If you've decided it's time to see a therapist, then you’ve already done the hardest part: recognized you could use support with your mental health or an emotional issue, found an appropriate doctor or counselor, and booked a visit. But what actually goes on once you arrive at the office—and is there anything you can do beforehand to make things go smoothly? This guide will help you understand the process for beginning therapy if you're a first-timer.
You might feel uncertain about going to therapy.
For all the progress that’s been made, the stigma against seeking mental health treatment is still real—and that’s despite the fact that about half of us will have to deal with a serious psychological issue at some point, says Marla Deibler, a licensed clinical psychologist and executive director of The Center for Emotional Health of Greater Philadelphia.
“We all have our own coping resources and repertoire and sometimes the stressors in our lives exceed our abilities to cope,” she says. “There’s no judgment in that.” You might still second-guess your choice to go, even as you enter the waiting room, but that’s no reason not to give it a try to see if it benefits you.
Doing some homework can pay off in your session.
There’s probably a reason you made the appointment (or that someone else encouraged you to do so).“ If that’s not clear for you, it's good to sit down, perhaps journal a little bit,” says Adam Gonzalez, a licensed clinical psychologist and founding director of the Stony Brook University Mind-Body Clinical Research Center in New York. “Ask yourself: What’s going on right now in my life, and what would I like my life to look like? What are some goals that I might have?” That can help you narrow down what you hope to get out of the experience.
Also consider whether or not you’re open to taking medications. If you’re seeing a psychiatrist (an M.D. or D.O. who specializes in mental health) or a nurse practitioner, that’s an option; psychologists, counselors, and social workers can’t prescribe, but may refer you if that’s a recommended part of your treatment.
A little online research into the types of concerns you’re having and what works to address them can also be useful. Look at the websites of advocacy organizations like the Anxiety and Depression Association of America or the International OCD Foundation, taking special notice of the evidence-based treatments, Deibler says. That said, don’t feel stressed out by the need to study up. The most important thing to arrive with is an open mind and a willingness to discuss your challenges and goals, says Atlanta-area psychiatrist Dion Metzger.
You’ll have to wade through some paperwork.
Your therapist or the office staff will likely handle issues like the copayment or visit fee up front. If you’re using insurance, you might want to inquire beforehand as to what your benefits cover. Sometimes, the number of sessions is limited—if you’re worried about this, bring it up with your therapist. Together, you can often request an exemption or explore other options that supplement therapy, such as group sessions or stress management and relaxation programs, Gonzalez says.
You’ll also have to sign some standard documents saying you’re consenting to treatment and specifying who your records can be shared with, and probably fill out questionnaires about your symptoms and medical history. If you’re taking medications—even for non-psychiatric reasons—bring them along, or come with details about the drugs and dosages. This gives your therapist a clear picture of your overall health (after all, some physical conditions or treatments can have psychological side effects).
Then, it’s time to start talking.
Once you’re in the office, you may or may not see the stereotypical couch and clipboard—Metzger has both, though she notes you don’t have to recline unless you want to. Her goal is just to make patients feel at home. (If the clipboard makes them nervous, she’ll try to minimize her use of it.) Once you’re nice and comfy, your therapist will guide you through a conversation about who you are and why you’re seeking therapy.
“I always start off saying: ‘This is just about me getting to know you. These aren't going be intense, burning questions,’” Metzger says. “People come in a very guarded, nervous about what this is going to be like. Once I say that, I can literally see them breathe a sigh of relief. They’re like, ‘OK, I can talk; I can have a conversation.’”
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She also reassures patients they don’t have to discuss anything they’re uncomfortable sharing. Therapy tends to work best when you’re open and honest. But even when you’re talking with a mental health professional, it’s normal to want to build up some trust before you spill all. “We want you to be comfortable and it can be a process,” Metzger says. “I have patients who don't disclose things to me until six months down the line.”
As you talk, you’re getting to know your therapist, too. You can ask questions about their training, experience with the types of issues you’re facing, and typical approaches. Some focus more on skills—coping strategies you can use to manage emotions—while others are more insight-oriented, helping you search for and understand the root causes of your negative feelings. There’s not necessarily a right or wrong approach, but at this visit, you can start to get a feel for what might resonate with you. “Not every therapist is a good fit for everyone, so try to get a sense of what it may feel like being in the room with that therapist,” Gonzalez says.
What you say is confidential.
Anything you do decide to disclose remains strictly between you and your therapist, with a few notable exceptions, Gonzalez says. If your therapist fears you’ll hurt yourself or others, he or she may act to intervene. They’re legally required to report domestic violence and abuse or neglect that involves children, the elderly, or people with disabilities. And, if they receive a court order to release your files, they’ll have to do so.
You might run through a wide range of feelings, including sadness and comfort.
Even if you don’t get too deep, you might find merely opening the box on feelings and topics you haven’t discussed openly before leads to powerful responses. “Sometimes people are surprised by how emotionally evocative it can be,” Deibler says. Often, when you’re struggling, you spend more effort than you realizing holding things together; it doesn’t take much to pull them loose.“ I usually tell them, I’m a psychologist. If people don’t cry in my office, I’m not doing a good job.”
Though some of this can be uncomfortable, Metzger's first-time patients primarily report a sense of relief. “They feel like they've unloaded it, and really even before we even started working on our therapeutic techniques, there's something very beneficial to just be able to talk about what you've been through,” she says.
You’ll leave with an idea of what comes next.
Though you might already feel better, don’t expect a quick fix to all your problems: “There aren’t many one-session cures,” Gonzalez says. Nor does therapy work like an antibiotic, where you swallow a pill and see results. Your therapist will provide observations and guidance, but you’ll have to put in effort to change your thoughts and behavior, Metzger says.
At the end of your first visit, your therapist will likely review what you covered, offer some thoughts, and propose a plan for how you’ll work together. This might or might not involve a diagnosis—sometimes that takes a few visits—but you should at least have an idea of what your therapist suggests you work on and some of the logistics of how you’ll do it. That usually includes what techniques you’ll try, how many sessions you might need, and what you’ll need to do on your own between them.
And, an idea of whether you want to go back.
Some therapists just aren’t that great, and even good ones aren’t right for every patient. Sometimes, you can tell right off the bat the two of you don’t click. If you seem to be labeled with a diagnosis too quickly—within just a few minutes—or if you feel judged, that’s a red flag things probably won’t work out, Metzger says.
Otherwise, it’s a good idea to give the relationship at least a two- or three-visit trial. If you’re unsure, you can actually bring up your discomfort with the way things are going to your therapist. “Tell me what doesn't feel comfortable to you and maybe we can figure out why that is—that might be actually something to work on,” Deibler says. “You know, maybe you have difficulty sharing private stuff because it feels really shameful. It's not necessarily reflective of that therapist, but of some of the things that are hard for you.”
After a while, if things really aren’t progressing, you might get more out of changing therapists or treatment approaches. Good therapists will understand this if you tell them or just don’t schedule another appointment, Deibler says.
If your first attempt doesn’t pan out but you still think you could use help, don’t give up. “A bad experience, unfortunately, can really sour somebody's complete vision of what therapy is,” Metzger says. Her advice? Do some research on therapists, armed with your newfound knowledge about what doesn’t work for you, and try again. “Therapy has the potential to be life-changing.”
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