I have this friend — we'll call her "Amy" — who has something against therapists. Her bias comes from her childhood, when she was dragged to therapy by her parents during their divorce.
"[The therapist] just nodded her head and frowned," Amy said. "It made me so uncomfortable. And I got nothing out of it."
"Bad experiences in therapy can actually be very damaging," said clinical psychologist Nancy Molitor. "It can erode a sense of trust, so you avoid seeking help in the future."
It seems like that old "headshrinker" stereotype—the doctor behind the desk saying "I see" while the patient spills their guts on the couch—has held on for decades. But Molitor said many people don't realize that today's therapy is not what it used to be.
"A decade ago people would be in therapy for years," she said. "Now that's rare, partially because our methods have changed and we are being trained to be more proactive, to involve the client in the process."
It's more common now for a patient to come in a couple times a week for a few months, Molitor said, as opposed to weekly appointments over long stretches.
"People just don't have the budget for long-term therapy like they used to," she said. "And they want faster results."
Terrence Koller, executive director for the Illinois Psychological Association, said many patients today will demand feedback from their therapists, as opposed to the quiet nodding often associated with the psychoanalytical approach.
"It's up to the therapist to communicate to the patient just how they work so there are no surprises," Koller said. "But there are some [patients] who'd rather have direction, or they want homework. They want the therapist to interact."
Often it can help your progress if you are honest when things aren't working, Molitor said.
"Many of my best sessions have been when the client can say, 'I want to talk about our relationship,' " Molitor said. "You would be amazed at how this makes the therapy take off —when you have a snag — if you are able to sit down and have a discussion about it. That is the beginning of a whole new, better relationship."
Whatever you do, make sure your therapist is licensed with the state, said Koller. "You must make sure they are because that gives the patient recourse should they feel there is something unethical or inappropriate in the treatment."
Finally, it's important to realize that your preferences could be a direct reflection of your life challenges, Koller said.
"If a patient knows they want to be listened to and not coached, this could be because they are never heard at home or in their family. So in therapy is the only place where they feel listened to," he said. "The same goes for when a therapist is giving too much feedback. That can make people uncomfortable. There could be an instance where they feel they are always being told what to do in their life and this type of therapy will bring up a wound. It's about finding the balance that is right for you."