Last week, I shared with you a personal story about why my first experience with therapy was a bit of a disaster. Part of what made it less successful than it could have been was my concern about what my therapist was thinking. Now that I’m a therapist, I have a pretty good idea of what’s going through the mind of a therapist (at least assuming that I’m fairly normal in this respect). So, if fear of judgment or rejection is making you nervous about going to therapy or being honest with your therapist, here are 10 things I’m thinking during session as a therapist.

1. “I wish you could see yourself the way I see you.”

When my clients are criticizing themselves or expressing thoughts of worthlessness or hopelessness, I often wish they could see themselves the way I see them. It’s easier for me to see my clients’ strengths than it is for them to see their own. All they can see are their flaws, lit up by a disco ball and sprinkled in glitter. The fact that someone can share their deepest insecurities and their biggest mistakes with me and I still have positive feelings toward them shows just how worthwhile they are. When you share your insecurities, rest assured that your therapist is not judging you for them — your therapist is actually thinking, “I wish you could appreciate just how awesome you are.”

2. “What am i feeling right now?”

The majority of my mental space during session is dedicated to deeply listening to what a client is saying. At the same time, I periodically check in often with my own reactions to what a person is saying or doing. I take a quick note about feelings or thoughts the client might be stirring up inside me and determine whether it would be helpful or therapeutic to share those thoughts. For example, “My goodness, I noticed as you were sharing about all that’s on your plate that I started to feel anxious just listening to it! I can only imagine what it must feel like to actually feel attached to that endless to-do list!” Talking about my vicarious reaction can sometimes help a client better recognize their own reactions to the events in their lives.

3. “Is this part of a bigger pattern?”

In addition to in-the-moment processing of what a person is saying, I’m also simultaneously connecting their words to previous comments they’ve made, what I know about previous life experiences, and what I’m observing about their current facial expressions and behavior. The goal is to detect patterns. So maybe a client is telling me that she is feeling sad that her sick relative will be removed from life support soon, but I’m noticing she’s smiling as she shares this. The incongruence between the smile and the sad news is worth discussing and connecting to other patterns of trying to “be strong.”

4. “I wonder what he’s not saying right now.”

A lot of growth happens in therapy by trying to uncover what isn’t being said. Sometimes clients consciously withhold certain information, but more often clients don’t even recognize they’re doing this. So they may share anecdotes or problems that are relatively easier to discuss and avoid the harder topics. As a therapist, I try to be on the lookout for this and gently move the client toward discussing the deeper issues.

5. “I wonder what led her to do that?”

Sometimes clients will start or end a story with, “I know I shouldn’t have done that,” or, “That was bad of me.” You might wonder whether your therapist is silently thinking, “Yep, you totally screwed up. What were you thinking??” And yeah, it’s true that sometimes your therapist will agree that a choice you made was maybe not the healthiest for you. But rather than judging a client for making that choice, my thoughts go to trying to understand where that choice came from. Most behaviors are understandable, and you can even have sympathy for them, when you really understand what was going through a person’s mind. I believe most people have good intentions, so even “bad” decisions are usually coming from a good place.

6. “What does this client need right now?”

Sometimes clients need direction, sometimes they need space to explore their own thoughts without direction, sometimes they need delicate, sometimes they need firm, sometimes they need reassurance, sometimes they need to be pushed to trust themselves. Clients need all sorts of different things — and what they need may or may not align with what they want. As a therapist, part of what I’m thinking about in session is trying to figure out what the client needs. And if that’s different from what the client wants, then I’m thinking about how to bridge that gap. My job isn’t just to give a client what he wants or to tell him what he wants to hear — you’ve got friends and family for that! My job is to relieve pain, and sometimes that means you need something that you don’t exactly want (like a little push to change).

7. “I wish I could do more.”

One of the most painful parts of being a therapist is realizing that we can’t take away people’s pain. Our job is to help heal, but that doesn’t mean we can eliminate all the things causing pain. We can’t undo the trauma that’s already happened, for example. I often find myself thinking, “I wish I could make this magically go away.” It’s hard to see a person suffering, and I’m frequently wishing there were more I could do.

8. “What can we do differently to move this forward?”

When I’m noticing a client isn’t making progress, a lot of my mental space gets dedicated to thinking about what we can do differently to start moving forward. Often, this is a conversation I’ll have out loud with a client because it should be collaborative. But prior to that, I’ve frequently had many conversations with myself wondering what I could do differently during session or what we might want to change so the client can make progress toward their goals.

9. “I really like you, but we shouldn’t keep meeting forever.”

I really like my clients. They’re cool people who have interesting stories, and together we have stimulating conversations that I look forward to. And if this were a friendship, then we’d be all set for a lasting relationship. But it’s not a friendship, so we can’t keep this going forever. Even though I like my clients and our sessions, I know it’s best for them to eventually separate and live their lives without therapy. So, one thing I’m thinking about during session is whether it’s time for that transition.

10. “What time is it?”

A bit of a boring one, but part of my job as the therapist is to keep track of time. And that’s not just to make sure that we end the session on time but also to make sure that I don’t send you back to work in tears because we were in the middle of an emotional conversation when the hour ran up. My job is to pace the session so that we have tough conversations and do important work but that you’re basically pieced back together by the end of the hour. It’s not always possible to nail that, but that’s the goal.

What Your Therapist Isn’t Thinking During Session

I’ve opened up and told you about what’s going through my mind during session, but it’s also helpful to know what’s not going through my mind. Here are some thoughts I’ve never had during a session:

• What an idiot. I can’t believe she did that.
• He’s not even trying.
• I just genuinely don’t even care.
• Whoa. What a terrible person!
• OMG I’d never do that.
• This is such a waste of time.
• I really don’t like him.
• How can I get rid of this person?

It’s true sometimes my mind might wander to an upcoming session or to what I’m going to have for lunch, but that’s usually fleeting. Instead, my thoughts are almost exclusively focused on what’s happening in session and what we can do to move forward toward the client’s goals.

How to Get Started with Therapy

Hopefully this has pierced the veil and decreased some fear you might have about your therapist judging you in session. If you’re looking to get started with therapy, check out these previous articles with tips to overcome the jitters that can keep us from scheduling that first appointment:

And make sure you carry along my worksheets to your first (or next!) therapy session to maximize how effective your sessions can be:

How to Know When You’re Done with Therapy

I mentioned that one of the things I’m thinking during session is “at some point, this is gonna have to end.” Hopefully, that’ll be a collaborative discussion you have with your therapist. But next week, I’ll share with you some signs to look for to tell you that you’re done with therapy and ready to move on. Don’t miss it.

Talk to you soon,

Dr. Finch

P.S.    Remember, this is education, not treatment.  Always consult with a psychologist or therapist about your mental health to determine what information and interventions are best for you.  See the disclaimer for more details.