How to start therapy
How Do I Go About Starting Therapy?
This is a question asked by many people. You might assume the answer is simple, but finding a therapist can get complicated. This article provides some useful information and things to think about before taking the plunge.
Here’s what I cover in this article:
Seeing a therapist
It’s a bit odd, isn’t it? Seeking therapy and paying someone to listen to your issues. It is common for people to feel discomfort and anxiety about seeking help via a psychologist, counsellor, or therapist. This is entirely normal. Then there’s the ongoing stigma around mental health issues, seeking help, and being ‘in therapy’. Fear of the unknown is also common: What will they ask me? Will I lose the plot?
Many people find themselves feeling stuck about making that first appointment. Acknowledge the discomfort about seeking help. Normalise it and ask yourself what you need to get over this barrier and into your first appointment. You might benefit from asking ‘Is this concern about therapy helpful?’ If the answer is no- ‘What is a more helpful alternative thought?’
How to email a therapist for the first time
There is so much choice now. The rise of online therapy has increased options but also confusion. Here are some routes to making that first appointment:
Get an offline personal recommendation from someone you trust
You may be entitled to access services via your family doctor/GP
An online search
If covered by health/medical insurance, there will be access to a list of approved providers
Always check a therapists qualifications and experience. Ask what their letters mean if unsure (e.g., LSW, PhD). A therapist should always be very happy to clarify their credentials.
Most potential therapists are happy to take initial queries by email. But, it’s also a good idea to make a phone call to get a feel for the person you might be working with. Don’t feel bad about asking lots of questions before booking that first session.
If you choose email, keep that initial message brief. A therapist usually needs just some basic details to determine if they are an appropriate practitioner for you.
What are the different types of therapists?
This topic can be highly confusing. Let's first remove psychiatrists from the conversation because they provide a relatively small number of talking therapists, especially outside the US.
The remaining major categories/job titles are: Counselor, Psychotherapist, Psychologist. All three groups train in one or more talking therapies (e.g., CBT, Mindfulness, person-centred counselling, dialectical behavior therapy). Any professional you see should be a licensed therapist.
There are differences in the type and length of training, areas of expertise, and approach to mental health problems. For instance, marriage and family therapists work with couples and family members. Other therapists might specialise in a specific age group (e.g., adolescents, older adults). Some professionals focus on treating specific mental illness (e.g., schizophrenia, panic disorder).
That would be the best therapy for me
There are also different types of therapy or ‘therapeutic models’. Each one makes assumptions about why and how people develop psychological difficulties. These assumptions (should) directly relate to what occurs in therapy. Cognitive Behaviour Therapy (CBT), for example, assumes that thoughts influence our emotional responses to events (e.g., relationship breakup). Therefore, therapy with this model will (partly) involve identifying and working with problem thinking patterns.
Other widely-used therapies include psychoanalytic psychotherapy, behaviour therapy, systemic therapy, and interpersonal psychotherapy (IPT).
An example first therapy session
First therapy session
The therapist will guide you in early sessions, so there’s usually not much preparation required.
In line with some therapy models, you might be asked to complete questionnaires and/or write on a requested topic. Besides these possibilities, think about explaining your issue/problem clearly and simply. Also, identify your main goal for therapy.
Talk to your therapist about this first session and what to expect.
How often should I meet with my therapist?
This will depend on the therapist, treatment plan, model of therapy, and nature of the problem(s).
Most often, people have weekly sessions. But anything from twice weekly to less than monthly is possible. Some therapists will ask you to meet regularly at a set frequency, then ‘taper’ down session frequency in preparation for work coming to an end.
What to talk about in therapy
You don’t have to worry about what to talk about.
Neither do you have to worry about saying the ‘right’ or ‘wrong’ thing. Your therapist should structure and guide the session. Obviously, they need your cooperation to help things run smoothly. But it is the therapist’s role to lead the way and help you to feel comfortable.
What happens to the information I share?
Anything discussed in therapy should generally be confidential, but there are a few exceptions:
When someone is in immediate danger
Therapists should attend ‘supervision’ which involves meeting with a colleague to discuss clients. Full client details are not usually required in these sessions (e.g., I don’t use a client’s real name in supervision).
Some practitioners and services undertake information sharing as part of their normal routines (e.g., letters to GPs).
How will I know when therapy has worked?
There is rarely an identifiable moment in therapy where a client says ‘That’s it, problem solved’.
In reality, therapy is part of a wider process of dealing with difficult issues and life events (e.g., you might also work with someone on your physical health). Therapy can steer you in a healthy direction, give you positive strategies, and improve your understanding of difficulties. Progress in therapy tends to happen gradually and may continue after therapy ends.
Do therapists have therapists?
Yes, some therapists do attend regular therapy. This is more common in certain therapeutic approaches.
However, all therapists should attend ‘supervision’ with a colleague. Having regular meetings with a peer ensures high quality, ethical, and safe practice. Supervision is not therapy, but there is a degree of support provided to practitioners. Working as a therapist is rewarding but, like other jobs, the role does have sources of stress.
Is therapy worth it?
Therapy can be worthwhile. But, you need to find a skilful therapist who’s a good fit for you. You also need to be ready for therapy. This process is not always easy. So it helps to have the motivation to make positive changes.
Therapy does not work for everyone, so it’s ok to try more than one therapist, or look at other options (e.g., self-help approaches, lifestyle changes).
Therapists near me
Remember that it’s quite normal to feel anxious about seeing a therapist.
However, the benefits usually outweigh the costs/discomfort. Don’t be afraid to shop around, do your research, and change therapists if the first session or two doesn’t feel right. A competent therapist will guide you through the beginning and early stages of sessions. You just need to be clear on what you want from therapy, what’s required of you, and to ask questions whenever you’re confused about the process.
For more information, read about bad therapy and what not to say to your therapist.
While waiting to start working with a therapist, why not try 15 mins for me.
We are Coaching & Clinical Psychologists with extensive experience helping people conquer a range of wellbeing and performance issues at home and in the workplace. Read more about our work, watch practical skills videos or browse other articles. Get in touch anytime.