It is crucial to know why you are in therapy, in terms of having an overall idea of what you want to work on and a sense of direction. But besides that, fretting over the content of your questions or trying to nail down the exact words to describe an issue will only increase your anxiety. As a result, you will end up feeling too uncomfortable about your sessions, experience resistance and will end up fighting with yourself.

Instead, between sessions, let those various questions and thoughts come and go in your mind. It’s fine to make a mental note such as ‘Next time I want to talk about such and such’ but there is no need to concretise it any more. By the time you sit in front of the counsellor, you might realise that something else is more relevant and that you want to focus on that.

I would suggest that at the beginning of each session, you and your counsellor allow for a moment of reflection during which you connect to what is important for you right there and then. This space will help you to settle into the session and clarify the themes you want to explore. This way of working will ensure that your therapy is guided by your authentic needs rather than a rigid set of pre-planned topics.

Most people think that getting upset during sessions is a necessary evil that simply needs to be accepted as an unavoidable part of counselling. In fact, many individuals refuse the idea of counselling exactly for this reason – they are worried that the therapeutic process will make them overly emotional and that talking about their issues will be a painful and destabilising process. This misunderstanding is unfortunately reinforced by TV shows and films depicting therapy as a place where remembering repressed traumatic events, weeping or being enraged is the only way to get better.

The truth is that staying in a highly charged emotional state for most of the session won’t be helpful, and will in fact slow down the healing process. When our nervous system is overactivated (that is, when we are very upset and feeling out of control), the area of the brain responsible for sense-making, memory and insight is switched off. Most of the blood in the brain flows to the limbic system which is responsible for survival and for dealing with threats, while the cortical areas associated with cognition and information processing are inhibited. In other words, when we are overwhelmed with emotions, we can’t think clearly and can’t properly hear and understand what our therapist is saying. We can’t make sense of our emotions because we are dominated by them. People can go through a whole box of tissues, leave their session emotionally exhausted, but without any sense of increased wellbeing and without having learned anything new.

It is therefore crucial that the therapist shows the client how to ‘put on the brakes’. By learning how to regulate the nervous system (for example through working with breathing, grounding oneself in the body or connecting to a pleasant memory from the past), the client will feel safe and will know that emotions are going to be processed in a way that is not overwhelming. The leading trauma therapist Babette Rothschild uses an analogy of a Coke bottle which is full of pressure. By unscrewing the cap slowly and with enough pauses, we can release the pent-up pressure without any spillage.

For therapy to be effective, the client has to accept the support of the therapist and be open to suggestions and feedback. Without this level of trust, it is very difficult for change to occur because keeping a safe distance from the therapist will only lead to a superficial way of working.

In fact, one absolutely essential condition of a transformative therapeutic work is for the client to become affected by the therapist. When you ‘let the therapist in’, drop your guard, and the therapist then responds in a warm and supportive way, this experience can lead to a profound sense of healing. You realise that being ‘vulnerable’ and open is not dangerous. Moreover, by seeing that it’s safe to open up, it becomes easier for you to open to other people in your life and reach out to them, which makes you feel more connected and supported.

But this willingness to be transparent does not always come naturally and the survival instinct to ‘hide’ and withdraw from an authentic contact will often take over, so be patient with yourself. Once you have spent enough time with your counsellor and see that they are truly caring, I would suggest that you take a risk and let yourself be transparent and direct. It might feel scary at first, but it is definitely worth it.

A lot can happen in one session. You might spend the hour exploring different themes and making links between them, or stay with one topic and delve into the details. Whatever the content of the session, it is useful to take a few minutes at the end and reflect on what has been learned. Ideally, the therapist should initiate this final reflection and make sure that there is enough time for it. The question you can ask yourself is ‘What do I want to take home with me today?’. The take-home learning could be a single word summing up your main insight, an image representing something you found useful or a plan to try something new this week.

This period of final reflections is called integration and it ensures that the therapeutic work is connected to your daily life and that the time between sessions is a continuation of the therapeutic process.

It’s a good habit to regularly look at the therapeutic work and acknowledge how far you’ve come and where you are heading. This activity of reviewing the past sessions and looking ahead is very useful because it keeps your therapy on track. As a client, you entered counselling with certain intentions in mind and reminding yourself of these will give you a and your therapist a renewed sense of direction. The beauty of regular reviews is that they highlight any progress made and this reinforces your trust in the process and gives you a sense of achievement.

Counselling requires a considerable investment of time, energy and money. By following the above suggestions, you will ensure that none of the effort you put into therapy is wasted. Being proactive and contributing to you own sessions in this way will give you a sense of ownership, which is a powerful catalyst of the healing process.