How to get the most out of therapy

It’s common to feel unsure whether therapy will be able to help you.

Especially if you're worried that you've not been offered enough sessions to make a difference. Or if you don’t have much choice about what’s on offer.

But there are steps you can take to make the most of any therapy you can get.

Therapy can be frustrating at times, but as long as you are ready to look at your problems honestly it can be a really useful space to talk about what's bothering you.

Tips for all types of therapy sessions

Here are some positive steps you can take to get the most out of any type of therapy available to you.

Consider if you're ready for therapy

It could help to ask yourself beforehand:

• Am I ready to explore my feelings and behaviour?
• Do I feel able to open up about things that are very personal or hard to talk about?
• Is there anything else I need to get help with first? For example, if you are struggling with housing issues or money issues, you may be able to find support with those issues elsewhere. Citizens Advice can be a good place to start.

Understand the type of therapy you're getting

Ask your therapist how they think this kind of therapy can help you, and what to expect from it.

If they use terms you don't understand, ask them to explain.

Decide what you want to achieve from therapy

It can help to set some small goals which you feel are achievable. Discuss these with your therapist so you can both aim to reach shared goals.

Try to set realistic expectations

Try to remember that therapy isn’t a magic bullet that will solve all your problems immediately. Instead, try to think of it as a process. It can take time before you feel ready to make changes in your life.

Talk about what's most important to you

Therapy sessions are your time, and you shouldn't feel pressured to talk about something you don't feel is important.

If your therapist asks you questions that you don’t think are relevant, you could ask them how they think they relate to your problems.

Tell your therapist what's working and what isn't

It can help to try and provide feedback to your therapist around how you are finding the sessions. They might be able to change the sessions so that they suit you better.

Tips for face-to-face therapy

If you have therapy face-to-face, these are some things you could try to make the sessions feel more comfortable.

Use your journey to the therapy room to prepare

Being in therapy can bring up difficult emotions and memories. To help manage these feelings, some people use the journey to the therapy room to prepare for the session.

For example, if you can, you could try walking to the therapy room.

Make the room feel more comfortable and safe

For example, you could ask if it's possible to change where you sit, or adjust the lighting or the temperature of the room so you feel more relaxed.

Take something in with you to help you ground yourself

For example, this could be a treasured item or something you can fiddle with.

Have someone you trust nearby, if you want

It could help you relax if you know someone will be there to meet you when the session is finished.

Tips for phone and online therapy

You might be offered therapy over the phone or online.

Some people prefer this, particularly if it’s difficult leaving the house or using transport.

But some might worry that it will be harder to have an open and honest conversation remotely.

Here are some tips to help make your remote sessions feel more comfortable.

Make a plan with your therapist

These are some things you could discuss before your first session:

• If remote therapy is suitable for you. For example, if you're struggling with an eating disorder, your therapist may feel that an in-person service would be more suitable. In this case, they should be able to refer you to other services.
• Whether you can choose between a phone or video call, and which one you would prefer.
• The confidentiality of your sessions, and how your personal data will be used. It’s the therapist's responsibility to make sure that any digital platform they use is secure.
• What number your therapist will call you from if you’re having your session by phone. Or if the therapist will withhold their number, so it doesn’t show on your phone bill. They sometimes do this to respect your privacy.
• Who will restart the call if you lose connection. This can be common, but usually only lasts for a short amount of time.
• If you’re on screen, try to think about the positioning of your phone or laptop. It can help with the connection to your therapist if you position your phone or laptop at eye-level.
• How long the session will last, particularly if you have problems looking at a screen for a long time.
• Whether you would prefer to turn your camera off for a video call.
• Any other worries you have about the session.

Ask for help with setting up your call

If you’re unsure about how to use video calling technology, ask a friend, family member or someone else you trust to help set this up. It's a good idea to test the technology before the online therapy session.

Age UK has a useful guide to using video calls.

Think about where you'll have the session

If you can, try to find a place in your home where you won’t be disturbed. If you’re worried about being heard by people you live with, using headphones for the session may help with privacy.

Or you could ask your therapist if it would be possible for you to talk to them while you’re out for a walk. Choose somewhere away from home, in a safe space for you.

Think about how to relax during the session

For example, you could hold a comforting object or take a moment to focus on your breathing.

Our page on relaxation has more tips.

It might also help to turn off any digital notifications such as social media or text messages, to avoid getting distracted.

Think about what you'll do after the session

If you’ve had your therapy session in your home, you might want to take some time away from the room where this took place.

Spending some time in a different room may help you wind down after the session.

You could try and plan a relaxing activity before going back to your usual routine, such as listening to your favourite piece of music. Or go outside for a short while if you're able to.

You may want to let someone you trust know that you’re having the session, so that they can check in with you afterwards.

Give yourself time to get used to it

It can take time to build trust and feel comfortable with a therapist. This could feel even more difficult when you’re not seeing them face-to-face.

If it takes time to get used to having therapy in this way, try to be kind to yourself.

If you're finding it hard to feel comfortable, it may help to tell your therapist how you're feeling. This might feel daunting. But being honest may help to increase your sense of connection with them.

If after a while you still find that you’re struggling with online therapy, you could ask your therapist if it’s possible to meet in person.

Working with a culturally competent therapist

Your therapist should be trained and able to work with diverse clients, regardless of differences in beliefs, values and background. This includes your ethnicity, gender, race, religion, sex and sexuality.

Finding an affirming therapist

You are allowed to ask NHS services for what you want. It's a good idea to tell them your needs as early as possible, when first booking your appointment.

It may not always be possible. But if they can accommodate you, they should.

If the NHS can’t match you with a suitable therapist, you might want to explore charity and private sector options.

These directories are a useful starting point:

• The Black, African and Asian Therapy Network (BAATN) – for therapists of Black, African, Asian and Caribbean heritage
• South Asian Therapists.org – for therapists of South Asian heritage
• Pink Therapy – for therapists from the LGBTQIA+ community

Our resources on racism and mental health and LGBTQIA+ mental health have more support options.

And our page on how to find therapy and counselling has more advice.

Asking for adjustments to meet your needs

To help you access and get the most from therapy, you might need to ask for some adjustments.

If you have a disability

If you have a disability, NHS and private therapy services have a duty under the Equality Act to make reasonable adjustments for you.

You might feel scared to ask a service to make changes for you. But if you know there are some specific things that help you, you can ask for them.

For example, you could ask if it’s possible to have longer or shorter therapy sessions.

Some adjustments might not be possible. It will depend on the size and resources of the service. But where it is possible and reasonable to do so, service providers should try to make changes to suit your needs.

Our guide to disability discrimination has more information on reasonable adjustments.

The National Autistic Society website also has advice on reasonable adjustments.

If English isn't your first language

If you're getting therapy through the NHS, they can do it in your chosen language through multi-lingual therapists or confidential translators.

Some therapies through the NHS are also available in British Sign Language (BSL) through SignHealth.

Preparing for the therapy coming to an end

It's common to have a mixture of thoughts and emotions about finishing therapy.

It's likely to depend on the experience you've had and the relationship you've formed with your therapist.

There's no one particular way you're supposed to feel.

If you're worried about how you'll cope, tell your therapist how you're feeling. They might be able to help you plan things you can do after your therapy has ended to help yourself, and work out your next steps.

The ending of therapy can also be a chance to use some of the things you learnt in therapy.

What to do if therapy isn't helping

Therapeutic relationships can be challenging. It can take time to build trust and feel comfortable with a therapist. And it's common to have times when you feel frustrated or upset afterwards.

But you might find that, even after sticking with it for a while, you're really not happy with how it's going.

In this case you may want to:

• Talk to your therapist about any problems you're having with the process
• Ask your therapist whether they can change the way they're working with you
• Ask your GP or the NHS service if there is another therapist you can work with
• Find another therapist, especially if you're paying them
• Explore other ways to support your mental health

It’s important to remember that sometimes you may need to work with a few therapists before finding the right fit for you.

And just because the first therapist didn't work for you, it doesn't mean therapy won't work for you in the future.

How to complain about therapy

If you have a serious concern about any treatment you've received, you can complain.

Your therapist should tell you their complaints process if you ask them for it. As a first step, you should try to raise your concerns directly with your therapist.

However, if you can't resolve your concerns this way, you could ask your therapist what professional body they're registered with, then make your complaint through that body. All professional bodies should have a complaints procedure you can follow.

You can only complain to a professional body if your therapist is registered with one. So it’s a good idea to make sure your therapist is registered with a professional body before working with them.

If you want another opinion before making a complaint, The British Association for Counselling and Therapy (BACP) offers a service for you to get help with counselling concerns. This is a confidential telephone and email service for any questions or concerns you have about good and bad practice in therapy.

See our legal pages on complaining about health and social care for more information about your rights.