By Sarah Godfrey
Sometimes therapy works brilliantly. Sometimes you may be disappointed. Being in therapy is like most things in life. What you put in is a measure of what you will get out of it. There has been a lot of research conducted on why therapy works. Studies suggest that cognitive-behavioural therapy (CBT), dialectic behaviour therapy (DBT), psychodynamic, and interpersonal psychotherapy alter brain function in patients suffering from major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder, social anxiety disorder, specific phobias, posttraumatic stress disorder, and borderline personality disorder (BPD)*
With the magic of science we now know therapy actually alters the brain and that is why it works. But why and how are intriguing questions. The bottom line is it is a two way process between you and your therapist. And both of you have to work at success. Therapist can work harder, define their effectiveness, learn to ask clients what works and what doesn’t, but clients have work to do as well. You will get the best out of your therapy if you:
• Turn up to therapy. Regularly. Consistency in your attendance goes a long way to successful change. Developing a therapeutic routine will keep you focused and allows the therapist to build on the skills and therapy conducted in the last session. Imagine your therapy is like a train ride. If you get off at the first stop and don’t get back on the next time the train arrives, you will never get to your destination. Hop aboard. It’s better than standing still.
• Do your homework. Handouts, tasks, goals, journals, reflections and challenges are designed to keep you working towards your therapeutic goals. They are reinforcements of the work you do in sessions and a measure of your own commitment to change. Keep them in a folder or book. Value your work and efforts. They are important and in the future if life pushes you back towards that old default self you can use those tools again.
• If it’s not working, talk about it. Learning to have your emotional needs met can be practised in your therapy. Talk to your therapist about your concerns. Think about the solution. Why isn’t it working? They are there to help you. Your feedback helps the therapists grow and develop. Everyone can learn something about themselves, how they react or something new during your therapy. Including your therapist. It is, after all, a team effort.
• Expect resistance. From yourself and others. Your friends and family are not in therapy and strangely enough they have loved and liked you just as you are, (well sometimes, most of you). Change can be an unnerving process. Talk to them about what you are discovering, your treatment plan and your struggles and success. If in doubt ask them to come to a session and talk further with your therapists so everyone can be on the same page, working towards your outcome. Your old patterns are entrenched and have ruled the kingdom of you for some time. Imagine change as a pair of tracksuit pants. You are very comfortable with your old, worn out pair. Yes, they may be faded, too small, have holes and let’s face it, not as comfortable as you tell yourself, but they are familiar and have been with you a long time. Going to therapy is like a stranger asking you to toss those old, familiar trackies in the bin and wear a new pair. They may fit and feel a little different. Maybe you are unsure of the colour and fabric? You will feel some anxiety letting that old pair of pants go. Trust me you will realise the new pair look great on you and will last much longer. Give it time.
• Be honest with yourself. Don’t expect 100% change if you are giving the process 20%. Your effort, commitment and determination to resolve your issues are key factors in success. Be realistic. Sometimes we can’t give 100%. Life is challenging, busy and complex. Cut yourself a break if 50% was all you could muster one week. Remember 50% is still a long way from not doing anything at all. So be realistic but try for 100. If change is slow and you are getting frustrated ask yourself, what has been my commitment level?
• Give everything a go. Sometimes your therapist will challenge you and ask you to think differently, take responsibility for your own behaviour and reflect on yourself in ways that may make you uncomfortable. Commit to the belief that all change is challenging. Nothing great is given away. We earn the success we want.
• Recognise the process. The role of therapy and your therapist is very important to understand. You are in charge of your progress. Imagine that you are the boat and your therapist the river. The therapist will quietly support you, hold you above the water and guide you gently downstream but you are in charge of steering the direction you want to go in and the speed you are sailing through the waters of change. 
• Finally, be realistic. To change the brain is not an easy task. Most treatments need 6 months to a year to create permanent change. And that is when you practice the new skills and cognitions every day. Be patient, dedicated and compassionate with yourself and don’t give up. Self compassion will get you through therapy. Don’t forget to hold your own hand and give it a squeeze on the tough days.
Most importantly, enjoy your therapy when you can. Find humour in the struggle, laugh when you make a mistake, find adventure in discovering a new way of interacting in this world. You have chosen to be brave and face the problems that have limited your happiness. This means you are successful. Therapy just builds on the decision you have already made.
You can do it.
*How Psychotherapy Changes the Brain. August 11, 2011 | Psychotherapy, Addiction, Major Depressive Disorder, Neuropsychiatry, Obsessive Compulsive Disorder, Special Reports By Hasse Karlsson, MA, MD, PhD