What happens in therapy? Maybe you’re a therapy veteran and you know how this works, you know what to say and you know what to expect. Or maybe your only experience of therapy is from the movies:

• Deep Roy plays a therapist in Tim Burton’s Charlie and the Chocolate Factory (2005). As an Oompa Loompa, Roy sits on a chair with a notebook and pencil and says absolutely nothing: he merely nods sagely while Johnny Depp lies on the couch and talks about his childhood. Depp does all the talking and comes to new insights about himself. He says that Roy is very good as a therapist. Roy says nothing.

• Judd Hirsch is the therapist in Ordinary People directed by Robert Redford (1980). He’s a somewhat active, empathic man who listens to Timothy Hutton’s character and helps him deal with the pain of his brother’s death in a sailing accident. As Hutton re-enacts the sailing accident, Hirsch promises not to let him go.

• Robin Williams plays a slightly alcoholic, grieving widower who is a college professor and therapist to Matt Damon’s character in Good Will Hunting (1997). Human to a fault, Williams almost punches out his client when the client disrespect’s Williams’ character’s dead wife. Williams’ character demands respect from his client and helps his client to form better adult relationships. In the end the client goes to California to see about a girl.

Borrowing a phrase from Billy Crystal in Analyze That (2002), therapy is a process, a means to change. People talk to therapists when they want change. They may want to change themselves; or somebody else. Or somebody else may want them to change. Johnny Depp wanted his father to love him. Timothy Hutton wanted not to feel guilty about his brother’s drowning. Matt Damon was an antisocial genius that others wanted to change so that he could better use his gifts. In every therapeutic situation somebody wants somebody to change. The driving force is usually pain. People want change because the way things are is too painful to bear, so they want to change themselves, or somebody else, to lessen the pain. People see or send others to therapists because they want the pain to go away.

Change is painful too. Think about the last time you changed: bought a new house, a new car, got fired, got a new job, left a relationship, started a new one, lost someone. Good or bad, all changes involve pain of loss and pain of learning new ways. Change can be exciting, of course. But also painful. So whether you will change depends on how much pain you’re already in. If the pain you’re in is greater than the pain of change, it might be worth changing.

When you come to see me, it’s not painful - not at first. I have a comfortable room. I will offer you coffee, or water. You will sit on my comfortable couch. And you will talk. Now how painful is that? And mostly I’m just going to listen to you. When was the last time someone really listened to you? You might even enjoy seeing me.

As I listen to you, I will begin to respond to you, to tell you what I hear you saying. Because I am a multigenerational therapist I will probably draw out your family tree, and ask you questions about your family, about things that seem to bear on the thing that is causing you pain and bringing you to my office. And I may do some other things with you, but mostly we will talk together. I have a few basic rules about my office:

• The room must stay safe for everyone in it. We don’t insult each other, or call anyone names, or threaten anyone. Anger can be expressed - I’ll show you how to do that safely, and respectfully. Sadness can be expressed, and often is. I make a lot of people cry. That’s why there’s Kleenex on the table. I make a lot of people laugh, too. I mean no disrespect when I bring humour to bear on your problem, but I know that laughter is a creative process, a means to change. But whatever happens, you’re safe in my room, and so is everyone who comes with you.
• You must be heard, understood, and respected. Next to what you do for yourself, the therapeutic relationship is the thing that causes the most change. It has to be a good relationship.
• We work on and talk about what you want to work on and talk about. The therapy hour is for you, not for me. I may tell you things about myself, but only if I think they are relevant to your concerns, and that they will help you.
• The therapy has to be helping you. I have ways of tracking that. And if it’s not helping, tell me. Then I will change. Or I will help you to change therapists, find someone more helpful for you.
• Something new should happen for you in my room. Some new way of thinking or feeling or behaving. To borrow a phrase from one of my alma maters, now gone and mutated into something new, I will invite you to creative change.

And this is what I require of you:

• Show up on time. Appointments usually start promptly on the hour.
• Pay your bill at the end of each session (I take cash, cheque, debit and credit cards).
• Keep your appointments, or give me adequate notice of cancellation (24 hours).
• Be honest with me. Tell me what’s really going on. Tell me how you really feel. And if you don’t know what’s going on or how you feel, tell me that. We can work with that.
• Let me be a guide to you. Consider what I have to say. Let me be direct and honest with you.
• Tell me if you think I’m wrong. Ask me if you don’t understand what I’m doing. Expect me to explain my methods so that we can be partners in change.
• Be willing to take risks, try something new.
• Think about what we’ve talked about, and practice homework, new behaviours and new insights between sessions.
• Cultivate a sense of humour, and an ability to laugh at yourself.
• Laugh or cry, but take the work seriously. Commit to making a lasting change.