What Should I Know Before Starting Therapy?

You probably found yourself here because you are thinking about starting therapy. Maybe you’ve tried before and had a disappointing experience, and you aren’t sure why it didn’t click. Maybe you’re ready to try this experience for the very first time. Either way, there is typically not a road map. Clients are expected to navigate the therapeutic process largely on their own, and might be afraid to ask questions. Start here if you’re looking for a beginner’s guide.

If you are looking for an explanation on paying for therapy, please see my previous blog post here.

Where do you look for a therapist in the first place? There are a few places I’d recommend looking:

• PsychologyToday.com is an amazing resource. Therapists must pay to advertise, and their website verifies all license numbers. You can filter your search by insurance, age, gender, issue, modality, and more. You can contact the therapist via phone or email directly from the website.

• Other online therapist directories such as TherapyDen.com or MintLeaf.co/Therapists

• Find an EMDR therapist at Emdria.org/find-an-emdr-therapist

• If you are in Michigan, Illinois, or Wisconsin, check out Great Lakes Psychology Group and browse their online directory.

• Call your insurance company directly, and ask for referrals who are already in network.

• Ask your psychiatrist for a trusted referral.

• Pointed Google searches, such as “addiction therapist online Michigan” will yield better results than a broad search for “therapist near me.”

• It never hurts to ask peers if they love their current therapist, but be sure to check out that therapist’s online presence first to make sure they are a good fit for you.

What does “good fit” mean in therapy? It is a nuanced answer. It is hard to define, and can be more of a feeling or intuition than a definition.

You should feel comfortable sharing things with your therapist without fear of judgment. If you find yourself hiding information or lying to your therapist because you are afraid they will harshly respond with criticism, something isn’t right.

You should feel like your therapist is not so much an authority figure, but a guide. You are still in charge of your own life.

You should be aware that your therapist will gently challenge, nudge, and confront you and that may feel uncomfortable. It should still feel like it is coming from someone who cares about you.

You should feel genuinely and unconditionally cared for by your therapist. Healthy boundaries will be in place, but therapists do this work because they care about people. If your therapist appears bored, disinterested, judgmental, or downright hostile, it is not a good fit.

Your therapist should collaborate with you on your treatment goals. If you find yourself being told what is going to happen without your input, run. Your therapist will need to be realistic with you and may say no to things (for example, if you are asking for a treatment that is not research-backed), but your input should still be respected and considered. Nothing should be put on your treatment plan without your consent.

You should be aware of your diagnosis. If you don’t know what’s on your medical record, ask. You are entitled to have access to all of your records at any time. Absolutely no part of your medical record is a secret from you.

Now that you’ve found someone, how does it work and what do you talk about? Will it be scary or uncomfortable? How often do you need to go?

After scheduling your appointment, you will need to fill out new patient paperwork, just like you would with any other healthcare provider. Something to note is that therapists often need this done before your appointment day, because they need your consent to receive services, and they like to have a preview of what your concerns are.

Your first appointment is called an intake, and uses a different billing code than regular sessions. This is because your therapist will spend the session gathering a lot of background information about you, your psychiatric history, family history, and what led you to starting therapy.

You and your therapist will make a treatment plan together. Here, you will discuss what your goals are and what you’d like to accomplish through therapy. You will also discuss how often you would like to attend. Your therapist may make a recommendation based on your symptom severity. Weekly or biweekly are the most common session frequencies. Some clients who have been in therapy for a long time like to reduce their sessions to monthly, after they have stabilized but still want to have check-ins.

If you are afraid you’ll have to talk about things that are scary or uncomfortable, you’re half right. Your therapist should not push you past your limit or force you to share things you aren’t ready to. It should feel more like a gradual journey of safety in which you feel ready in your own time to share, with some gentle nudging and encouragement from the therapist. It is important to note, though, that growth cannot happen if you are standing still.

Your therapist might end the session by giving you homework, which I encourage you to take seriously. It may be something like meditating 3 times over the next week, or writing a letter to your past self, or exercising your right to enforce a boundary with someone. You should feel safe and encouraged to try the homework, and if not, you and your therapist can troubleshoot at your next session.

Therapy is both comfortable and uncomfortable, but you should always feel safe, cared for, and encouraged. If you need help, ask!

What questions do you have about starting therapy?