Going to therapy can be a little nerve wracking, especially if it's your first time.
What’s supposed to happen? What should you say to friends and family when they ask questions? How do you know if you’re seeing the right therapist? And how do you make the most of therapeutic counseling anyway?
These are all very normal questions and concerns. Pop culture has perpetuated many myths about therapy and how we care for our mental health. The private nature of therapy itself is even partly responsible for the slow overturning of these myths.
But don’t worry. We’ll break down in this article what to expect from therapy, what a good match with your therapist should feel like, what the common mistakes in therapy are, and how to get the most out of therapy in general.
How therapy works
It’s common to feel nervous about therapy before starting. A therapist’s job is to work through that feeling with you. When you and your therapist or clinician are a good match, you’ll develop what therapists refer to as a therapeutic relationship. You should feel comfortable with your therapist. The more honest you can be, the better therapy will work.
If you haven't seen a therapist before, it can be overwhelming figuring out where to start. We've broken down a simple timeline of how therapy sessions work. It covers how to choose a therapist, what your first session may be like, and what to expect over time when taking care of your mental health.
1) Think about what you want to get out of therapy.
This may seem obvious, but it will also be one of the first questions most therapists will ask you. Do you have general relationship issues you want to work on? Or are you more concerned with a specific family member? Do you want to feel less anxious? Or are you suffering from severe panic attacks and want to learn healthy coping skills?
Whatever your goal is, narrowing in on it will help you and your therapist get to work. And don’t worry — that goal can change and evolve over time. It’s just a good starting place.
2) Make a short list of therapists you’re interested in.
There are many different types of therapy and therapists. We have a guide to the different types of therapy you may see listed on practitioners’ websites. Once you have an idea of the types of therapy that sound interesting to you, it's time to find a therapist.
If you haven’t chosen a therapist yet, we have a guide for doing so. It will help you understand the different types of psychotherapists. A clinical psychologist with a PhD is not necessarily a better therapist than a licensed clinical social worker (LCSW) or any other type of therapist. It all depends on what type of expertise you're looking for and if you feel comfortable talking to that person. The best way to determine that comfort is to schedule consultations.
3) Schedule consultations.
Good therapists will expect you to schedule a phone call consultation before booking an appointment with them. You should not feel pressured to pay for a session without this consultation.
The point of the consultation is to determine if you’re a good match for each other. Do they have the expertise you need for your specific issue? Do you feel comfortable speaking to them? Are they a good listener? Once someone feels like they might be a good fit, schedule your first appointment with your new therapist.
4) Go to your first appointment with an open mind.
The first session of therapy can feel pretty awkward. The therapy relationship is likely a different dynamic than you’ve experienced before. Treat this as an opportunity for open-mindedness. This session is about laying the groundwork, getting to know each other, and beginning to make a plan.
Don’t be surprised if you experience unexpectedly raw emotions. Many people cry in their first session just at the sheer relief of having someone to talk to. Let it out! That’s what therapy is for.
5) Talk about your next session.
Depending on how many therapy sessions you intend to have, whether short-term or long-term, it's practical to discuss what to expect for the next session. Your therapist may have specific areas they want you to report back on, or exercises they'd like you to try.
This is also an opportunity to share any curiosities you might have about different treatment methods. For instance, if you read about the benefits of eye movement desensitization and reprocessing (EMDR), or perhaps a type of cognitive behavioral therapy, you can share that with your therapist.
You can also use this time to say you’d like to reflect on your latest session before booking your next. Therapy should be a safe environment. If it doesn't feel that way, you are under no obligation to continue with that therapist so long as services rendered are paid for.
6) Be prepared for your next session.
You might think that what happens during therapy hour stays in therapy hour, but for therapy to work, you’ll need to be doing work between sessions. We’ll break down in the next section how to do this well.
7) Keep the dialogue open.
You and your therapist may set a goal in your first session about when you’d like to have your final session, or you may keep it open-ended. The important thing to remember is that this is a client service. If at any point you feel uncomfortable or have questions about your therapy, it is perfectly ok to ask them.
What do you talk about in therapy?
The short answer is everything. Depending on the type of therapy you’re in, you may stick to one specific issue, or you may talk about just everyday life. Good therapy is meant to translate to the real world. It should improve your mental health and well-being, and overall, make you feel better.
It may take time to see positive changes — therapy can be really hard work! But even just the act of venting can help improve our outlook.
Plus, there’s nothing stupid to talk about in therapy. Your therapist will do their best work when you’re honest about what’s on your mind, whether it’s the state of the world and your place in it, or just a tweet that made you feel bad. Everything is fair game in therapy.
How to get the most out of therapy
Therapy is different for everyone. What works for one person may not work for someone else. However, there are a few tips and tricks that can help us all make the most of it.
Don’t obsess over being polite.
You can ask questions. You are allowed to disagree with your therapist. And if something doesn’t make sense to you, say so. No amount of advanced training in psychology or years of study will ever invalidate your feelings. Speak up if something feels off.
Don’t keep things to yourself.
The best way for your therapist to get to know the real you (and to help you!) is for you to be completely honest about what you’re thinking. If you’re worried about feeling judged, remember that a good therapist isn’t there to make judgments.
Be your most authentic self.
If the very idea of being authentic is confusing or feels unnatural, tell your therapist. That is valuable information for the work ahead. If you’re struggling to describe or articulate how you really feel, say so. Honesty is the best way to get to the root of what you’re struggling with and how you’re really feeling.
Let your emotions show.
Therapy is the one place you don’t have to bottle up your emotions. If something comes up that makes you angry or sad, let those emotions out. Every therapist has heard a variation of someone saying, “sorry, I don’t know why I’m crying.” Part of therapy is helping you navigate those emotions.
Try not to focus solely on symptom relief.
As an example, say you want to stop having panic attacks. A therapist aids you in mitigating those attacks, but they also want to get to the root of why you’re having those attacks in the first place. It’s like taking ibuprofen for pain. It alleviates the pain, but you still need to figure out what’s causing the pain in the first place.
Set boundaries around therapy.
It can feel natural to discuss new therapy with a significant other or family, but try to create thoughtful parameters around how you speak about it. There may come a time when you don’t feel comfortable sharing what happened in therapy. It’s wise not to set up expectations that you’ll always share. Plus, sometimes a peanut gallery is more destructive than valuable.
Keep a journal.
The work is not done when the therapy hour is done. Whatever you covered in your last session will come up in your next session. Throughout the week, try to practice what you learned in therapy. Keep an eye out for what emotions come up and what new challenges you may face.
The best way to keep track of how you feel between therapy sessions is to keep a journal. It can be a notebook or even just a private Google doc where you scribble your thoughts. It’s perfectly ok to refer to this doc in therapy. Your therapist will probably appreciate the work you’re willing to put in.
Establish a process for check ins.
It's useful to plan in advance how you can reach your therapist between sessions. Sometimes doing the work results in feeling emotional, overwhelmed, and lost, and you may want to email or call your therapist for a quick reflection on how to manage these emotions. Your therapist should have a protocol for contacting them between sessions.
Expect to drag your feet sometimes.
Sometimes we just don’t feel like going to therapy. You can cancel sessions in advance, but be cognizant of this feeling and why you may be feeling it. Is it time to find a different therapist? Or are you working through something really challenging?
Therapy is similar to exercising in that way: we might want to veg out instead of work out, but we usually feel better if we exercise.
Get business out of the way.
Start each session with scheduling questions, payment, and other administrative duties. It helps to get this out of the way so you’re not interrupting the emotional work at the end of the session.
Don’t worry about the clock.
Your therapist will be the one keeping an eye on the time. Do your best to turn off devices and be present. Therapy is typically only 50 minutes — try to dedicate that time to yourself.
Do try to schedule therapy at a good time.
Sometimes we can’t be choosy with the timing of our therapy hour, but if you can, it’s best to schedule it when you can have some time to reflect after the session is over. It’s easier to be fully emotionally available when you don’t have to be back at work immediately after.
Don't expect your therapist to tell you what to do.
Therapy is less about advice and more about helping you make decisions that serve you. It can be tempting to ask a therapist to just tell you what to do, but be wary of therapists who are quick to give advice. They may be serving their own agenda more than yours.
Therapy is hard work. Positive changes take time. It can be frustrating, and that’s ok. If you get frustrated, it’s perfectly acceptable to talk about it with your therapist. If at any point you feel like you’re not accomplishing anything in therapy, talk to your therapist about both their long and short-term plans.
Reading these tips shows that you’re willing to do the work, and that’s the most important thing. Good therapy will often feel like work. Therapy is an investment in yourself and your future, and it should feel as such. A strong therapeutic relationship will make you feel safe and heard, and if you can put the work in, you’ll see the benefits of therapy across every aspect of your life.
If you or someone you know is seeking mental health care, you can reach out to our Care Coordination team at [email protected] or by phone at 415.202.5159.
If you or someone you know is experiencing an emergency or crisis and needs immediate help, call 911 or go to the nearest emergency room. Additional resources can be found here.