Mental Health / Speaking Out

What Really Happens In Therapy?

. 11 min read . Written by Priyanka Sutaria
What Really Happens In Therapy?

In this two-part series, I talk about how I went for therapy for a year, and what actually happens when you get mental health support.


When I had a mental breakdown after seven weeks of lockdown, it was a major win for me. Let me explain why.

As of 2020, I have struggled with anxiety and depressive episodes for about twelve years. And for as long as I can recall, my response to most traumatic stimuli has always been to buckle.

My troubled mental health has always felt to me like earthquake after emotional earthquake. Buckling under pressure is just what I have tended to lean towards. So when it took seven weeks of being in a pandemic, in a lockdown, in a high-stress situation for me to finally buckle — it tasted like success. That was when I knew that I had made the right decision by going to therapy.

This episode convinced me (yet again!) that the mythology of therapy has to be rewritten. I’ve written about that, and you can read about that here.

But in this piece, I want to talk about my mental health, my experiences with therapy, and what my mental health processes are.

Trigger Warning: There are a lot of potentially triggering words and descriptions in this article.

Note: While I have been in therapy, I am not generalising its effects or giving you advice that you should follow.  What worked for me might not work for everyone; more so because these are processes tailored to me. 

Additionally, my experiences are also impacted by the fact that I have had the privilege of being able to access a good therapist, and have the support of my family to do so. Both of these are not easy to obtain in India.

What Actually Happens In Therapy

As I said in Part 1, it took a decade for me to go from ‘something is wrong’ to ‘I am in therapy’.

This is that story.

My First Brush With Mental Help

I recognised that something was wrong almost as soon as it began going wrong, at the end of seventh standard. My external indicators included sudden anger management problems, which I knew for certain were not normal. Losing your temper is one thing, but frequent black outs while being angry are certainly not.

I was lucky, in a way. My parents were aware something was different, and they did not see the tackling of mental health using professional help was a problem. They took me to see a therapist, but she was not equipped to deal with a child.

She asked me why I was angry. I did not know (I mean, come on! I was 13!). She told me to keep a diary and write down whenever I got angry and why. It didn’t work, and seemed foolish to me. Especially because the reason I was actually blacking out from getting angry was that I was being bullied in boarding school, and I didn’t know it was bullying

If she had talked to me instead, I would have stuck around. But I didn’t, and the episodes got worse and worse. At home, where I wasn’t bullied, my parents were struggling to help me while I ranted about how everyone hated me.

When I left boarding school, it got a lot better very fast. Without the immediate presence of the trigger, I found it very easy to just forget and suppress what happened. Plus, I had already had an unhelpful brush with mental help. I didn’t want to relive that uncomfortable experience again.

But suppression can lead to outbursts and spillage, and I did have random episodes here and there.

But overall, I was heading in the right direction. Yet, I couldn’t get by on my this forever. 

My Second Chance To Mental Help

In college, away from home once more, I was bullied yet again. And the dam of suppressed memories exploded into one three-year long breakdown.

Three mistakes I made:

1. I acknowledged that something was wrong, but I tried to self-diagnose instead of getting help.

2. I avoided telling my parents and friends how bad it was, even when I was thinking about death 24×7. Not suicide. Just dying. But I kept it all to myself.

3. I didn’t realise how stubbornly I was pushing away the possibility of getting help because I had one off-putting experience.

So I tried again. 

It went worse, because this time, I went to one of Mumbai’s top psychiatrists, and he was operating some kind of industry in his clinic. First, one assistant took down my history in a room. Then I was asked to fill a form with about 200 questions in a very short period of time, which is not the best thing to do to someone who has come in saying they have anxiety attacks.

Then I was made to wait an hour. Then another person took down my history. Finally, when they took me to see the doctor, he sat behind a large desk in a room populated with 3 assistants. He belittled me, made me feel crazy, and blamed me for my problems.

My sister had accompanied me, and at one point, he stopped addressing me entirely, talking only to her. He told her that I could not be trusted to take medicines because I wasn’t stable (false!), and I would have to be taken for injections every week instead.

He didn’t even speak to us for more than ten minutes before sticking us in the waiting room again. By then, I had had enough and I just walked out after paying the inhumanly high fee.

I was incensed. I had come here for help and instead I had been made to feel unsafe and stressed the whole time. I deserved better.

And armed with my newfound dignity, I was finally certain that I needed help and that it was going to be with someone good. I refused to give up this time.

Third Time Lucky With Mental Help

Eventually, through a family friend, I went to a third person with the hope that they could help me. And what do you know… third time’s the charm!

The third person I went to was a clinical psychologist and psychotherapist. In the first session, she asked me a few questions about how I was feeling, what was happening, and other personality indicators.

She asked me to get my blood sampled for a few tests, and seeing that my B12 and iron levels were extremely low, she asked me whether I would prefer pills or weekly injections. This was when I knew that I had made the right decision to come to her. 

A lot of what made this therapist the right one for me was that I felt autonomous. A lot of what I had been struggling with was a lack of control over my life, and the way in which I responded to my triggers. 

Being granted autonomy was a part of the therapy setting that was created for me. It lead seamlessly to the identification of my micro concerns and the reconstruction of my responses.

In my second session, I received a diagnosis: Post-Traumatic Stress, which manifests for me in the form of anxiety, panic attacks, depressive episodes, and ideation of death. Previous versions have also included anger, as mentioned above, and self-harm through starvation and lack of self-care. 

Basically, I have spent twelve years living with the unholy trinity of (1) perpetual sinking feeling, (2) occasional hysteria, and (3) The Void. 

I worked with my therapist for a year. And having been out of therapy for exactly two years, I won’t lie, I have come out of it a refreshed person. 

And what I realised was that while I did have a guided narration through the journey, a lot of the reason I am able to manage my mental health today is because of the work I put in too.

But Really Though, What Actually Happens In A Therapy Session?

Here’s what went down in my therapy sessions:

1. My therapist had a desk, but for the sessions her and I sat face to face in chairs next to the desk. It made me feel less intimidated, and more open to sharing. She offered me a beverage every time. I had coffee.

2. We spent every session talking about my experiences. We wondered out loud what the reason behind a response to a certain stimulus might be. We worked to understand how I am feeling about it, and we never just spoke about it once. We spoke repeatedly about a few triggers, a dozen times each, to learn how to reconfigure the ways in which I was expending my mental energy.

3. Through the course of the year, this persistent discussion and active detangling of my complicated mindscape, we had developed a few processes which were just adaptations of the way I was dealing with it myself. By upgrading and tweaking those defense mechanisms which were not destructive, we were able to make my transition from disorganised to organised processes smooth.

As I said in Part 1, I needed healing. I found so much of it in therapy. The rest of it, I am discovering along the way.

What Are My Mental Help Processes?

When I started therapy, I had ten years of mental health issues under my belt. 

I had gone from boarding school, back to hometown, college, and work, all the while struggling for stability. Yet, in between anxiety attacks and bedbound days, no matter what, there was always The Next Thing

I would always think to myself: this will all be better when I move on to The Next Thing. It didn’t matter if it was better or worse than the previous thing, but for ten years I waited for The Next Thing to change the tide. 

And it didn’t work, not very much, but it moved me along until I found courage in The Next Thing once again, and this time The Next Thing was therapy. I found therapy. and through therapy, I found processes.

The funny thing was, I already had the process. It was The Next Thing, but I was looking at it with an escapist’s eye. 

Therapy, with its repetitive identifying, learning, processing, and unlearning, created a space for me to look at The Next Thing as a process. 

How To Visualise The Next Thing

There’s more to The Next Thing now, than just what is upcoming. By duplicating the therapy setting, I can ask myself questions and build up to the process myself! 

Here is how I build up to The Next Thing in three questions:

1. Where is the next thing? (For me: going home from boarding school, starting college, starting work, and finishing studies.)

2. What am I leaving behind? (For me: a militaristic school never meant for me and the anger it left me with; a stifling town not worth my energy; a toxic college that saw me bullied and did nothing; and social media which made me feel pressured to become the worst version of myself coupled with suicidal urges.)

3. What is adding value to my life? (For me: getting back into a familiar space with my family; defining my creative self and unlearning societal conditioning; figuring out who I am as an adult in the workforce; and studying what I truly love.)

How To Anticipate The Delightful

Earlier, the trigger of being in the terrible present was always exacerbated by the need to escape from. This way, however, therapy helped me turn it into a present continuous form of anticipating.

Now, when things trigger me, I don’t try to bat the trigger away. I don’t think pretending like it doesn’t exist is helpful for me. I like to keep my distance without ignoring it. I don’t let it in, but I watch it. Why is it here? What does it want? 

Then I ask myself: can I see The Next Thing? The Next Thing could be a minute, an hour, a day, a month, a year later. 

But do I see it? If not, can I spend the energy I would spend agonising over the trigger visualising the next thing? 

The Next Thing is the process of anticipating the delightful, but it is also about working towards it. 

It’s a combination of theory and practise, and that’s what I love about it. It appeals to the thinker in me, and it makes a doer out of me.

How To Build Self-Esteem 

For me, self-esteem was denied because of how much I hated myself based on projections I made on other people’s interactions with me and about me. Primarily, I was certain that there was something wrong with me, rather than with those who bullied me.

Holding myself to impossible standards and comparing myself to others constantly was poisoning my image of myself. 

Through therapy, I found a way to lift the blame from myself without shifting it. It was through talking about the trigger that I was able to learn why I was feeling insecure. Through this journey, I learnt to forgive myself. 

This is the best advice for someone who blames themselves for feeling mentally or emotionally atypical: Pick the path which you believe will lead you to forgive yourself.

Forgiveness may not always be followed by self-love, but you will definitely find that you hold yourself in higher esteem.

Until a year after therapy, I hadn’t realised that I always have spent more time in my head than in the outside world; it has been my safe space since I was a child. My trauma made my safe space unsafe.

Therapy helped me leverage that to help myself become better by guiding me in taking the energy I wasted on loathing myself, and converting into energy I could use to nurture myself. Therapy gave me the tools to make my mind my safe space again. 

It was not overnight, it was a lot of hard work, and it took a lot of unlearning and relearning and self-cringing to make it happen. But every single second of every day is worth it.

I will not try to tell you what is the right choice for you, but I will recommend taking the first step towards finding out what it is.

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