Uncertainty: it’s even present in therapy

Sometimes folks begin therapy believing that attending therapy alone will solve their problems. They believe (even hope) that by talking with a trained therapist, they’ll start to feel better, and their symptoms will dissipate.

People ask me: how long will this take? What time commitment do I need to make? What’s the success rate? When can I expect to feel better? What do I need to solve this problem? The answer to all of these questions (and likely many more) is, “it depends.” 

Yet, it’s reasonable to want answers to what seem like straightforward questions:

Question: How long will therapy take? 

Answer: It’s going to vary based on what you’re trying to address and how much time you’re able to spend reflecting on what’s in therapy and making changes outside therapy.

Q: I’m trying to address depression: how long does that take? 

A: Again, it varies based on symptoms, your history, your support network, whether you’re also taking medication, whether medication works (or continues to work), and how you utilize your time in therapy. Are you able to implement what’s discussed in therapy, even if you’re not feeling motivated on your own? How do you want to balance what’s going on for you in the present as compared to what may have happened previously in your sessions?

Q: If I do everything that’s suggested or discussed in therapy, what will the time commitment be?

A: Again, that depends on whether you can just make yourself do what’s discussed without having to find your self-talk or brain fog or lack of motivation. What’s suggested may also vary in terms of how time commitment; if you’re trying to implement a meditation practice, the time spent there should increase over time as you become more able to sit with your thoughts, emotions, and sensations.

We like to know what’s involved to be able to integrate a new commitment (such as participating in therapy and doing the necessary work outside the weekly session) into everything else that’s going on in our lives. We may be caught by surprise just how debilitating mental health symptoms can be. Or how they can impact us years after a precipitating event that we thought we’d addressed.

Not having all of the information up front can make it harder to commit to an ambiguous process, which therapy is. When something feels overwhelming, and we don’t have a way to measure our progress or to know where the finish line is, maintaining tenacity can be even more difficult. Intrinsic motivation (i.e. motivation based on the inherent satisfaction of a process or motivation based on an internal desire) is likely needed to stick with a process when you’re trying to figure out what works for you or what allows you to get past a specific block or change a specific, long-ingrained habit.

Though I’m using therapy as an example, our dislike of uncertainty shows up in numerous situations, similarly causing discomfort or distress. (Uncertainty related to this presidential election? Does that resonate for anyone?) Feeling uncomfortable with uncertainty can lead to the presence of symptoms consistent with anxiety. Asking question after question–trying to get concrete answers to each–is a sign that we want some type of reassurance.

Some tips for coping with uncertainty

How do we cope with uncertainty? How do we engage in a process not knowing the outcome? How long could it take? Or will it be successful? (If I answer, “it depends,” how does that feel? Note your reaction.) I offer a couple suggestions, though there are many others.

Do what you can and are able.

While we don’t have control over everything, we have control over our own actions. We have the ability to choose how to respond to something and to take actions that are in accord with our goals. As I’ve been addressing uncertainty in relation to therapy outcomes, a practice of control related to therapy is tracking your feelings and thoughts and situations throughout the week to share what’s most relevant with your therapist. This doesn’t need to be in any formal CBT-type of way but simply jotting down specific times during the week where you feel most stressed and noting what sensations or thoughts you have with those can help direct your next therapy session. You may also exercise control by journaling to reflect on each therapy session, noting what you learned or what surprised you, and by completing any exercises/homework your therapist suggests and learning from these.

Become comfortable with ambiguity.

When you notice yourself feeling uncomfortable by not having the answer or not knowing what will happen next, ask yourself why you need to know. Notice if you’re feeling the need to dictate circumstances or exercise control, if you’re feeling the need to plan, or if you’re feeling something else. By getting curious about why you want to or need to know something, you’ll better understand what’s beneath your discomfort. Instead of trying to “solve” the discomfort, curiosity allows you to just experience what is, knowing it will pass. Although it seems counterintuitive, allowing yourself to get comfortable with discomfort actually helps it pass more quickly. 

Attend to what is.

Be present! Trying to predict the future (something none of us can do) often leaves us feeling more anxious–and may create an attachment to a version of the future that may or may not happen. Such attachment can magnify or intensify suffering as current anxiety or future disappointment. Mindfulness helps with this, and mindfulness is a practice. Which means you have to practice! Just as you can’t sit at a piano and play your favorite music without practice, our minds and bodies aren’t conditioned to notice and observe the present. With respect to therapy, you might think ahead to or try to visualize an outcome without being fully involved or attuned to the process. And it’s unlikely to get to the outcome you want without engaging in the process.

In summary, if you’re contemplating starting therapy, it’s going to be hard to know exactly how it’s going to go and how long it may take. Therapy is a process that can not only address the symptoms that initially led to your seeking therapy, but therapy can lead to growth and change in other areas of your life. You may not expect other parts of your life to change, and you may welcome your ability to confront other challenges and to learn about your courage and resilience even if that means working toward your original goal takes longer.