At a glance
Having been in therapy before changes what you need to prepare, and mostly it means preparing less. You already know how a session works. What is worth bringing is what you learned about your own way of using one. This article helps you start from there rather than from the beginning.
Clinical insights from 22 years in psychotherapy
I am Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- The fluent second account. People returning to therapy describe their difficulty better than they did the first time, and the fluency can keep the material at arm’s length.
- The comparison running underneath. Returning clients are often measuring the new hour against the old one for several weeks before they say so.
- What the last therapy did reach. People tend to report what did not work and leave out what did, and the part that worked is usually the better starting point.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
What do I bring in from the last time?
More than you think, and most of it is useful once it is said out loud.
If you have sat in a session before, you arrive already knowing a great deal: how long an hour feels, what you do when a question lands somewhere tender, which subjects you have a practised way of getting past. That knowledge is an advantage. It is also a set of habits, and the habits came from a particular room with a particular person in it.
So the useful preparation is not rehearsing your history again. It is noticing what you are expecting to happen because of what happened before. If the last therapy ended badly, you are probably watching for the same ending. If it ended well, you may be waiting for the same feeling and treating its absence as a bad sign. Either way the previous work is in the room on the first day, and naming it early saves weeks.
Should I explain the previous therapy?
Briefly, and with more attention to how it ended than to what was covered.
A full account of several years of work takes a session and tells me less than you would expect. What I want is smaller: roughly when, roughly how long, what shifted, and how it stopped. The ending carries most of the information. Therapy that tailed off because the appointments got inconvenient leaves something different behind from therapy you walked out of, and both leave something different from therapy that finished because it was finished. You do not need to have made sense of it. You only need to say which of those it was.
What is worth writing down, and what is not
Write what you would be sorry to leave without having said, and leave the rest to the hour.
- Worth writing. The thing you never managed to say in the last therapy, even in one word.
- Worth writing. What you want to be different about the work this time, stated as something you would notice rather than something you would feel.
- Leave out. A summary of what the last therapist thought was going on. Bring your own observation instead, and how I work is set out on my page about online psychotherapy.
- Leave out. A plan for the first six sessions. The order tends to arrive better than the one you would design.
If you bring a page, put it on the table and say it is there. A list you are quietly working through takes the hour away from both of us, and it is easier to use openly than to fight.
Does expecting less protect me?
It protects you from disappointment and appears to cost you something in the work itself.
Across 6 trials holding 491 participants in all, people who rated their treatment as more credible and expected more from it tended to improve more by the end, and that link held whether the therapy was delivered at a distance or face to face.1 The trials pooled different difficulties and different measures, and the distance arms were guided written programmes rather than live sessions, so this is a direction of travel rather than a rule about any one person.
I read it as a reason to take your own hopes seriously, not as an instruction to manufacture optimism. Low expectation after a therapy that went nowhere is reasonable, and it is also the thing most likely to keep the new work shallow for a while. Said plainly in the first hour, it becomes part of the work. Left unsaid, it quietly sets the ceiling.
What helps on the day, and when preparing works against you
Arrive with enough margin that the session is not the thing you are late for.
- Leave the hour before loose. Coming straight out of a meeting means spending the first 10 minutes arriving.
- Decide nothing on the way in. You do not have to have chosen the topic, or worked out what you want from me.
- Notice what you are hoping I will not ask about. Worth naming early, even if you follow it by saying you do not want to go into it yet.
- Give yourself somewhere to go afterwards. Some people leave lighter and some leave stirred up, and it is easier when the next hour is yours.
Preparing stops helping at the point where it turns into managing me. People who have been in therapy before are unusually good at this. You know what a therapist is likely to find interesting, and you can hand it over in a way that keeps you comfortable. If you catch yourself assembling the version that will make you easy to work with, that effort is the most useful thing you could bring in, and it is rarely only about me.
Preparation is also the wrong tool for part of this. If the hesitation is about whether to start again at all, a free 30-minute call settles more than a week of thinking does. I work in English with people wherever they are living, through online therapy in English, which for most people removes the practical reason the last therapy ended.
Questions people ask
Do I have to go over everything again?
No. A few sentences about when, how long and how it ended is enough to start from. The rest arrives when it is needed.
Is it awkward to say the last therapy did not help?
No, and it is one of the more useful things you can bring. What did not work narrows the field faster than what you hope for does.
Should I pick a different method this time?
Sometimes, and it is worth deciding after a session or two rather than before the first one. What went wrong is more often about what was never said than about the method used.
Will starting again take as long as last time?
Usually not, because the early part of the work has already been done once. People who return tend to get to the difficult material sooner than they expect.
What if I only half want to start again?
Say that in the first hour rather than deciding it alone beforehand. Half wanting to is the ordinary condition for starting, not a reason to wait.
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Sources
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
