Thinking about starting therapy can be quite intimidating at first. You may be asking yourself, "which therapist do I choose?", "do I really want to talk to a stranger?" or "how much will it cost?" This article seeks to answer some of those questions.

Why our past experiences matter

It was Sigmund Freud, the founder of psychoanalysis (a talking therapy), who discussed how those unprepared to think about their past, or unacceptable thoughts, were effectively offloading these impulses into their unconscious – a part of your mind that's doing its own thing without your knowing, like dreaming. And if you throw a bad experience into that part of your mind, it can take a real effort to keep it there (repression), and that effort can be converted into a symptom, like anxiety.

Part of my work as a psychodynamic counsellor is to work with a patient to develop a safe enough relationship so that such repressed experiences can surface gradually. And it's during this work that a counsellor and patient together might become aware of and curious about patterns of behaviour; such behaviour can indicate ways that we keep painful feelings and experiences at arm's length.

In my work, I have watched patients discover how they had pushed painful memories into a part of the mind they didn't have to visit. Some patients need long-term psychodynamic counselling because it can take time to unpack years of experience.

Why the therapeutic relationship matters most

There are several distinct modalities of talking therapy. Some patients opt for Cognitive Behaviour Therapy (CBT) which is goal-directed and time-limited. Psychodynamic therapy takes a longer-term approach and cannot be easily rushed, targeting lasting self-understanding. Psychodynamic therapy, CBT, indeed any therapeutic modality, can all play an important role in navigating psychological distress.

However, the quality of the relationship between counsellor and patient matters the most – it's more important than the modality used. The most important bit is that you've started talking to someone. And frankly, if you feel talking therapy isn't working for you, it's probably because you're not getting on with your therapist. There isn't a good "fit". So, get another therapist – there are plenty to choose from.

Ambivalence and readiness

Ambivalence is a huge word in psychodynamic therapy. You might be tempted to start therapy, but you're afraid of what it might look like. You don't really want to confront the problem, but you know that something must change.

I have met patients who are just not ready for therapy; it might just be the wrong time for them. Work is too busy, finances are stretched, thinking is elsewhere. It's what's stopping them that interests me.

Psychoanalyst Donald Winnicott wrote about a parent's ambivalent feelings towards their child, loving them but also needing a little space from time to time, arguing that a parent doesn't need to be perfect, just "good enough". His argument surely speaks to something wider than parenting: ambivalence is in all of us. The prospect of therapy might feel daunting, but that's not a reason to wait until the fear goes away. This is a topic I wrote about in an earlier essay.

How conversation and reflection work

In its simplest form, talking therapy is about conversation. Freud began instructing patients to lie down on a couch and say whatever came to mind – free association. That experience of a predominantly one-way conversation is initially bizarre, and often uncomfortable – but that's the point. Are you prepared to experience vulnerability and pain, in a safe therapeutic environment, for increased self-awareness?

The one-way conversation should be about the patient, not the therapist. A good therapist must consider whether the patient can reflect on their life and experiences, and whether they feel safe enough to speak openly about themselves.

Psychodynamic therapy is about putting words to experiences that might otherwise remain hidden. Through conversation, experiences become real, and don't just linger in the mind. Without the willingness to reflect, experiences and feelings stay locked away.

Willing to invest in yourself

Perhaps now you've become interested in starting therapy, but not 100% sure what to do. My advice is that you need to be willing to show up, to be honest, and to accept that it will be hard work. You need to embrace an "I'm going to invest in myself" attitude. Just beginning a new way is more important than being locked in from day one. Just starting is a start.