How long-term work unfolds, and where to begin if you are wondering whether to try therapy again.

I have been working with people for over 13 years. Sometimes people come to me not at the beginning of their journey, but after seeing a psychologist, trying another therapy, reading books, taking courses or learning techniques. Things became easier, something was resolved, and then comes that “BUT”: the root seems to be still there. This text is for anyone considering therapy again and hoping not to be disappointed once more.

“Why didn’t you go back to your previous therapist?”

I always ask whether someone has had therapy before. I want to understand what happened there and why it ended.

And this is where things get interesting. If therapy helped and the concern was resolved, returning to the same professional would seem logical. Why not? The answers vary, but their essence is similar: “I wanted to try something different”, “I felt she wouldn’t be able to help me with this”, “something was missing”, “we never got that far”.

In other words, the person senses something but cannot quite put it into words. The previous issue has been addressed, yet something remains. Somewhere intuitively, they feel they need someone different.

I take that feeling very seriously. It is not a whim, or “I just can’t stick with anything”. In a sense, it is the first expression of what brings you to therapy, before you have the words for it.

And let me say this straight away: I do not judge your previous therapists. I do not know what happened in those relationships, and anything I said about them would be speculation. What matters to me is something else: what you responded to, what did not work, why you left. That is already part of our work.

Relief is not yet change

People often come and say: “I understand everything about myself. I know why I feel anxious. I’ve learned to cope with it.” And that is true. That is already significant work.

But looking more closely, “coping” often means keeping things under control. Calming yourself, pushing yourself, meditating, planning, checking. It works. BUT each time it takes effort again, and every new situation triggers the same thing.

It is like a ship with a leaking hull. You can patch one hole, then another. You keep patching, and suddenly a new one appears. You cannot patch every possible hole or predict where the next leak will be. So we need to look at what is causing the damage.

People therefore often arrive thinking that their old techniques no longer work, or do not do enough, and expect new ones. They imagine I will reveal or explain something that will change them. What happens is the opposite. A new technique is not what is needed here. What is needed is a gradual exploration of what lies deeper: what brings on this anxiety, where it comes from, how it repeats, including between us in therapy. And when this is worked through, the question “What other technique should I try?” simply falls away. Because there is no longer something to cope with.

I once worked with someone for whom every trip outside was an ordeal. They went out and worked, so everything looked fine from the outside. Yet whenever they were out, thoughts would start attacking them: everyone is looking at me, I look wrong somehow, I am doing something wrong. They knew how to bring it under control: calming themselves, pushing themselves, meditating. But every outing still came at the cost of a surge of anxiety.

We worked less on the thoughts themselves and more on what gave rise to them. One day, as we were reviewing a period of our work, they suddenly realised they had not been thinking about this for a long time. They could go out calmly, go to work, and had even made progress there. Those frightening thoughts that had caused so much suffering had somehow quietly stopped troubling them.

They had not even noticed when it happened. But this is often what change looks like.

What the first sessions are like

The first session lasts 50 minutes, and it is already a working session, not “just a chat”. I ask about your current situation: what is happening now, what hurts, what has brought you here.

Sometimes, even in the first session, I can see that another professional or another format would be better suited to your concern. If so, I will tell you and suggest where to turn. That is more honest than keeping someone in a setting that cannot help them.

If we continue, the first four or five sessions are a period of getting to know each other and assessing the situation. Why not just one? People arrive full of pain, concerns and stories they have long wanted to tell someone. One session cannot reveal how a person developed, what happened to them or how their inner processes work. That takes time.

There is a second, equally important reason. At the first session, a person wants relief but may not yet understand what they need for it. Their focus develops as we go: they talk, begin to think about themselves and notice things. By the fifth session, they can usually say more clearly what they want from therapy.

At the fourth or fifth session, we discuss what I have noticed, how we might work together and whether we both want to continue this work.

“I don’t know where to start”

This is a very common question, especially for people coming to therapy for the first time. Those with previous experience usually simply begin speaking. But even with experience, it can happen: you sit down, and your mind goes blank.

In those moments I say something simple: begin with whatever concerns you most. Or say whatever comes to mind, even if it seems off-topic. We will still find our way to what matters.

You do not need to prepare, make a plan or find the “right” wording. Noticing what lies behind what you bring is my part of the work.

What can get in the way when you return to therapy

These are patterns I most often see in my practice. Other people’s experience may be different.

Expecting results in a familiar form. Even people who do not expect a quick result often still expect a particular kind of result: a new technique, an explanation, advice. Yet change often comes from an unexpected direction and is recognised afterwards, as in the story above.

Reporting instead of talking. After previous therapy, a person often seems to present their history to me: here was a problem, there was another, and here I felt better. This is understandable: you want to show that you are not a beginner and have already done a lot. But then the living concern that brought you here can disappear behind the report.

Not saying when something feels wrong. If something irritates you, does not feel right or makes you think we are going round in circles, say so. To me, not only to yourself on the way home. I will not be offended; on the contrary, it is valuable for our work. Often, precisely where something feels “wrong” between us, the pattern you came with is repeating itself.

What regular work looks like

Online, from any country, in Ukrainian or Russian. We choose the frequency together.

Pay per session — €45 / $50 for a 50-minute session.
A package of 4 sessions, once a week — €160 / $180.
A package of 8 sessions, twice a week — €300 / $340.

I do not say in advance how long therapy will last, because I do not know what we will encounter. And nobody can honestly know that beforehand.

What usually changes

The first weeks. There is a regular space where you can say what you cannot say to anyone else. What has been exhausting you becomes less random and incomprehensible. The intensity eases a little: the problem is not yet resolved, but you are no longer alone with it.

After several months. A pause appears between an event and your response. “I reacted calmly.” “Before, I would have stayed silent; this time I asked.” Decisions you had postponed begin to move forward.

Long-term work. A recurring pattern becomes recognisable before it fully unfolds. Your sense of worth no longer depends from moment to moment on how someone looks at you. Choice becomes possible, instead of one familiar reaction.

What I do not promise

That you will become a different person. That war, money concerns or a partner who does not change will disappear. That it will take exactly N sessions. Or that it will feel easier all the time. At first it can feel harder, because what was held in check begins to be felt. That does not mean something is going wrong.

Something to do today: ten minutes

Take a sheet of paper or open the notes on your phone and write an answer to one question:

“Why didn’t I return to my previous therapist? What exactly remained unresolved there?”

If you have not had therapy but have tried books, courses or techniques, the question is the same: what did they give you, and what remains?

Write as it comes, without editing. “I don’t know, it’s just a feeling” is an answer too. You do not have to solve the puzzle. The aim is different: to give that “something remains” its first words. Those words often become the starting point for therapy.

If you would like to continue with support

If writing made something clearer, or showed you that you cannot take this further on your own, you can come for a first session: 50 minutes online. We will look at your situation and, over a few sessions, decide together whether and how to continue.

You can book through the link below. Or simply send me a direct message on Instagram, @olena_kyrylova_psy. I reply personally.

And if now is not the time, that is fine too. This page is not going anywhere; you can return whenever you wish.

Olena Kyrylova, psychoanalyst. Member of the National Psychological Association, Psychoanalytic Division; certified specialist of the Ukrainian Confederation of Psychoanalytic Psychotherapy.

Arrange a first session — message me on Instagram

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Therapy, books, techniques — yet something still remains