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What to Expect When Starting Therapy

Posted by KB & Associates, LLC on January 9, 2020 at 2:20 PM

"You made the first step, one that can be at once exciting, difficult, and scary: you made an appointment with a therapist. This can be the hardest part. Take a moment to applaud yourself for your courage. Then take a deep breath, because it will all be okay. But now what?

If you have never seen a therapist before, waiting for that first session can be nerve-wracking. It can be uncomfortable to think about talking about intimate details of your life with a stranger, or to admit that you are struggling with something. Perhaps someone else in your life prompted you to make the appointment, and you may be unsure of what you will even talk about with them.

 

Many people have misconceptions of what therapy will be like, or ideas from movies or TV shows. While every therapist – just like every client – is different, here are some general ideas of what you can expect from your first few sessions, and some tips for getting the most out of your therapeutic experience.

 

 

 

1. Dispelling Myths: What Therapy Isn’t

 

In popular media, therapists are often portrayed as distant and emotionless. The client will lay on a couch, facing away from the therapist, and spend a lot of time talking about their relationship with their mother or father or dissecting the meaning of dreams.

 

While some therapists do practice this brand of therapy – called psychoanalysis, based on Freud’s work at the turn of the century – most do not.

 

Generally, the therapist will sit facing you. While therapists strive to be objective, most do not take on a distant or emotionless stance; rather they will be warm, empathetic, and responsive to what you care to tell them. Therapists are human too, and most are focused on forming a therapeutic relationship with their clients. According to Carl Rogers, founder of Person-Centered Therapy, this includes congruence (being genuine and real), unconditional positive regard and acceptance (being nonjudgmental), and accurate empathetic understanding (striving to completely understand you and where you are coming from).

 

Some therapists may explore your relationship with your parents, but generally only if you want to, and only if they believe it is related to your reasons for coming to therapy. Similarly, many therapists do not spend a lot of time looking at dreams you have had, unless that is what you want to talk about.

 

 

 

2. What Will I Talk About?

 

The good news: it’s up to you! The bad news: it’s up to you!

 

Most people have a reason they seek out therapy, a part of their lives they are struggling with. Perhaps it’s feelings of depression or anxiety, or a problem in a relationship. In the first session, the therapist will probably ask you about your presenting problem, the reason you are coming to therapy. This may include symptoms, like trouble sleeping, change in appetite, or racing thoughts; they may ask questions to gather more information about the context, such as your support systems, family life, work life, and what you do for fun.

 

Once the therapist has a general idea of what is going on in your life and who you are, it will be up to you how fast or slow you want to proceed in telling them more about your issue and how it affects you, and how much you want to tell them about you and your life.

 

Most therapists would agree that the client (that’s you) dictates the direction and speed of sessions. You can talk about whatever you want, but if the therapist feels sessions are getting off-track, that is, moving away from what brought you to therapy, they may gently guide you back to the matter at hand.

 

 

 

Tip: Therapy works best when you are completely honest with your therapist, even if it’s uncomfortable. Remember that one condition, unconditional positive regard and acceptance? That means your therapist won’t judge you for what you tell them, no matter what. Therapists have also heard it all before, so even things you are ashamed of won’t shock them.

 

Besides this, therapists are ethically and legally bound by confidentiality: they aren’t allowed to tell anyone else what you talk about with them (with a few exceptions, such as if you reveal you are in danger of harming yourself or someone else).

 

 

 

3. How Long Will I Be in Therapy?

 

Like what you talk about in therapy, this is also largely up to you. (Note: If you are paying using insurance, your provider may stipulate a maximum number of sessions you are allowed. Check with your insurance provider or therapist to see if this is the case.)

 

Generally, you and your therapist will decide together how long therapy will last. Sometimes an issue can just take a few sessions – such as deciding whether you want to change jobs or go back to school – or many months can be spent processing traumas or grief.

 

When the therapist feels that you have gotten the most out of your time together, they may bring up termination- talking about ending sessions or cutting back to once every few weeks or once a month. Often, they will also offer maintenance sessions- allowing you to make one or two appointments should something come up for you in the future.

 

The short answer is, it’s up to you.

 

 

 

Tip: It is your right to end therapy whenever you feel you are done. It is best to be honest with your therapist and tell them if you don’t feel you are getting what you want or need out of your time together. In such cases, your therapist may switch to a different approach, or suggest other therapists you can try. In any case, the therapist will not take it personally if you want to end therapy at any point, but they may encourage you to continue in some capacity.

 

 

 

Mega Tip: Sometimes you just won’t “click” with a therapist, and that’s okay! It’s important that you feel a connection with your therapist, and that you are a good fit. After all, you’re telling them a lot of intimate information and may spend a lot of time with them. Again, it’s important to be honest with your therapist about this. Most importantly, though, is that you feel comfortable being vulnerable. It’s okay to look around for a therapist until you find one you really “click” with. Keep in mind, however, that it may take a few sessions to really warm up to each other.

 

 

 

4. Does Being in Therapy Mean I’m “Crazy”?

 

People come to therapy for a variety of reasons, from adjusting to changes in life – such as a move or losing a job – to coping with more severe issues, such as processing trauma or managing symptoms of schizophrenia. Regardless of your reasons for seeking therapy, you are not “crazy.”

 

There is a stigma in our society against those who seek therapy. But there is no reason to feel ashamed or to buy into society’s prejudice against seeking help. If you break a bone, you would go to the doctor’s; similarly, if you are struggling with some aspect of your life or your mental health, it is okay to go to a therapist. Indeed, if someone refused to go to a doctor if they broke a bone, you would wonder why they don’t want a professional’s help to heal; in the same way, there is no reason to struggle with life’s challenges or your mental health when professional help is available.

 

Therapists are trained to be respectful and objective, regardless of what issues a client may bring to therapy, or how relatively “severe” others may view the issues. Basically, if it is a real issue to you, it will be a real issue to your therapist, and they will never treat you as “crazy.”

 

 

 

This is a short list, but I hope it will alleviate some of your fears and misconceptions about therapy. If you feel worried about the first session and what you can expect, you can usually call your therapist’s office or email them and talk to them about their approach and what you can expect. They will be happy to answer any questions or to make you feel at ease with them and the process before you begin treatment."

 

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