Preparing for Therapy

So you’re thinking about starting therapy.

Some people decide to go to therapy on a whim.  Maybe their good friend found it to be helpful after a recent break-up, or maybe their spouse found healing after a sudden loss.  Other people mull over the idea of starting therapy for years before deciding to do so.  After all, there are so many barriers to accessing this type of care: it is incredibly costly- both financially and emotionally.  There aren’t too many things we commit to doing every single week for months on end, if you think about it.  Oftentimes people can be hesitant to meeting with a therapist because they just aren’t sure what to expect.  And gosh… not knowing what to expect, the unknown… there aren’t too many worse feelings for a lot of people.  

If you’re new to therapy and considering starting, read on to learn more about what therapy is, what it is not, and how to think about your own journey here at its beginning.

What is therapy, anyways?

I like to preface this section with an important disclaimer- there are as many answers to this question as there are therapists.  Going to therapy is different from going to other professionals or specialists, where you may receive very similar treatment regardless of the human you get scheduled with.  Therapy, on the other hand, can look like so many different things.  Below, I’ll do my best to describe what you might expect generally, as well as more specifically.

As therapists, we often talk about “entering therapy”.  Not starting, or picking up, or initiating therapy.  Entering therapy speaks to the process that therapy entails - it is a commitment we make to sitting with ourselves and a trusted therapist, to exploring who we are and why we are the way we are.  It is the relationship that these two people make between one another, a relationship grounded in trust.  Entering therapy is entering into a relationship, one that provides a safe container for us to explore the curiosities we have about ourselves and the world around us.  

Within the relationship, people can expect themselves to sit with someone who is compassionate, non-judgmental and curious.  Therapists do have different theoretical orientations, different training, and different life experiences… yet at the end of the day, it is our nature to provide people with a space for them to be truly themselves.  Or to be truly not themselves, depending on what kind of day someone might be having!  Our own inner dialogue, as well as our external environment, give us plenty of opportunities to feel ashamed about our decisions, our past, our approach to relationships.  The work of a therapist is to ensure that their clients do not feel judged or blamed.  After all, who would want to be open with someone who they felt was placing judgement on their life choices?  Not me.

Therapy is finding the answers to the questions you might have for yourself - and oftentimes, these questions don’t even enter our minds until we’ve been in therapy for a little bit.  And- spoiler alert- these answers are generally ones we already have deep within ourselves.  Sometimes it just takes some focused time, attention, and the support of someone else, to land on the truths that we have been looking for.

“Therapy is finding the answers to the questions you might have for yourself”

What therapy is not.

Because therapy can vary so much, sometimes it’s easier to describe what it isn’t.  These are generally universal truths that should apply to the majority of peoples’ experiences.  Therapy is not someone telling you what to do.  It is not giving advice, although when we are asked directly to do so, some of us certainly do so to different extents.  Therapy is not blaming your parents for why you are the way you are, or connecting dots for you.  If I am ever connecting dots for a client in a way that carries no meaning for them, or does not resonate with them, I’m probably not doing my job right.

Therapy is not being forced to talk about things that make you uncomfortable, or to assume that every traumatic thing that has happened in your life has ruined you in some small way.  

You and your therapist.

It is important that people entering therapy know that they hold the ultimate power in deciding who they embark on this journey with.  We know that the best therapy outcomes directly relate to the quality of the relationship someone makes with their therapist.  The best outcomes don’t depend on what fancy training their therapist might have, or whether they go in three times a week.  It really does come back to that relationship, which is what makes choosing a therapist so critical.  Again, the power is in your hands, even if you don’t know a gosh darn thing about therapy (other than what I’ve attempted to explain here).  So, what does that mean?

“ We know that the best therapy outcomes directly relate to the quality of the relationship someone makes with their therapist”

A wise therapist once said, ‘you wouldn’t go back to a restaurant where the food was gross, the service was terrible, and the place smelled bad.  The same thing should go for your therapist.’  If the first therapist you sit down with doesn’t strike the right chord with you, consider looking into a different person.  If you sense that this therapist might not be someone you can grow to trust, be honest with yourself and make the hard decision to keep searching for the right one.  Sometimes we can pick up on this after one session, or sometimes it can take a couple of weeks or months.  No matter the situation, know that you have permission to exit the process.  Therapists know that they can’t be everything for everyone, and we try hard to be comfortable and accepting of that fact.  So if it’s not working, don’t force it.  

Also, and this is so hard - ask for what you need.  People are all so different, and have such different needs, that it can be challenging at first for us therapists to really know whether this process is working for you or not.  We should ask about that 1,000 times more than we probably do - like, “are you getting what you need out of this?”  If you aren’t asked this, but you do have thoughts and feelings about it, please, please speak up.  Let us know if you need more structure.  Let us know if it’s feeling too structured.  Let us know if you aren’t ready to talk about something, or if you need to pivot the conversation and talk about something more urgent or pressing.  Let us know if you’d rather sit in the chair than the couch, or if it would be more comfortable to draw while we talk.  Let us know if the time we initially agreed on isn’t working anymore, or is causing you enough stress that it just doesn't feel worth it. 

I’m going to get diagnosed?

Yes, if you are planning on billing your insurance plan for therapy, your therapist will need to give you an accurate diagnosis.  This may be something like ‘Generalized Anxiety Disorder’ (what we call anxiety) or ‘Major Depressive Disorder’ (what we call depression).  Of course there are countless other diagnoses out there.  Not only does having this descriptor allow sessions to be billed to insurance, and therefore be affordable - it also gives you and your therapist a shared understanding of what symptoms you’ve been experiencing.  It’s an important opportunity to get on the same page, and ensure that we’re hearing and seeing you accurately.

The nitty gritty.

Let’s talk logistics quickly, since this is often covered during the first session… and I have a theory that we try to pass on so much information that first session that nothing actually sticks.  I know I’ve come away from initial sessions with my head spinning and eyes crossed (yes, therapists go to therapy too).  So, here goes.

Therapy is weird - we often call them “hour-long sessions,” when in reality, they’re more like 53-55 minutes.  So no, we aren’t kicking you out of the room early each week.  We just need a wee bit of time to, well, wee.  And grab a snack, do a quick doom-scroll on our phones, etc.  Or is that just me?!  These sessions are generally at the same time every week, although talk with your therapist about what works best for your schedule.  Some people need more flexibility, which not all therapists may have.  It is ideal to start with your therapist on a weekly basis to establish that relationship that is at the heart of the work.  

Insurance benefits are all different, and some people pay out of pocket for therapy.  It’s important to have a frank conversation with your therapist about the costs associated with sessions, as well as the cancellation policy.  Generally, you still are charged the full fee for therapy when a session is canceled within 24 hours… and insurance won’t cover this cost (ouch).  So late cancels certainly add up - keep this rule in mind if you don’t want to be on the receiving end of a hefty bill.

So that’s an overview of what you can expect when you are about to enter into therapy. Hopefully you’ve found some nuggets that will help you along in your journey.