Ten  years ago I wrote an article about intermittent therapy: sporadic but intentional counselling sessions whose timeliness serves a very meaningful therapeutic purpose.

Today, I want to revisit this topic, but from a different angle: irregular counselling appointments which don’t offer the therapeutic growth potential of planned intermittent therapy or regular counselling sessions.

Of course, there are always exceptions, such as people who would never engage with counselling unless they could start infrequently until trust could be established, as well as other very valid reasons that aren’t at the top of my mind.

And there are a number of systemic and practical factors that can interfere with a regular therapy schedule, as I discussed in depth in last month’s article, so I won’t repeat them here. These are all relevant, but not the focus of this piece.

Some folks wonder what is holding them back internally from committing to counselling. And, because we’re all different, not all of these factors will apply to you. But let’s take a look at some possible psychological barriers and some potential solutions.

Challenging Topics

This may look like….

• Therapy has touched on topics that I feel very uncomfortable discussing.Sometimes therapy can take us to places that we either don’t expect or are not ready to talk about.
• I’m afraid/embarrassed to bring up uncomfortable topics or I don’t know how. We may want to talk about difficult topics but we may have fear that we cannot handle it.
• We feel that we’re  ‘too upset’ to go to our counselling appointment, which often has more to do with fears about how we will come across to our therapist.
• I don’t feel ready to deal with certain issues in therapy, although I’d potentially be open to it in future. Pacing is important!

These concerns are valid and your counsellor may or may not realize that this is happening for you.

Possible solutions

• Let your therapist know that there are topics you would prefer not to talk about or let them know that you have some concerns and are struggling to know how to bring them up. Is their response caring and concerned? If so, the chances are better that they could help you talk this through and feel understood.
• Although it’s easier to do so if you have good rapport with your therapist, some clients prefer just to say, in a session, “I don’t want to answer that question” or “I don’t want to talk about that.” These are valid boundaries.
• If there are things that you want to talk about but are afraid to, ask your counsellor if you can collaborate on a strategy for how to feel safe while talking about them, as develop a post-session coping strategy.

Things to Do With Me

This may look like…

• “I have an avoidant attachment style.” If you have grown up in a family situation where your feelings were ignored, most people internalize them, which often becomes a long-term coping strategy. The emotional intensity of talking about our thoughts and feelings with a counsellor, opening up and growing a therapeutic relationship can feel overwhelming.
• “I have a deep-seated fear of being judged by my therapist.” A strong fear of being judged is common amongst counselling clients. Being judged by others, especially by a therapist, can be crushing (although I feel that it’s less common than you may think). If you also worry about being liked by your therapist, you may avoid therapy out of fear that your counsellor might see you in an unflattering light,“if they knew about X.”
• “I haven’t done my therapy homework.” Counsellors differ in their expectations around homework, because this often has more to do with how structured the therapy itself is. Does progress depend on the completion of homework? Can growth still happen even if homework isn’t completed?

Possible solutions

• Alerting your therapist that it’s difficult for you to open up can be helpful, particularly if you and your therapist don’t know one another well. This allows your therapist to spend more time with you understanding your concerns, providing support, and collaborating with you about a pace that works best for you.
• While it’s true that a therapist could judge you, it doesn’t mean that they should. Sometimes, too, when we’ve been judged and rejected in life, we might be on the alert, watching for it, including in therapy. This can be a good topic to bring up in therapy and see how your therapist reacts. Do you feel supported?
• I’ve talked about therapy homework extensively in a previous post but if you don’t like homework, it’s better to tell your therapist rather than dealing with it by avoiding therapy. Or, sometimes we’d like to do homework but we need more time to do it. Does there need to be more space in-between sessions?

The Therapy Process

This may look like…

• “I don’t know where the therapy is going – what is the purpose?” When is the last time that you and your therapist checked in about your counselling? I’m a firm believer that clients have the right to initiate a discussion about their therapy journey, needs etc. Therapists also range in terms of how often they initiate such discussions too.
• “I want something different out of the therapy but I don’t know how to ask or I feel awkward asking.” This can happen when clients and therapists have a different take on the therapy method, Some clients (and therapists) prefer a structured therapy “program,” while others are looking for a more spacious frame which includes more questions, understanding and reflection. Also, for clients who are new to therapy, it can be hard to know what kinds of things you can ask for, or question.
• “I don’t agree with the recommended therapy schedule so I find myself cancelling a lot.” You may have specific ideas about how often you want to attend, which may be different than what was recommended for you.
• “I’m not making the progress that I am seeking or I feel stalled in my therapy.” How do you and your therapist measure your progress in therapy? Some clients may wonder if they’re making progress, what the goals are and whether a client can advocate for what the focus of therapy should be. These are all such valid questions.

Possible solutions

• Most of the above comes down to communicating with your therapist. I’ve noticed a trend over the years around avoiding difficult discussions out of a fear to make things “awkward.” I agree that awkwardness is not easy, although it may be a necessary phase towards having a meaningful and productive discussion. Therapists should be adept at managing awkwardness and creating a safe space where clients can voice their concerns, no matter what they may be. Further, if you feel that you have an idea of your needs, please speak up, because your therapist won’t be able to read your mind. It’s better to be upfront than to cancel repeatedly as a way of avoiding the therapy schedule. Perhaps it just needs to be modified!
• If you’re concerned about whether or not you’re making progress, this is usually a good time to review your goals with your therapist and provide any updates about what you are looking for. You may also wish to schedule regular check-ins about your progress. It can also be helpful to review what your original goals were and where you’re at with them now. Besides your memory, this information can usually also be found in your therapist’s initial note.

Concerns About the Counsellor

This may look like…

• “My therapist’s questions are unpredictable which makes me feel on edge.”
• “I’m looking for a different style of counselling.”
• “I don’t like my therapist.”
• “I like my therapist but I’m not so sure that therapy is working.”

As I’ve said many times before, therapists are just as different from one another as the clients they serve, so you may be matched with a therapist who is not right for you. Often our first instincts are correct and we choose someone that resonates and will be a good fit, but other times, meeting and having a session shows us that it just isn’t. Sometimes this issue can be more complicated if you really like your therapist but you’re wondering if that’s interfering with your progress in therapy.

Sometimes when we’re new to therapy it’s hard to know what style of therapy and therapist would work best for you. It can also be anxiety-provoking if you don’t know what the therapist will ask or how the session will go. If you’re a therapy veteran, you may have a better idea about both your needs and the counsellor style you prefer.

Possible solutions

• Take advantage of any free consultations being offered. This is a great opportunity to get a sense of the counsellor’s manner and how you feel in their presence. I also recommend identifying your goals and asking potential therapists how they see themselves supporting you. Not all clients are interested in knowing the ins and outs of therapies that the counsellor is using but you may wish to discuss therapeutic methods that you would definitely want to avoid or approaches that have worked well for you in the past, if applicable.
• Is there something the therapist can do that would help, such as discuss the objectives before the session? Please let them know!
• If you don’t feel it’s the right fit, it can be helpful to discuss this with the therapist so they know why you’re leaving and that therapy will be coming to an end. Ultimately, though, the choice is yours around who you want to counsel you.

In Conclusion

Many of these concerns can be resolved by opening a conversation with your therapist, which can often become a porthole to going deeper in your therapy. Can your therapist pivot and offer you something more along the lines of what you feel you need? Or, is it a no-go just a function of our respective uniqueness as people? Genuineness in counselling, both for client and counsellor, is key.