Therapy can be extremely beneficial if the patient and his or her therapist work together as a team. Good therapy can be enlightening, educational, improve relationships and increase quality of life. Unfortunately, bad therapy can be unproductive and a waste of time. It can even be harmful or make the situation worse. Assuming the therapist is providing the right amount of structure and accountability, what can the patient do to get the most out of a course of treatment? One thing that will increase the benefits and reduce the negative side effects of therapy is preparation for every session. It is the difference between having an expensive conversation with the therapist and getting some high quality work done.

The therapy session is a very short amount of time compared to a week or two weeks between sessions. This makes it important to keep a record of what happened during the week. Instead of attempting to remember the important aspects, a journal or notebook will provide focus and prevent wasting time.

An inexpensive notebook works well for this. A small one that is easy to access throughout the day is best. Structuring it in the form of a mood journal can be very helpful. This is accomplished by dividing the pages into three columns. The first one is for important events that occurred during the week. The second is for the resulting mood or feelings produced by the event and the final column is for the thoughts that led to the moods.

As a cognitive therapist, I like this format because it sets up the session nicely. It dove-tails into a rigorous analysis of the patterns of thought that may be exacerbating negative mood states such as anxiety and depression. New ways of thinking and behaving can be implemented to improve mood and overall effectiveness.

For others, it can be helpful to journal at the same time each day, in freeform. Writing a summary of the day or simply the first thoughts that come to mind may help the therapist see a sample of what has been happening throughout the week. At a minimum, making a list of topics for the session is beneficial.

It is difficult for me to remember what I had for lunch yesterday, much less how I felt three or four days ago. Without a record, all experiences tend to fuse into one mood. If someone's predominant mood is consistently negative, neutral or even positive experiences may not be recognized as such. Working through each one separately can help untwist the irrational thoughts that perpetuate the distorted perceptions of reality.

Because the actual face time with the therapist is such a small portion of the week, the greatest amount of work occurs between sessions. The patient and the therapist can design homework assignments that will maximize the benefits of the work done in sessions. Taking notes or summarizing the session right afterward, prevents forgetting and helps maintains follow through.

Just the action of working hard in one focused therapy session can lead to a boost in mood and a positive change in self-concept. The change is immediate and can be a confidence builder for someone who has felt incapacitated and helpless.

Another reality of therapy is that working through painful experiences can activate painful feelings. It may feel worse before it feels better. This is a time when many people drop out, feeling defeated, with a negative perception of therapy. Keeping a record of progress can help. By showing that despite some intermittent regression, functional behaviors and thought patterns have produced positive changes.