By Valerie Ross and Leigh Newman

What in the world are those mental-health professionals scribbling down on their pads… but refusing to say out loud? At last, some answers.



1. Please Stop Asking Why!

Most of us come to therapy wanting to know why the heck we are the way we are. It’s important to understand the reasons we do what we do, says Scott Bea, Psy.D. at the renowned Cleveland Clinic. But often, that “why” isn’t enough to help you get past the issue, and there are times when it’s not even necessary. For example, if you have a phobia about elevators, understanding how this fear developed, though interesting, probably won’t help solve the issue. A “why" alone won’t get you on that elevator. “Explanations themselves don’t change the habits the brain has developed,” says Bea. “People have to take on the arduous effort of changing those patterns themselves.”

2. This Week You Might Not Have Time To Watch ‘Downton Abbey’

When you’re feeling depressed, or when events in your life have become overwhelming, just getting to your weekly session and addressing those problems for an hour can feel like a job well done. Therapy that works, however, demands much more from us, requiring us to sort through emotions and, at times, to do real, live homework during the week. Let’s say you have a tendency to worry (a lot). You may be given the assignment to refrain from ruminating on the negative for a few days. If you’re depressed and lethargic, you may be asked to follow a schedule that gets you up and out of bed. Therapists might challenge sufferers of social anxiety to have encounters with strangers, such as asking for directions to a bowling alley or farmers’ market. Psychologists and social workers understand that being clear and direct about these non-session assignments can make patients fearful -- and resentful, especially after they've gone through the effort of a 50-minute revealing verbal exchange. Cindy J. Aaronson, Ph.D., MSW, admits that since patients will often respond, “Ohmygod, homework,” she usually avoids using that specific word. Her less intimidating replacement, however, she's keeping -- darn! -- to herself.



3. My Advice Might Just Be The Worst Thing For You

Lots of people go to therapy looking for a fast, tidy solution like “Yes! You should quit your job!” or “No! You absolutely should not quit it!” Therapists, however, don't want to provide us with that response. Here’s why: They don’t have all the information, and so their solution might be the absolute worst thing for you. Instead, they want to guide you to your own solution by asking questions, assisting you through your own thought processes, and helping you identify what’s keeping you from making a decision. For example, if a patient is considering leaving her boyfriend, only she knows what’s really going on. “I see her once a week for 50 minutes, and I only know part of the picture,” says New York psychotherapist Allison Lloyds.

4. The Things That Unsettle You? They're No Fun For Me, Either

Cognitive behavioral therapy often requires people to get close and personal with the very things that make them anxious. So therapists such as Simon Rego, Psy.D., director of psychology training at Montefiore Medical Center, often find themselves, say, handling spiders in the office to help demystify the creatures to arachnophobes, or touching public-toilet seats to help OCD sufferers acclimate to germy surfaces. For many -- especially those new to the field -- this can be quite stressful. “We’re human,” says Rego. “We have fears of our own.”

5. I Know You’re Lying -- And It’s Okay

Nobody tells the truth, the whole truth and nothing but the truth. Memories don’t play events back like digital cameras. We tend to see things only from one point of view (ours) and remember them a little differently each time. After all, says Bea, “people are telling us their version of how they’re experiencing things.” Add to that: We sometimes directly lie because we think certain details are irrelevant, embarrassing or personal. (“I never smoke! I only eat organic! And I never, ever get mad at my mother.”) In most cases, counselors will keep quiet about when they suspect we’re fudging things a bit, even unconsciously, because calling someone a liar during a session can intimidate a person, destroying trust rather than creating it. Instead, they prefer to wait for us, subtly asking questions that reveal our conflicting accounts and offering us other opportunities to share more honest -- and usually more revealing -- portrayals of our lives.

CORRECTION: A previous version of this story stated incorrectly that spiders are insects. They are arachnids.