What to Expect if You Start Therapy
A lot of people are curious about therapy, and they have at one time or another considered starting therapy. But most people do not know what to expect if they meet with a therapist. The uncertainty this causes can lead many to never even attempt therapy, and it may also lead to disappointment for some who do give it a try. Therapy really is nothing to be afraid of, but it does help to have accurate expectations when going into therapy. So here, I want to spend some time describing what you can expect if you decide to start seeing a therapist.
Disclaimer: Much of what I say will vary to some extent depending on the exact type of therapy you seek, for what, and who you meet with. Most of what I say is broadly true for the majority of therapeutic experiences, but I cannot guarantee your own experiences will be exactly what I describe below.
Before diving straight into what you can expect if you start therapy, I do want to take a brief moment to address a couple of points: when therapy is appropriate, and how to find a therapist. These are topics that warrant going into further detail, so I will write posts in the future that do so. But for the purposes of this post, here's a summary.
Therapy is intended to help those who are struggling in a variety of ways. You do not have to be "crazy" or "full blown depressed" to work with a therapist. If you feel stressed, overwhelmed, nervous, apathetic, disinterested, annoyed, irritable, like you lack focus, or any other similar symptoms, therapy can help. When it comes to kids, we can also help with things like disruptive/oppositional behavior. Yes, you can argue that these symptoms can fit just about anyone. To an extent, that's true. Mental health is a spectrum, not black and white. The point is that therapy can help if you have those feelings and feel overwhelmed or unable to manage them.
While therapy can sometimes be helpful for connecting you to resources, that is not the primary role of therapy. If you feel that you need financial assistance or anything similar, that's better handled by case/social workers.
As for finding a therapist, generally the best way is to check with your insurance provider to see who is in-network. Usually psychologists are under "mental health" or "behavioral medicine." You should look for a psychologist (Ph.D. or Psy.D.) or a licensed clinical social worker (L.C.S.W.). Psychiatrists (M.D.) should be sought if you think medication may be helpful. A combination of both psychotherapy and medication is generally the most effective course of treatment, but I recommend starting with psychotherapy then working with your therapist to determine if medication may also be helpful in addition to therapy.
Ok, with that out of the way, let's discuss what you can expect if you start therapy.
Scheduling an Appointment
Unfortunately, the very first thing you can often expect when trying to start therapy is a long wait for an initial appointment. Mental health clinics are often underfunded and have waitlists. It's a problem many of us are aware of, and many people unfortunately don't think to seek services until they really need them quickly. So if you have any thought that you might want services within the next few months, it may be worth having your name added to a waitlist. Even if you get in early, you can start to work on ways to cope with upcoming stress, potentially minimizing the impact of anything you know is coming up.
What can be tempting for some is to use the emergency room/department as an immediate way to get therapeutic help. However, this is generally not very helpful for patients and can result in expensive bills. The ER/ED is absolutely appropriate if there are any immediate safety concerns (e.g., suicidal thoughts). But if you are feeling stressed and overwhelmed, yet you're confident that you'll be safe, unfortunately the best option is generally to wait until you can get into the outpatient clinic.
The First Appointment
Once there's an availability, you'll get scheduled for an initial appointment. The way these are handled depends on the clinic, but there is one underlying common theme: it's an intake. The goal of the first appointment is to learn about you, your needs and desires for therapy, your history, and so on. This helps us come up with an initial diagnosis (if one is appropriate), and to help determine what type of therapy will be most helpful. It is a unique appointment, and generally very little therapeutic work is involved.
Many people attend the intake appointment, then drop out of therapy because they mistakenly assume that therapy will be just like that initial session. Sometimes the first therapy session or two can have a somewhat similar feel to the intake appointment, but therapy should pretty quickly become focused on, well, therapy. The reason we need the intake, and maybe some additional questioning for the first real appointment or two, is to help us know how to best help you.
Sometimes when people come in for therapy, they have an idea that the problem they are facing is simple. If I just get help with overcoming X, I'll be fine. But the reality is almost always that there is more going on. Or at the very least, overcoming that X is a complicated thing to do, at least to do well. Humans are very complex, and we need some time to get a good understanding of your situation from a biopsychosocial perspective.
So have some patience at the beginning. We have your best interests at heart when starting things slowly.
After the intake is complete, it's time to start with therapy. That may be with the same person who you met with for the intake, or it may be with another clinician. The format of the therapy may vary, including individual (one-on-one), family (one clinician meeting with you and other family members), or group (a couple of clinicians with several individuals). Individual and family therapy are the most common, and that's generally what you should expect if you go to a clinic. Group therapy can be beneficial, but you need to explicitly express interest in attending a group; you shouldn't unexpectedly be assigned to a group.
Whether the format is individual or family therapy (and the format may alternate between them depending on the week; e.g., if the primary patient is an adolescent then sometimes parents will be part of a session but sometimes not), the therapist will work with you (and potentially your family) to help problem-solve, learn coping skills, learn how to understand what's going on, and so on. We as therapists generally act as educators and a source of guidance, helping you to understand yourself and to find solutions that work well for you.
How that looks will depend on the challenge being faced. If you're a parent with an oppositional child, therapy will likely focus on teaching you some parenting techniques that can help. If you're a person with a lot of worries, therapy can focus on understanding those worries and how to counteract them by adjusting your behaviors and thoughts. But regardless of the specifics, the goal of therapy is to be a back-and-forth between you and the therapist. You help the therapist understand how best to help you, and the therapist helps give you guidance based on evidence-based treatments.
Less common therapies
What I described above is markedly different from stereotypical "therapy" from the Freudian era. While most therapists now focus on evidence-based treatments, especially cognitive behavioral therapy or straight behavioral therapy, there are therapists who still utilize other methods.
I don't want to say that more traditional psychoanalysis isn't helpful, but it's not for everyone. Some people have a specific interest in attending that form of therapy, which involves meeting multiple times a week and typically requires you to do most of the speaking (based on provided prompts). If that's a good fit for your wants then it can be beneficial. The scientific evidence for/against different components of psychoanalytic therapy is a topic for another post. But just know that what I described above should cover most mental health clinics, just not all.
But that brings me to an important point.
Something to keep in mind when starting therapy is that the fit between you and the therapist is very important. We ask very in-depth and personal questions, and it's important that you feel safe/comfortable with the therapist you work with. Because of that, many clinics are open to any preferences you have for a therapist (e.g., male vs. female). In fact, some clinics will openly ask if you have a preference. And expressing a preference does not in any way make you racist/sexist/etc. Many people have various reasons for having preferences, including a desire to have someone who is more likely able to relate to your own day-to-day experiences.
But even if a therapist fits your initial criteria, that does not necessarily mean they will be a good fit for you. Most patients stay with their first therapist and are satisfied with them. But for some, it's just not a good fit, and it's very difficult to make progress in therapy if it's not.
We as therapists are all different people. That means we all interact with people differently, talk about things in slightly different ways, have different interests and knowledge that may or may not line up with your own. If you're working with someone and don't have anything against that person, but you just don't feel like you're connecting with them, that's ok. You can be open and honest about that, and you can potentially be transferred to another therapist who may be a better fit (assuming the logistics work out).
We will not be offended if you feel like we're not a good fit for you and if you wish to try working with someone else.
The amount of time that therapy takes can vary widely depending on your needs, the format of therapy, and so on. For some structured forms of therapy (e.g., PCIT), it can be anywhere from 10 to 20+ sessions. It depends on how consistent you are with following the "homework," how complex your situation is, how long it takes to identify the most appropriate way of working with you, and so on.
But something relatively consistent is that you can expect sessions to be roughly once/week, and for about 45-60 minutes each session. Sometimes sessions are more frequent (especially at first or during any time of crisis), and they may be less frequent as progress is made (e.g., every other week while transitioning off of therapy).
That being said, some people stay in therapy much longer. It all just depends on your personal needs and wants. But our goal is to help get you to a place where therapy is no longer needed. We have no intention of rushing people out the door, but we also want to encourage you to try handling things on your own if you seem ready.
Eventually, therapy will likely come to an end. When that will occur is something that you and your therapist will discuss, likely starting several weeks in advance. Something to know when going into therapy is that our goal isn't to make things perfect. The goal of therapy is to help you reach a point where you feel that you can handle things on your own.
Life is always messy and imperfect, and there's nothing we can do to change that. So once the conversation arises about when therapy should end, it can be tempting to think "but there is more to work on!" Sometimes that's true, and therapy will continue. But sometimes you need to trust your therapist when we suggest that you are prepared. Maybe the sessions will become less frequent as a way to transition and help you realize that you are able to handle things well between the sessions.
Something to keep in mind is that therapy ending does not mean you can never return. Some people need "booster" sessions after a while. Sometimes stress increases again and you find yourself needing further guidance. Returning to therapy is always an option, and you can contact your therapist to see if they are able to start seeing you again. Depending on the clinic, you may be able to bypass going through the intake process again so you can get back into therapy more quickly.
Hopefully this is a helpful summary of what you can expect if you decide to start therapy. Again, the specifics will vary from clinic to clinic, and situation to situation. But overall what I've described above is roughly what you can expect. It's a very helpful process that goes much more quickly and smoothly if you know what to expect and commit yourself to following the therapist's guidance and "homework."
Have any questions about therapy that I didn't address? Has your experience with therapy been similar, or different? Let me know in the comments!