Whether this is your first time seeking out mental health counseling, or you are already familiar with mental health services, here’s some information that will be helpful in getting what you need from the therapy process.
The foundation of effective therapy is a trusting and secure relationship with your therapist. Let’s take a look at the conditions that promote safety and collaboration in the therapist-client relationship.
Three conditions for therapy
Carl Rogers, known as the father of counseling, created the humanistic or client-centered approach to therapy. Rogers suggested there are 3 necessary conditions for therapy.
| Condition | How this is met by therapist |
| 1. Empathy– the ability to deeply understand and connect with the client’s feelings, thoughts, and experiences. | Clinicians demonstrate this skill by actively listening and accurately reflecting back what the client is experiencing with emotional warmth. This validates the client’s feelings and promotes self worth. |
| 2. Genuineness– the therapist’s ability to be authentic and transparent to connect on a r | The therapist demonstrates this skill by being honest and open about their own feelings and reactions when it helps the client’s growth. This encourages the client to also be honest and authentic. *It is important to balance genuineness with professional boundaries to avoid things like a therapist over-sharing or projecting their own values onto a client. |
| 3. Unconditional Positive Regard– is accepting and supporting the client in a non-judgmental way. | The therapist demonstrates this skill by praising a client’s progress and continuing to offer compassion even when the client is struggling with self-destructive behaviors. *UPR does not mean lacking in accountability. It means the accountability provided by your therapist is coming from a place of support and is not cruel, punishing, or dehumanizing. |
What Else? Secure Attachment in the Therapeutic Relationship
Have you heard of attachment styles before? In summary, attachment theory was developed by studying how children and adults behave in relationships. Therapy is a very social and relational process, so attachment theory applies to the therapeutic relationship, too.
Secure attachment happens when someone feels a healthy balance between being an individual and being part of a supportive relationship (whether the relationship is parent-child, romantic partners, best friends, therapist-client, etc.)
There are 5 conditions that promote secure attachment. What are they, and how are these conditions met by a therapist?
| Condition of secure attachment | How this is met by therapist |
| 1. Feeling safe | The therapist provides an environment that feels physically and emotionally safe to be vulnerable within. The therapist is protective of and advocates for the client’s best interests. |
| 2. Feeling seen and known | The therapist can demonstrate to the client they understand the client’s emotional experience (emotional attunement). |
| 3. Feeling comforted | The therapist provides compassionate responses with emotional warmth when the client discusses difficulties and concerns. The therapist provides a healthy level of soothing and reassurance. |
| 4. Feeling valued | The clinician expresses delight for the client’s efforts, progress, joys, etc. |
| 5. Feeling support for best self | The therapist encourages the client to engage in self- exploration (without imposing their own values on the client). |
Next time you have a session, see if you notice how your therapist may attempt to provide empathy, genuineness, positive regard, or the conditions for secure attachment. Let them know when they are getting it right- when their responses help you feel understood. If you often do not feel understood or validated, you can discuss this with your therapist and provide feedback on what would feel more validating. It is also important to remember that it takes time to build these conditions.
Frequently Asked Therapy Questions & Concerns
I talk about my problems again and again but I need more than to vent.
Bring this up to your therapist and ask about setting specific goals for treatment. It can help to say you would like to focus more on building skills for a specific goal like developing more self-compassion, improving communication, or coping with anxiety. Also, ask yourself, if I was getting what I needed from therapy, what would be different? How would I know? This will define your desired treatment outcome.
I feel like I should be getting better faster.
It makes so much sense that you want to feel happier, healthier, calmer, and more stable as soon as you can. It’s easy to get performance anxiety about your ability to improve in therapy. At the same time, healing does not happen in a state of urgency. Success in therapy is not about speed or perfection, it is about being intentional, open to change, and dedicated even in the face of setbacks.
I feel an urge to be performative, to “get an A+ in therapy”, or to say what I think my therapist wants to hear.
It is not unusual for clients to struggle to show up authentically or to want to win their therapist’s approval. This is especially common for clients who have developed pleasing people as a survival skill. Survival skills usually show up in the therapy space, and when this happens, it creates a good opportunity to work through and explore being more vulnerable. Being honest and vulnerable is a big win, even if it feels awkward or scary at first.
I am worried I am “too much” for my therapist or “too messed up” for therapy to work for me.
So many clients have these worries. Remember that your therapist has gone through a lot of training in their education and career to be prepared to work with clients. Also, even if your therapist is stumped, this does not necessarily mean you are “too messed up.” It might mean more time and commitment is needed or that you need a different approach.
I think my problems are not bad enough to require therapy.
It might be helpful to get curious about what you consider “bad enough” and the benefits of getting help now. Minimizing how difficult it is to get through the day is not uncommon for clients, and you do not have to be in a crisis or emergency to benefit from therapy. When a client is stable and not in crisis, this can actually be a great time for deeper emotional work and personal growth.
I think I have progressed enough to no longer need therapy, so I am going to cancel all my future sessions.
It is important to talk to your therapist before discharging from treatment. Ideally, at the beginning of your work together, you will discuss what your desired treatment outcomes are, and this will be a guide for your readiness to end treatment. It is common to gradually taper off; for example, if you meet weekly, dropping down to bi-weekly or monthly for some time. Even if you feel absolutely certain about ending treatment now, having a final “termination session” gives you and your provider the opportunity to discuss your progress, areas where you can continue to grow, and a discharge plan that will help you maintain the positive changes you have made so far.
My provider said or did something hurtful. What should I do?
As stressful as it might sound, usually the most effective thing to do is communicate to your therapist what they did or said, how it impacted you emotionally, and what specific action or response you need instead. A good outline for this is “When you said/did ____, it made me feel_____(emotion). Instead, would you be willing to ____? This would help me feel more understood and safe.” Talking things out like this can actually make your relationship with your therapist stronger.
I do not feel supported by my therapist, and talking it out was not helpful.
If discussion does not lead to repair and understanding or if you are concerned your therapist is violating legal or ethical standards, it might be worth requesting to speak with their supervisor or filing a complaint with their organization and/or the licensing board. You also always have the right to terminate treatment and request a referral for a new provider.
My therapist does not seem to have the specializations needed to help me.
Talk to your therapist about their specializations and their education, work experience, or lived experience with an identity, diagnosis, or therapy approach that is related to your treatment. Lived experience is when someone has personal experience with something. For example, a therapist who is black, queer, Christian, etc. has lived experience with these identities since they are a part of those populations themself. If it is important to you, many therapists feel comfortable answering questions you might have about their beliefs or worldview. Your therapist does not necessarily have to share the same experiences or beliefs as you to be effective though. Therapists are responsible for being aware of their own biases and refrain from imposing their values onto clients.
Between sessions, nothing changes, and I feel like I am not progressing. This seems like a waste of time and money.
It is important to provide feedback to your therapist on how beneficial therapy has been for you. So, if you feel you have hit a plateau, let your therapist know that you feel stuck. They will hopefully validate your concern and turn toward it with curiosity to explore what could be improved or what new things you could try. It is important to keep in mind that the therapy process is not entirely contained within the meetings you have with your therapist, and you are ultimately the agent of change. Completing assigned homework between sessions is crucial in order to transfer information and skills from sessions to your real life. Homework might be a worksheet, reading a self-help book, watching educational videos or podcasts, practicing mindfulness skills, writing a self-compassion letter, using communication skills, etc. in between sessions. The time and energy you dedicate to this will maximize the benefits of therapy, and you will likely progress faster. If your therapist does not assign homework, you can request this.
Therapy is too much for me to handle it at this time. Life is too overwhelming right now.
You have the freedom of choice to decide if and when you are going to engage in therapy. Some seasons of life may be better than others for intense forms of treatment like trauma focused therapy. At the same time, there will likely not be a perfect time to start, and putting off therapy too long may lead to a crisis, which would be even more overwhelming for your life. Thoughtfully weigh the pro’s and con’s before making a decision.
I do not think I can handle life without my therapist. I am terrified of what will happen if they move, change jobs, take medical leave, retire, etc.
Therapy is such an emotional and intimate process, so it is not abnormal to feel a strong connection to your therapist. It is also important to know that you are the one doing the work, and you are a capable person!! It is important to have healthy boundaries to avoid developing a codependent relationship with your therapist. Therapy is also a time limited process, and you can find a therapeutic alliance with a new provider should you still need therapy.
I was recommended to attend a support group or program that includes group therapy, but I feel like I cannot handle the social anxiety of being in a group and/or worry I will be “too much” for other group members.
Clients often feel uncomfortable with the idea of group therapy, and at the same time, that is exactly what makes group therapy an amazing opportunity for growth. If you tend to avoid socializing due anxiety, group therapy provides youwith opportunities to face the fear and over time improve social skills and gain confidence. If you tend to isolate due to depression, group therapy provides opportunities for you to break out of that behavior pattern. Group therapy challenges us to practice identifying and expressing our feelings and needs in real time- not just with a professional (the therapist) but also with peers (other group members). If you are worried about others judging you, know that everyone is coming to group therapy and support groups with things to work on and a need for support.
People also tend to have more in common than they do different. If you are having thoughts that sound like, “I am too damaged for group therapy…I will upset other people…or I will take away from other people’s treatment.,” those are self-defeating beliefs that we can work on reframing!! You are not damaged- you are suffering, and we all experience pain. As for upsetting others- it is powerful to feel our feelings alongside each other. Similarly, it is important for our nervous system to learn the difference between discomfort and danger. We can handle some discomfort in group therapy, work through it together, and feel stronger and more connected. Your group facilitator will also set boundaries around triggers that may be trauma related or any topics that might be off limits due to encouraging risky behaviors (e.g., glorifying substance use). Lastly, your treatment is just as important as the other group members, and group members can actually benefit from hearing others be vulnerable. So, your presence may give to others rather than taking away.
If any of the above resonated with you or someone you love, reach out to Athena Care so we can help. You can contact us by filling out this short form or call/text us at +1 877-641-1155 or email [email protected].
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Ashton Anselmo, LPC-MHSP
Counselor
Ashton has experience helping clients with mood disorders, PTSD, substance abuse, anxiety disorders, OCD, ADHD, and autism. They specialize in helping clients with historically oppressed identities, particularly LGBTQIA+, neurodivergent, and non-monogamous communities. Ashton values cultural humility, advocacy, and trauma-informed care.
Meg Stein, CFP
Editor
Meg is a certified mindfulness instructor and works at Alive and Aware Practice in Durham, NC. She has over ten years of experience as a content creator and marketing consultant, working in mental healthcare and social justice.
Sources:
Brown, D. P., & Elliott, D. S. (2016). The five primary conditions that promote secure attachment [Handout]. Therapist Uncensored. https://therapistuncensored.com/wp-content/uploads/2017/06/BrownElliott.5Conditions-1.pdf
Social Work Institute. (n.d.). The core of client-centered therapy: Carl Rogers’ humanistic approach. Retrieved August 18, 2026, from https://socialwork.institute/psychological-basis-of-counselling/carl-rogers-humanistic-approach/
American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf