I've been thinking about this stuff for a while and putting together my thoughts in this post may help me out (along with others). I want to share what I am finding are things which allow me to get the very most out of each session. I am sure these ideas are out there in the ethers, but I want to do it myself here and now.
1) Remember you are the customer.
This sounds simple, but it will help you to keep on track with your healing. You are going to an expert in order to obtain mental health healing.
This one simple point can help you reclaim your sense of balance within the therapy relationship. Sometimes it is hard on us when in the throws of the T relationship and we feel the T pull away at the end of sessions, or when they take too long to return an email or phone call. It feels like T has all the power in the relationship.
The truth is, we have the most power. A T can't just walk out on us. There are ethics behind this and even though they can terminate clients and refer them to someone else, they legally and ethically can't just look at us one day and say "You know, I hate you. I don't ever want to see you again as long as I live." But we can do that with our T.
2. Honor the Relationship
Even though we are the customer, the T is a human too. They are as human as our dentist or our clergy. They are moms and dads. Many of them are survivors of trauma. They are clients of other Ts.
Even though the relationship is going to focus on us as the client, always keep in mind that the person in the nice chair is a fellow human. They are flesh and blood. They can feel pain and feel joy.
Remember that even when T can't tell us they think about us, the truth is that Ts do think about clients outside the office. They will see something come up on TV or read an article and thing "Oh, that is a good point! I need to keep that in mind when working with so-and-so!"
Show common human courtesy. It is good to be honest with your T - my next point - but do it without attacking T. Ts will put up with a lot more than your dentist will. If you were to kick your dentist in the shins when they accidentally hit a sensitive part of your tooth while drilling, I suspect your dentist would tell you to go find someone else to fix your choppers. But session after session, Ts take on the transference of their clients. They do expect this, but that doesn't give us an excuse to not behave in a civil manner. If you want to get the most mileage out of your therapy hour, try very hard to treat your T with the same dignity you would treat your dentist

T is not a personal emotional punching bag. They are a professional human who will walk with us on our journey into healing.
3. Be HONEST
"Therapy done right is hard. The only thing harder is not doing therapy when it is needed." A retired psychologist Ph.D. friend of mine told me this once.
When we are on-the-clock, it is time for us to get to work. It is time to put on the paper-gown and allow our T to see who we really are.
Spending 2 min of every 5 min in angry stuffed silence burrowing a hole through the T's floor is not hurting our T. They are there for the full session regardless of what we do inside that time. The loss is our own.
Now it is hard to open up and use every single min of therapy time in the best way. And sometimes being silent is presenting honestly our emotions. There was one session when I spent ten whole min in silent eye contact with my T. It was not a staring contest. It was me allowing him to see deep into my heart and eyes the deepest pain that just didn't have any words.
The difference here is in how we use our silence in sessions. If we go into the session and spend half the time running around the office in our clothes saying "No! I won't put on the paper gown!" - well, the doctor has to sit there and just wait for us to do what we need to do. They aren't going to yell at us. They will just wait.
Keep in mind that you are spending your time and money on expert medical advice. In order to get the most bang for your buck, work hard on being able to be an open book with your T. Lies and running away from the truth are defense mechanisms. And your T will help you through those. But try hard to do your own part by being honest even about the avoidance. "I am sorry, but putting on a paper gown just bothers me a ton. I won't run around the office now. But I will sit here in my suit and talk with you about why it bothers me."
4. Trust
Finally, this is something that will bring the most quality into your session time. Your T is not there to harm you. There are a few bad apples out there, but they are the exception and not the rule.
If you think your T is not being ethical about something big, bring it up to another T and go from there.
But for the most part, Ts can be trusted. This doesn't mean they won't hit a nerve every now and then - back to therapy is painful. But their hearts are in their profession. They are Ts because they want others to heal. Being a T isn't something they put down at the end of the day. They love people at the core part of themselves. This is just who they are.
Trust that your T wants to help you heal.
Trust that your T will behave ethically and professionally.
With just those two things, you can combat a lot of internal agony that comes up in the course of therapy. If T takes three days to return your phone call, you will not waist energy thinking "T hates me!" You will know "T wants to help me heal." T may have missed your call or may have been (gawd forbid!) a human and just forgot! But the trust is still there that T does want to help you heal.
In order to get the most out of therapy, the trust needs to be there. Use the skill of being honest in session to help build up this trust. "You know, sitting in this paper gown makes me freeze! I can't stand to be cold!"
Ohhh! Well, perhaps there is a way to bring in a space heater to allow you a bit more comfort?
The doctor / expert / T is not there to make your life harder than it already is. They are there to help you heal. But it is your job to allow them to do so.