For a therapist, the first session with a client is everything. Not only is it where you start to build a relationship, but it’s also where you gather all of their background information, the puzzle pieces you use to construct a picture of who they are — the most important of which is why they’ve come to see you in the first place. That’s usually the first question out of the gate.
I once had a client who responded, “I was watching House last night, and one of the characters on the show saw a psychiatrist, and the psychiatrist pointed out all of these things they didn’t even realize about themselves, and they had this amazing, mind-blowing experience. I want to experience something like that.”
I paused. “Okay,” I said slowly. “Is there anything in particular that’s bothering you, or anything specific that you want to address?”
The client stared blankly back at me.
This was not going to go well.
After my last post about being in therapy, I got a number of questions about how the process works. This is completely understandable, as when it comes to therapy, most people know only the random tidbits they’ve gleaned from distant relatives and The Sopranos. As a result, many are thrown for a loop when they start the process and find that it’s not exactly what they expected. This can frustrate client and therapist alike, so in the interest of all parties, here are a few things you should know before you begin.
You should have a goal in mind. The client I described earlier had an unrealistic expectation for therapy: She wanted me to blow her mind. Somehow. But that’s not how it works. Simply walking into the office and expecting the therapist to pull something helpful out of thin air isn’t reasonable; you need to have a sense of what you want to work toward. Wanting to learn how to manage your stress, to understand why you interact in a certain way with others, to feel less sad, to stop obsessing about food, to figure out your sexuality, to understand why your kid throws tantrums, to communicate better with your partner — these are all reasonable goals. Wanting your therapist to amaze you is not. (That may happen, but it shouldn’t be your main objective, because you’ll probably be disappointed.)
This leads to my next point:
Therapy takes work. I’ve had any number of clients who seemed to think that simply coming to therapy was the big accomplishment, and now that they had made it into my office, I would reward them by producing a prescription for happiness or doing some kind of alchemy that would magically make them feel better.
Don’t get me wrong: Making it into a therapist’s office is a big deal. But that is not the ultimate goal. And if your therapist had a prescription for happiness, they would probably not be your therapist; they would be reclining on their private island in the Caribbean, because they would be a bajillionaire and never have to work again. And no one would ever need therapy.
Therapy requires you, the client, to do a lot of work. You have to be open and honest about your experiences, past and present, and your fears and concerns about the future, however embarrassing or unrealistic they might be. You have to reflect on your feelings, thoughts, and actions; you may have to revisit painful experiences; you may have to sit in uncomfortable feelings; you may have to put some things into practice outside of your sessions and come back and report how they went. Yes, your therapist will be working too; it takes a lot of effort and skill to see how all of the pieces come together, how your past experiences shape your current ones, how your behavior is reinforced by your environment, why you feel and think and act the way you do — all while keeping tabs on your behavior in the session and their own feelings and using all these factors to determine where to go next. Your therapist is tracking things on multiple levels, and that kind of work is no joke. So therapy is a lot of work for the therapist — but it’s also a lot of work for the client, and you should know that going in.
The best time to go to therapy is when you are *not* in crisis. When it comes to your physical health, you wouldn’t want your first encounter with a doctor to be in the ER when you’re having a heart attack. At that point, their main goal will be simply to keep you alive. Ideally, you’d first see a doctor when you’re feeling well to make sure that everything looks okay, to establish a game plan to manage anything out of the ordinary, and to avert a heart attack in the first place. The same is true for your mental health. If you go to therapy only when you’re in crisis, the main goal for you and your therapist will be to get you back to a place where you can function. You won’t have a lot of margin to think about much more than that. The best time to see a therapist is long before the crisis happens so you can develop healthy patterns and prevent the crisis altogether.
You should like your therapist. When you think about it, it doesn’t really matter if you like your dentist or your mechanic; it helps, certainly, but at the end of the day, how you feel about them personally has little bearing on how well they fill your cavities or check your brakes. In contrast, you share with your therapist your deepest vulnerabilities, wounds, and pain. Not liking them will significantly impact your ability to do that — and to be open to their feedback. So find a therapist you like. You may have to visit a few before you find one, but many will do a first session or a phone consult for free. If they seem like a weirdo or you don’t click, find someone else. (Unless you see a bunch of people and you don’t like any of them, in which case… you, or your attitude about therapy, might be the problem.)
… but therapy is not the same as talking with a friend. If it were, you could simply talk with a friend and save yourself the money. Your therapist may do things that a friend might not, like make observations about your body language and how they’re experiencing you in the moment. On the flip side, they might not do things that a friend probably would, like tell you about themselves or give you advice about what they think you should do. Some things that aren’t normal in the real world are par for the course in therapy. The point is to get you as aware as possible about yourself — your thoughts, your feelings, the messages you send and receive from the people around you.
Therapy is not cheap. Many people assume that therapy won’t cost much, perhaps because it requires no fancy equipment. They are wrong. Depending on where you live, therapy can run anywhere from 80 to 200 dollars an hour. This, to some, seems unreasonable. But 1. your therapist is working hard, as I described earlier; 2. their education and experience weren’t free; and 3. your payment for therapy signifies your investment in it. Even agencies that serve the lowest-income clients almost never provide free services, because when people regularly get something for free, they tend not to take it seriously. We pay for what we value.
That being said, many clients do not pay full price for therapy. Many therapists have sliding-scale fees, so if you legitimately cannot afford their services because of your income, they can offer a reduced rate. Also, many insurance plans cover mental health services; some cover a certain number of sessions a year and some even cover unlimited sessions, usually with a small co-pay. The downside of using insurance is that you have less choice in who you can see (and, with certain providers, you may not get to see your therapist more than once a month). In addition, therapists who are still in training usually have lower rates than licensed ones; the drawback there is that they have less experience. (I wouldn’t rule out this option, though — I had classmates who were so naturally gifted that they were better therapists in their first year of school than some of the licensed clinicians I’ve met.)
If you’re a college or graduate student, your school almost certainly has a counseling center on campus, where you get a certain number of sessions a year simply for paying your (required) student fees. Not nearly enough students know about these services — or take advantage of them. Given how expensive therapy can be in the real world, this is a pretty sweet deal. In addition to therapy, your school’s counseling center may offer resources like workshops and group therapy. The downside: Like seeing a therapist through your insurance, you have less choice in who you see, and you may have to wait a while to see someone, as many counseling centers have waiting lists. But many of the best therapists I know work at universities.
Things might get worse before they get better. People vary in their responses to the first few sessions of therapy. Some feel so much relief from talking about their issues that they feel better immediately. Others, however, find that facing their problem head-on is painful, or that the problem is deeper and more complicated than they realized. They may realize that their depression is related to a loss in childhood that they never fully processed, for example, or that their issue will take more than a few sessions to fix. And instead of feeling better right away, sometimes they feel worse than they did when they first went in. It’s very common for people to drop out of therapy at this point.
But the thing is: Sometimes, things get worse before they get better. This is completely normal. You have to acknowledge the problem in its entirety in order to address it. You need to face the pain in order to heal from it. So uncomfortable as it might be, if it gets worse before it gets better, I urge you to stick with it. If you keep working at it, it will get better. And you’ll be better off for it in the end.
So that is my advice to you, should you be considering therapy — which I think everyone should. If you need more information about how to find a therapist, you can find steps and referrals here. And whoever you are and whatever you’re going through, I wish you the best on your journey to healing and wholeness.