What to expect in therapy?

If you have never been in therapy or counseling before you may have a certain image or idea of what it might look like. “Are they going to ask me to lay down on a couch and spill my life story?” “Will he/she tell me I’m crazy and can’t be helped?” What will people think of me if I tell them I’m going to a “shrink”? These are all great questions and very normal worries people might encounter before their first session with a therapist or counselor. Let’s take a look at what will happen when you are ready to seek outside help from a therapist.

Therapy, also referred to as counseling by some, typically begins with a phone call to a therapist of your choosing where they might spend up to ten minutes getting an idea of what your struggle is and what goals you have for therapy. This is a good opportunity to ask about the therapist’s fees and scheduling practices. The first phone call is where the relationship begins to build and your therapist can decide whether what you are struggling with is something that they have the experience in helping to treat. It’s important for both you and the therapist to be honest about whether it sounds like a good working relationship. The relationship is the biggest piece in indicating change for individuals – so make sure you feel comfortable with the therapist you choose.

Once you have decided on an initial appointment there will typically be some forms to complete prior to seeing the therapist. Usually these are provided to you at the therapy office prior to your session, however, some therapists might have them on their website or could email them to you. When you show up to the office you will likely enter into a waiting area and there may not be someone there to greet you – therapists are typically in sessions up until the next appointment time. If you opted to complete forms at the office they will likely be waiting for you in the waiting area to complete while you wait for your appointment time – so be sure to arrive 15 minutes early to allow yourself time to complete these without cutting into your session time.

Once it is your appointment time the therapist will likely come out and introduce himself/herself and bring you into their office. Most people opt to sit on one of the couches or chairs, but there is no reason why you can’t lay down if that is what you prefer; the important piece is making sure you feel as comfortable as possible in this setting. Next, the therapist should review his/her confidentiality practices and any limitations to confidentiality. Therapists are considered “mandated reporters” which means they are obligated to report any reasonable suspicion of child abuse, elder abuse, or dependent adult abuse. Additionally, if there are ever serious concerns of suicide or homicide risk the therapist may be obligated to intervene to ensure safety. (These breaches of confidentiality could vary by discipline and by state). Be sure you understand these practices and ask any questions you might have.

Next, your therapist will want to know what brought you in to counseling and what you are hoping to achieve. Take some time to think and reflect on these things before your session in order to make the most of your time with the therapist. Some people jot ideas down on a piece of paper and bring the paper to session with them so that they don’t forget. This practice is similar to if you were going to a medical doctor for a specific concern. The therapist will then want to assess the situation further through some questioning and reflections. He/she will ask about your symptoms, your level of functioning, family, social and work life in order to get a clearer picture of you as a person and any influencing factors. The session typically lasts 45 to 50-minutes (each therapist is different). By the end of the session the therapist will ideally have a clearer idea of what your struggle is and an idea of how they will approach this situation. Do not expect your situation to be resolved after one session of therapy. This first session is really about getting to know you and your struggle before making any recommendations. Keep in mind that therapy is a process for change. You are the expert on your life and your therapist is there to help guide you in the direction you want to go. It may take a few sessions together before any change begins to happen, so be patient with the process.