What is your therapist doing during the session?

Sometimes, you might hear people say that therapists just sit there, stay silent, occasionally repeat what their clients say, or even seem to be “half-asleep”—and get paid for it. And honestly, anyone could do that, maybe even better—after all, we all know how to talk and nod, right?

Well, as a psychoanalytically trained therapist, I'd like to share with you what *actually* happens during a typical therapy session.

So, here’s what I do during a 50-minute session:

- *I listen with my ears* to what you’re telling me.
- *I listen beyond my ears*, through countertransference: I pick up on the emotional reactions you’re transmitting nonverbally, through what’s called projective identification. This way, I attempt to hear even the parts where you are staying silent.
- *I listen to and observe your body language*: I notice your posture, how you’re sitting, the way your hands move, and so on. Sometimes, your body conveys strong emotions that words can’t express.
- *I connect these three elements* to understand you better and help you see yourself from a new perspective.
- *I decide what kind of intervention* to offer—whether it’s focused on the “here and now,” your emotions, or analyzing unconscious defenses you might not even realize you’re using.
- *I choose the suitable moment* for that intervention during the session.
- *I gauge when it’s appropriate* to provide psychoeducation, explaining what’s happening between us and helping you manage frustration with a clearer, steadier view of yourself and your processes.
- *I analyze what I’m hearing* and connect it to your goal for the session.
- *I link your session goal* to your broader therapy goals.
- *I check in with myself*: Am I staying empathetic and genuinely wanting to help? Am I maintaining therapeutic boundaries, or am I slipping into a non-therapeutic alliance? And if so, why?
- *I keep track of where you are* in your therapy journey and how close we might be to the next potential crisis—like when you might say, “I want to quit therapy!” Not because you actually want to quit, but because the frustration or trauma feels unbearable, and running away seems easier. But if you’re in therapy, you’ve probably already tried running from yourself and realized it doesn’t work. And yes, we can prepare for these crises. With a therapist who understands this, you might not even realize it’s a crisis until they gently point it out.
- *I try to balance* not pushing you too hard while still showing you when and how you’re trying to escape from yourself, from me, or from what’s happening in therapy.
- *I reflect on how this session connects* to the last one and how it might shape the next one. The emotional impact you leave with today will influence what you bring next week. This helps keep the process cohesive, not fragmented.
- *I draw on various theoretical frameworks* to make sense of what’s happening, and I might share some of this with you—but not too much, because I don’t want to turn therapy into a psychology lecture or become your teacher instead of your therapist.
- *I ask myself if my personal stuff* is intruding on your therapy. Sometimes, clients’ stories hit close to home, and as a human being, I might feel sadness, anger, or even regress emotionally.

*Outside of sessions, I:*

- Constantly read books and articles, especially on psychoanalysis, object relations, and couples therapy.
- Write my own articles.
- Keep learning.
- Regularly consult with supervisors and see my own therapist—carefully chosen professionals who help me maintain the quality of everything I’ve described above.

As you can see, the amount of the invisible work is massive and emotionally intense. So, if you think your therapist is just sitting there, repeating what you say, occasionally dozing off, and then sending you a bill, that’s probably not the case. Or, at least, speaking for myself. But nodding is there, for sure.

Published by author on Psychology Today: https://www.psychologytoday.com/us/blog/the-psychology-of-relationships-and-emotional-intelligence/202503/what-is-your-therapist-doing