levels to physical movements, from symptoms to functioning levels, from responses to defenses. These details let the therapist know where the patient is, whether the interventions are being effective, and important factors such as risks and strengths. This does not take away from the individual, a therapist can see you and assess at the same time — like how you can pay attention to your car sounds without forgetting how to drive.
4. A therapist remembers what you’ve said: as you share your story and inner thoughts and feelings, a therapist will be noting the hints and comments to explore when appropriate. Sometimes what is avoided can be more telling than what is said, the “elephant in the room”. 
5. A therapist reflects and redirects: two of the basic skills that are small but mighty are reflecting and redirecting. Reflecting can be as simple as repeating what was said. If you want to make a person feel heard and cared about, simply repeating what you heard has a big impact on relationship quality. Redirecting is a more delicate move and is used to help patients build skills (such as empathy), to undo defenses, and to maintain focus and oriented to goals. For example, if a patient has a tendency to complain, a therapist may redirect with “what DID you like about it?”
6. A therapist keeps good ethics and is professionally responsible. Whatever a therapist uses in the session, the choices should be proven by research to work and should not harm the patient. Therapists are trained to not have dual relationships with patients (friendships, business relationships, favors, excessive gifts).
7. Therapists have boundaries around communication. A therapist has guidelines about how to get in touch and what to do in case of crisis. A therapist considers the attachment style of the client (anxious, mixed, avoidant) and may use communication as an opportunity to do on the spot intervention.
8. Therapists also should only use self disclosure, sharing about self, when it benefits the client and the therapist has worked through the personal story to the point where emotional responses are modulated. Sometimes I have shared personal stories that are difficult to modulate in order to show a client that I too can struggle with modulation. This should be discussed and explored so that it isn’t confusing or awkward.

An experienced therapist has many tools, techniques and approaches to help you with the goals that you identify. If you have concerns, talk about them with your therapist, they are likely a reflection of what happens for you in your other relationships.