Everything You Need to Know About Starting Therapy

If you’ve ever been to the doctor for a routine physical, you probably know what to expect. This is standard. But when it comes to seeing a mental health professional, many people aren’t as familiar with the process. This, among other things, could deter someone from seeking the help they need. I’ve spent years in therapy, so I’m familiar with how it works. My hope is that together we can make this common knowledge, and ultimately alleviate the confusion and apprehension that comes with seeking this kind of help.

Your First Session
Many therapists will have you fill out paperwork online prior to your appointment, while others will ask you to come in early to your first appointment to complete it in person. You can expect to be asked basic info, such as why you’re seeking therapy, if you’ve been in therapy before and if you’re on medication. These questions can feel really personal. For some people it’s the first time ever really talking about such feelings and thoughts. Actually checking off a box to say you’re feeling depressed or saying it out loud can make it feel more “real.” Over time talking about these things becomes more comfortable.

During your first session, your therapist may go over your intake form with you, as well as ask general “get to know you” questions. They might explain how therapy with them works, what types of therapy they specialize in and how they can help you. You should feel free to ask them questions. It’s typical for therapists to want to set up your next appointment; know that you can cancel or change it.

Your therapist should go over billing with you. Policies vary from expecting payment on the spot, to billing you later, to even offering a free first session. If you have insurance, be sure to have your card with you. Talk to your therapist to find out if they take insurance.

Getting the Most Out of Therapy
Therapy is more collaborative than your typical doctor’s appointment. Your therapist will work together with you to come up with goals and decide what you’d like to focus on in therapy. Treatment is ongoing and you play an active role in it.

Every therapist has a different style. Some therapists might look to follow your lead. Others might ask more questions and direct the conversation. Some are more warm and emotional, whereas others are more formal. Your therapist might take notes when talking with you. Some people find this intimidating or uncomfortable. If you do, you can say something. It’s important to be open with your therapist and express any preferences you have. While it’s normal to be nervous or scared as you begin your journey in therapy, keep in mind that your relationship with your therapist develops over time. Just as with other relationships, getting to know each other does not happen immediately. This is just the beginning and with time the dynamic can improve.

It’s normal to feel uncertain about what to say or how much to say. It’s also OK to not know where to start — that is your therapist’s job. But don’t be afraid to take part in guiding the conversation if you want to. You can say whatever you want in therapy, and you can set boundaries when there are things you don’t want to talk about. You can share as much (or as little) as you’re comfortable with. If you’re hesitant to spill your guts right away — that’s OK. There might also be ways to make yourself more comfortable. One of my friends says it has helped her to have something mindless to do with her hands like play with a stress ball, slime or silly putty. Other people have told me that drawing during their sessions has helped them. Go at your own pace and find what works for you.

If you’re struggling to figure out what topics are most pressing to talk about in therapy, one strategy you can use is journaling. Doing so can help you keep track of how you’re doing and what issues or themes might be recurring. It’s also not uncommon to bring notes to therapy. I’m a huge proponent of coming with notes or at least ideas of what I’m going to talk about. In my experience, the better prepared I am for the sessions, the more I get out of them. If I get nervous and freeze I can reference the notes or hand them to my therapist. If you find you have so much to say and not enough time to say it all in one session, you may consider asking your therapist to meet more frequently.

In my experience, I’ve found that therapists tend to operate on a weekly or bi-weekly schedule, especially when first getting to know you and understanding your story. I highly encourage this, as it can take time to establish a therapeutic relationship in which you can work towards your goals. It’s up to what you want, as well as what your therapist’s schedule allows. Some people go monthly or on an as-needed basis. Some weeks call for multiple sessions, and there’s nothing wrong with that. Being in therapy doesn’t define you, but the strength to seek therapy can.

Therapy is a journey. It takes time to figure out what works best and what you need from your therapist. Remember, you’re paying for a service. If you aren’t happy with the service, you have every right to discontinue it. Go into therapy with an open mind. Know you can always change therapists — they won’t be offended, it happens all the time. You deserve treatment that works for you. Go out and find it!

Additional Resources
If you haven’t already found a therapist, check out this article I wrote about shopping for therapists. There are also many other resources online.

One of my go-tos for mental health info is YouTuber Kati Morton, an authentic, good-humored and passionate licensed therapist who uses her presence on social media to educate people. With hundreds of videos, and new ones each week, Kati Morton is a hub for info on mental health. Check out Kati’s insights on starting therapy.

What have your experiences with therapy been like? Any tips you’ve found that you’d like to add? What do you wish you’d known?