So, What Are You Hoping To Get Out Of Therapy?

It’s virtually inevitable that I’ll be asked this question next week. And it’s a good question – there’s no point in two people going into business together if it turns out that one is an expert in smoking bacon and the other is vegan. But in the 6 psychiatrists and 6 psychologists I’ve seen, I’ve never managed to answer it.

My biggest problem is that I mostly see therapy as a participation sport, where I get a ribbon just for showing up. Maybe I’ll make more progress if I have a clearer idea of where I want to go.

Emotion regulation and distress tolerance

I’ve got tools galore. I’ve got colouring books and exercise games and stress balls and voodoo dolls. I’ve done DBT and I have worksheets and plans. And when I get upset, I still really believe that the only way to feel better is to hurt myself, and that hurting myself doesn’t matter. I need to work on that.

Shame, self-hatred and compassion

Shame stops me doing a lot of things I’d like to do – like surfing even though I’m bad at it, going to the gym when there are other people there to see me sweaty and ugly and panting, dancing at a concert even though I gave up ballet at 5 because my body rarely cooperates with what my brain is telling it to do. Shame keeps me awake at night remembering that stupid thing I said in high school. And self-hatred makes me punish myself for all the shameful things I see in myself.

I’d like shame to quit running my life. I’d like to look at a photo of myself as a child without being overtaken with the desire to hit my child self in the face. (I’d also like to understand why I have such violent urges towards the smaller versions of me.)


I’d really like to be able to say no to having sex with anyone I don’t want to have sex with. I’d like to stop feeling like I’m responsible for the happiness of everyone I know. On a more prosaic level, my workload would be greatly improved if I could learn to politely refuse when coworkers ask me to draft that document for them.

Mostly, I’m afraid that if I do have children, I won’t be able to set boundaries to protect them. My mother is unable to handle any sort of confrontation, and I’ve followed in her footsteps. For example, when I was 3 a man she knew grabbed me and threatened to break my arm for stepping on his garden, but she wasn’t able to say anything to him, so I took myself into the (stranger’s) house to hide alone. Don’t get me wrong, I wasn’t in any actual danger, but it’s not the kind of parent and not the kind of person I’d like to be. If my niece was in that situation, I would like to be capable of asking the person to take their hands off her and not to speak to her that way. Right now, I don’t know if I could, and I hate that.


When my brother C was barely 20, he needed surgery on his hand. When he woke up in his hospital bed, disoriented, I was standing beside him with my parents, and I joined them in mocking him for being a wimp over the canula in his hand, and rolling our eyes at each other when he wanted help holding a glass to drink from.

I am kind, most of the time, and I am caring, most of the time. But I struggle with a belief system that says that people who have trouble enduring physical pain are somehow lesser. Inferior. It’s often hard for me to summon compassion for somebody who has been scratched by a bush, or has a sore throat, or got knocked over at basketball last night.

I don’t like this, even as I can feel myself holding onto it. Pain is pain. It’s not my job to try to toughen people up by telling them that what they’re experiencing is wrong, that it’s not as bad as they think and they’re just being pathetic.


It’s kind of bizarre that I never developed an eating disorder. Most of the women in my family have a tortured relationship with food, and my mother, who was obese, projected her issues onto my teenage self, calling me a pig and pinching my hips. And like any neurotic teenager, I internalised that, embellishing a little – my usual refrain is fat disgusting pig. I overeat to drive away uncomfortable feelings, and even though I know that objectively I’m slightly under the “ideal” weight for my height, I always feel overweight.

But the most disruptive part of my relationship with food is my issues with other people eating it, another heirloom handed down through generations. My grandmother has a favourite threat – “if you’re going to eat like that, you can go outside and eat on the mat with the dog“. She’s not joking. In turn, my mother was very strict about table manners with me and my brothers. C and I both have almost a phobia of watching and hearing other people eat, especially crunchy food. Somebody could sexually assault me and I’d still smile at them on the street, but eat an apple next to me on the bus and I will disembowel you.

It makes being with other people challenging. The rage that rises up in me is completely inexplicable and barely controllable, and my hands clench into fists under the table. I can hear the judgments that arise – are you so greedy you have to eat that right now? jesus christ, slow down, why are you shovelling your food down your throat? – and I can hardly breathe through the urge to hurt them and make them stop.


I graduated from law school with first-class honours, and was the highest-achieving student in my state in my Aboriginal Studies degree. And I am so terrified of having a real job with real responsibility that I didn’t apply for a single graduate job, and went on to do two unpaid internships instead, and begrudgingly took a job when one of my intern organisations offered it to me. The idea of making mistakes and being reprimanded is so anxiety-provoking that every day of work is a struggle.

I have to learn not to crumple and cry every time I’m scolded for forgetting to insert page numbers on a document. If I can’t grow enough resilience and self-confidence to be able to handle the normal stresses of working, I don’t know how much longer I can stay alive.

Gratitude and remorse

I am a disaster at thanking people for Christmas presents. I’m also a disaster at apologising for accidentally breaking other people’s new expensive Christmas presents. Expressing gratitude is too vulnerable and gives other people too much power over me, and my shame at fucking up is so overpowering that if I admit to doing something wrong by apologising, I’m afraid I would actually drown in the wave of shame.


I’ve been taught not to get help in an emergency. A few years ago, at my brother C’s birthday party, my father collapsed, clutching his chest, unable to breathe, crying and making a kind of gasping, moaning sound. I thought he was having a heart attack and said I was going to call an ambulance, but my mother told me, sharply, “No!“. C and I both stood there, frozen, looking at each other for guidance but both unsure of what to do. I repeated a few times that I was going to call an ambulance, but each time I was told not to, and each time, I obeyed.

In hindsight, it seems so simple and obvious. The worst possible consequence of calling an ambulance is that it turns out to be unnecessary and I’m shamed by my family and possibly the paramedics for overreacting. The worst possible consequence of not calling an ambulance is my father dying on our kitchen floor while I watch and do nothing. No contest. But if the same thing happened again, I would do exactly the same thing, because in that moment of panic, that ingrained it’ll be fine don’t be a drama queen overpowers any capacity for logic.

On a broader spectrum, I guess this is mostly about wanting to have a better handle on what’s ‘normal’. Sometimes my family thinks something is hilarious, and I feel unsettled about it, but I don’t trust my judgment. An example is a favourite family story about my grandfather and my mother, when she was 4 or 5. They would go walking through the paddocks every day, and each day, Papa would offer my mother his hand. When she took it, he would touch the electric fence, sending a shock through her body.

Everybody thinks this is so funny: that she was so guileless she would keep taking his hand, every time, even though she kept getting shocked. But I think of that little girl, trustingly reaching out for connection and being hurt and mocked, and it just seems sad. I think about Rachel’s experience of attachment and pain being wired together, and it seems like such a literal personification of that.

But even though I’m sure, I’m not sure. Am I making it into a bigger deal than it really is? I want to know. I want to be sure.


It would be a distortion of the truth to say that this is something I want to work on. I feel triggered just thinking about it, and I’ve had to stop, close my eyes and take a few deep breaths. But I can acknowledge that the situation isn’t ideal. My mother had gynecological cancer with a high fatality rate, and she only survived because it was caught so early. Despite this, and despite having a few (minor) symptoms, I’ve never had a pap smear. I know this cancer kills – a friend my age died from it less than 2 years ago – and I do think about it, sometimes, but I would literally rather die than have anyone anywhere near my genitals.

On the other end of the spectrum, creating life rather than losing it, there is no way I could handle being pregnant. I’m happy to look into adopting, but it’s expensive, and I’d like to have a choice.


A few months ago, my teenage cousin came to stay with me, and we played a game called Scruples, which poses real-life scenarios and asks what you’d do. It quickly became apparent that I would lie, cheat, steal and do pretty much anything short of setting a puppy on fire in order to save money, or hold onto money that wasn’t even mine. I grew up middle-class but with parents who both grew up in poverty, so I understand it, but it’s also not a great way to be.

Of course, I won’t tell her most of the things on this list, and certainly not any of the details. That’s the paradox of shame – the only way to move past it is to talk about it, but shame is a powerful silencer. I’m ashamed that the list is so long, and a little ashamed of basically saying “please help me stop being a shitty person“. I’m afraid that I’m wanting too much, afraid of the shame I’ll feel if she says “those are good goals, but they’re really out of the scope of what psychiatrists and psychotherapists do – my role is really just to help you get the self-harm under control“.


So, What Are You Hoping To Get Out Of Therapy?

25 thoughts on “So, What Are You Hoping To Get Out Of Therapy?

  1. Umm your list is amazing. Well thought out, specific examples, etc. It is also your list so you don’t have to share it, especially with someone you are just meeting. Even if they are a therapist. At some point when the relationship or trust has built I hope you will share it because working through these things is important. It doesn’t seem like an overly long list or impossible list to me.


    1. I appreciate the affirmation! I am embarrassed about it being well thought out, because it makes me feel like I’m spending too much time thinking about therapy. I once sent Anna an explanation of my different stages of self harm and a few weeks later my psychiatrist commented to me that she’d told him I’d obviously spent a lot of time thinking about it and I ruminate on self harm too much. That really stung. So I will be wary of sharing this list but hopefully one day in bits and pieces I’ll be able to.


      1. You aren’t spending time thinking about therapy, you are spending time thinking about recovery and what it means to you. That is a good thing. And I am mad at Anna for saying that about your other list. Of course you spent time thinking about SH, thats sort of the nature of it. And to really diagram it is tough work (something I have been unable/unwilling to do). And then to shame you on top of that and not even talk to you directly about her concerns? seriously? how unprofessional, how uncaring, how misinformed, how lame. Its like we have to educate them about some of this really basic stuff and its totally not cool because we are paying the price (and not just financially). This is a good list. Your self harm list was good too. i am getting angrier the more i think about it. screw them! seriously they have issues. It would be great for you to be able to share this list with your new provider so they can be completely on board with your goals, and know the major concerns. And if there are issues you could walk away before any major investment. You have every right to be cautious because of your past experience, but I am so angry for you.


      2. You’re always in my corner! Thank you, E. It did feel like a slap in the face and this is really affirming. Have things been happening with Elle that have been upsetting you too?


      3. ugghh my reply got really long. Suffice it to say there are little things that bug me. Nothing major like you and others have had to deal with.


      4. Your first comment, or a reply to my question that you decided was too long and deleted? (I love your long comments, by the way. Totally make my day.)

        I have no judgment for you getting upset over little things – often they’re the things that stick in our mind and niggle us the most, because they don’t seem big enough to bring up so we never get to clear the air about them, and we get the added bonus of beating ourselves up for being upset about something “trivial”. So please, feel free to talk or rant to me any time.


      5. you are right, those little things can be soooooo aggravating precisely for those reasons! the long response has turned into a full page rant. Apparently I’m more worked up then I realized about a few things 🙂 Shortened version: I don’t like feeling like I have had to educate her on things like SH and I don’t understand why she doesn’t brush up her knowledge, especially when I’ve found some resources and shared them so easily accessible to her. I realized it makes me feel less then safe because I’m trusting her to be the expert, or at least be able to help me with some outside perspective! And I shouldn’t be winning in the “there is nothing that can be done” department. Why doesn’t she call me out when I’m arguing in circles? I don’t realize its happening until afterwards that I am debating and trying to “win.” And its mind blowing that she lets me get off contract. seriously. And maybe she could follow up on a few things with me from previous sessions? Be a little more curious as to why I do or don’t do things? discuss ways to be less stuck? I don’t know I’m not the expert. Maybe I just suck too much at therapy.


      6. Well, no wonder you’re feeling frustrated! Self harm is by nature a very isolating experience, and even more so when it feels like your therapist is leaving you to handle it alone. And the same with not following up on things – when they don’t try to understand our experiences (by research if necessary) and don’t follow up on things we’ve talked about, we feel like they don’t care and we’ve been abandoned, and it feels awful, especially when it takes so much for us to confide these things in the first place. I know it would be hard to bring up these frustrations with her directly, but maybe if the topics or the situations come up again, you could ask her why she does things that way/whether she read the resources/if not why not?

        Liked by 1 person

      7. umm yes it would be hard. It would feel mean. It does feel abandoning in some sense, but I also try to remind myself that she is human. She is good at lots of things, just not this. I wish she was.


  2. Sirena says:

    I think this is an amazing list and is perfect to share with a therapist you want to work with. But I also understand if you don’t feel like you can share it with a new person. I don’t think you’re a shitty person, I think like all of us, you are a sum total of your experiences.


    1. I know comparing is pointless, but I look at my brother C and how he got his emotion regulation issues under control without any therapy and it does feel like there must be something particularly shitty about me. I’m happy that you think the list is good – thanks S.


      1. Sirena says:

        You don’t know that your brother has. Some people repress things and they come back to bite them later in life or maybe he has emotional issues that he keeps very secret from everyone. Also trauma affects everyone differently, there’s a lot of factors involved. You’re not shitty. You are hurting.


      2. You mean I don’t know everything? How can this be?

        But you’re right, obviously. The fact that he’s stopped punching people in nightclubs and throwing TVs out the window doesn’t mean he’s necessarily a model of emotional stability.


  3. Very thorough and insightful. And I think attainable, long-term goals. So much of the beginning of therapy is building the relationship and just being there, working through the challenge in letting someone in. So you can tackle these more deeply-rooted, long-standing challenges. I don’t think you can do it wrong, sharing it now, or letting the goals come out over time.


      1. You can read them! All you have to do is click on whatever link it takes you to and I’ll grant you access. I switched it to private because I accidentally published a post Saturday night meant only for my therapist, that contained identifying information, and I felt uncomfortable having the site public. But I still want to maintain the connections I’ve established, and you are certainly one of those people.

        Liked by 1 person

      2. Oh, good! I was assuming you would have put up a public post inviting requests if that was the case, and I didn’t want to come banging on the door if you were trying to sleep.

        Long-term is the part that worries me. 18 months in therapy and I haven’t even scratched the side of any of this.

        Liked by 1 person

      3. Yes that would have been nice. When you shift to private, you can’t post something as “public” (to my knowledge). The whole site becomes only viewable to people granted access. And I am only granting access to other people with blogs. Which feels exclusive, but it is what feels safe right now.
        Well, 18 months in therapy, but I wouldn’t say the most effective therapy for your needs. I think 18 months in effective therapy would show you quite a bit of difference.


      4. You open yourself up so much and as you said to E the other day, you’re mostly writing because writing in itself benefits you – so it’s an amazing gift that you let anyone read it at all. You should definitely put whatever restrictions you need in place.

        Liked by 1 person

  4. Hi Rachel, this is a weird way to contact you, but I’ve been a lurker/sometimes commenter on your site and I miss reading your posts! Do you have an anon email to contact you at to request a log-in?


    1. Thanks PD! I’m frustrated with myself for not actually sharing it with my therapist, but I guess at least it’s something I can go back to when I’m thinking about whether I’ve made any progress.

      Liked by 1 person

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