It takes a lot of courage to walk into a therapist’s office. Many people think of asking for help for months or years before they actually reach out. Finally, you’ve taken that first step. Congratulations! Now, once you’re inside, how can you make the most of your experience? How can you make sure you are getting what you truly need?

Therapy is not a miracle drug. It requires work; you get out of therapy what you put into it. There is no halo of light that adorns the heads of those in therapy. The experience of writing a sizable check each week does not enact characterological change. What are the basic tools necessary for making therapy work for you? Finding the right therapist is a prerequisite; other articles have filled these pages with information on finding a competent therapist who meets your needs. But once you’re finally in the room, what then?

You bring much with you into the therapist's office. Pain, difficult feelings, burdens from your life and from others. These can be hard to talk about. Your therapist, at first, is a stranger. It is difficult to make yourself vulnerable, to open up about your struggles and your life. There may be things that you have never told anyone at all. You may think: Why should I tell my therapist now? What will my therapist think when I say this? How will he look at me afterwards? Isn’t it easier not to think about, to push it away yet again? How can I say this out loud to someone else when I can’t even say it to myself?

All of these questions come from one root: fear. Fear of being judged, of being looked at in a certain way, even fear of saying something out loud and thereby it becoming a reality. It can be easier to avoid these fears, to pretend something doesn’t exist, or to hope that it will go away. All of these feelings are normal. But you are in therapy now. You have taken a courageous step already. When you are ready, you can take the next step.

Let your therapist in. He can help you learn skills to deal with your life in a healthy way, and begin to heal on the inside. But in order to do that, he needs to know what is going on in your inner world.

The ability to be honest and open with your therapist will set the tone for your treatment. Often, the therapist has no other source of information about you other than what you share in your sessions. If your therapist does not know what you are struggling with, he will be of limited help to you. Often clients are ashamed to share their deepest secrets, understandably so. That’s okay. Give it time.

Have you ever been mad at a friend? Have you felt that he didn’t understand you, or did something he say or do hurt your feelings? How did you respond? Many of us would not say something to a friend if he said or did something to offend us; we don’t want to be viewed as rude or overreacting. These things can happen in therapy as well - therapists are human! - but such grievances are seldom shared with the therapist. That’s understandable, but regrettable. The therapeutic relationship, the relationship between therapist and client, is the vehicle for change. If there is something blocking that relationship, the ability of therapy to effect change will be greatly limited.

This relationship is different from any other relationship. In society, there are norms. There are always certain things you shouldn’t say to certain people, and there are certain things that are never acceptable to say. In therapy, these rules simply don’t apply. There is nothing you can not say to your therapist. There are limits to confidentiality (in situations like risk of harm to self or others), but there is no such thing as “you can’t say that.” Your relationship exists for the sole purpose of you getting help. If there is something that gets in the way of your getting help, it has no room in the relationship. On the positive side, if you give your therapist an accurate picture of what is going on in your head, he will be much better equipped to help you.

Be vulnerable. It can take time to let down your defenses; often this happens in stages. If you don’t feel ready to share something at first, don’t. Give yourself time. You can even speak about feeling uncomfortable or unready. A good therapist will understand, give you the space you need, and help you through it. Ultimately, therapy is what you make of it. It can be a tremendously healing, growing experience. But it takes honesty and vulnerability. And it takes work. Letting your insides out in the safety of the therapy room is a great place to start.

Shimmy Feintuch is a licensed social worker practicing in New York City. As a therapist, Shimmy currently works with children, adolescents, their parents and adults of all ages who are struggling with anxiety, depression, behavior problems, and other issues. Shimmy can be reached by emailing: [email protected].