Better Understanding Therapy: What’s It Like and What Really Happens in a Therapy Session?

If you’re new to the idea of therapy, the process can seem mysterious. You might have lots of questions. How do you even find a therapist? Is it going to be uncomfortable? Is it expensive? Will it work? What will we talk about?

Since people often explore therapy when they are already experiencing a stressful time or mental health concern, the process can feel overwhelming. Thankfully, it isn’t so scary once you break it down.

“Therapy is about a relationship between the client and the therapist,” Jessica Small, a licensed marriage and family therapist in Aurora, Colo., told Healthline. “…I attempt to meet the client where they are at and build a rapport that will give them the safety and security they need to begin to be more vulnerable and open.”

The Basics of Therapy

Therapy refers to psychotherapy, also known as talk therapy or counseling. Therapy can be used to treat a range of problems, including mental health conditions and/or day-to-day concerns that affect your mental health.

“Psychotherapy is an approach for treating mental health issues by talking with a psychologist, psychiatrist or another mental health provider,” according to an article published by the Mayo Clinic.

“…During psychotherapy, you learn about your specific issues and how your thoughts, emotions and behaviors affect your moods. Talk therapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.”

The Mayo Clinic website describes these types of psychotherapy:

• “Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and learn healthier coping skills.
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others.
• Acceptance and commitment therapy, which helps you become aware of and accept your thoughts and feelings. It also helps you commit to making changes and improves your ability to cope with, and adjust to, challenging situations.
• Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of thoughts and behaviors that you may not be aware of. These therapies help you find out what motivates you and help you resolve conflicts.
• Interpersonal psychotherapy, which focuses on problems with your relationships with other people to improve how you relate to others, such as family, friends and co-workers.
• Supportive psychotherapy, which improves your ability to cope with stress and difficult situations.”

Why Even See a Therapist?

People see therapists for many reasons. Some are working to manage a mental health condition like depression or anxiety, and others are searching for more effective ways of handling problems in their daily life.

“Knowing when to see a therapist can be a little challenging sometimes. After all, everyone has a bad day or goes through a rough patch every now and again, but how do you know when talking to someone might help?” writes Amy Morin, LCSW, in Verywell Mind.

She created a list of some of the ways therapists can support you. They include:

“Managing your mental health”– A therapist may help you manage stress, regulate your emotions, and/or help you if you are reaching for unhealthy coping skills.

“Self and relationship improvement”– If you are struggling to reach your goals, are looking to improve your relationship(s), and/or want to increase your self-awareness, a therapist may be able to help assist.

“Dealing with major life events”– A therapist may help if you are going through a life transition, want help processing a traumatic event, and/or are interested in some parenting support.

“Productivity management”– Speaking with a therapist my also benefit you if your mood is impacting your appetite, sleep, or ability to complete work.

“Finding yourself” – If you have noticed that you lack interest in activities that previously brought you joy or if you have noticed that your social life is suffering, it may be helpful to talk to a therapist.

“Challenging negative thinking”– A therapist may also be helpful if you are seeking to change your unhelpful thinking patterns, improve your overall happiness, or if you suspect you may have symptoms of a mental illness.

“When problems interfere with our capacity to function, therapy can help,” says psychologist Scott Bea, PsyD, in a Cleveland Clinic article. “But if we just want to feel better and hope something magical will happen, it won’t work. We have to be willing to endure some discomfort.”

How Does Therapy Make You Feel?

Dr. Bea’s mention of discomfort is important. When you meet with a therapist, you might discuss things that aren’t easy to talk about. However, it is with a positive end goal in mind. He says that during therapy, you can “expect to experience a wide range of feelings,” including:

• “Safety and acceptance.
• Discomfort, anxiety or sadness as you face certain truths.
• Profound insights about yourself.
• Hope as you begin to conquer feelings.
• Elation as therapy unleashing power you didn’t realize you have.”

In short, while you may experience a range of emotions in therapy, it ultimately may help you understand yourself better – and help you to go a little easier on yourself.

“When we’re self-accepting, we’re in better spirits, more flexible and more resilient,” Dr. Bea says.

What Happens in Therapy Sessions?

Every therapist, and every therapy session, is unique. What happens in your therapy session will largely be based on what you are experiencing, and your needs and your goals. However, there are some common themes for what you can expect.

“Each session is, essentially, a problem-solving session. You describe your current situation, and your feelings about it, and then the therapist uses their expertise to assist you in trying to resolve that problem so you can move closer to having the life you wish to have,” according to psychologist Suzanne Gelb, Ph.D., J.D., in Psychology Today.

During your appointments, the therapist will often encourage you to talk about your feelings and what challenges you’re facing, according to the Mayo Clinic article. Some patients might find it difficult to open up at first. Your therapist will help you get more comfortable doing so over time.

Emotional responses are to be expected, according to the Mayo Clinic article. Crying, getting upset or even experiencing an angry outburst can happen. Your therapist might also give you specific activities to act on what you’ve learned.

Your First Therapy Session

Knowing what may happen at your first session can help you feel more comfortable. Some of your experience will depend on what kind of provider you see, and if their office is in a medical or professional building or a home setting.

“When you get to the therapist’s office, expect your initial experience to be similar to a doctor’s appointment. You will sign in when you get there, sit in the waiting room, and wait for someone to call your name. If your therapist has a home practice, the scene might be a bit more casual,” according to Verywell Mind. “While waiting, you will likely fill out some paperwork, including:

• HIPAA forms
• Insurance information
• Medical history, including your current medications
• A questionnaire about your symptoms
• Record release form
• Therapist-patient services agreement”

When you walk in to speak to your therapist, they will likely start the conversation in an easy way to put your mind at ease before moving into more specific questions. They may give you a roadmap of sorts to describe what your relationship will be like. Your therapist may ask you about how you are feeling, why you decided to go to therapy, what challenges you may be experiencing and other questions to orient the therapist to your state of mind and history.

“You and your therapist should also come to an agreement about the length of your treatment, methods to be employed, and ins and outs of patient confidentiality,” according to the Verywell Mind article. 

Another pointer is to think in advance about your goals, an article in Psychology Today suggests. It could help to write down some notes and questions to take to the visit.

“I would hope my clients come in with an idea of what they’re hoping to get out of therapy,” Shani Turner, PhD, a therapist and assistant professor of clinical psychology at William James College, says in the article.

The answers you give during your first therapy session will help your therapist set up a treatment plan for your specific needs and goals. There’s no “right” or “wrong” answer to any question. In fact, not being able to answer a question can also help give your therapist insight into what you’re going through.

Advice for First-Time Therapy Patients

First-time patients often wonder how well therapy will work – and how long it may take. Here are some pointers to keep in mind.

According to the Mayo Clinic article, it’s important to know that therapy might not provide a cure for your mental health situation. And it might not make difficult circumstances go away.

There are, however, some tips to help patients get the most out of therapy. The article suggests these:

• “Make sure you feel comfortable with your therapist”
• “Approach therapy as a partnership”
• “Be open and honest”
• “Follow your treatment plan”
• “Don’t expect instant results”
• “Do your homework between sessions”
• “If psychotherapy isn’t helping, talk to your therapist”

It’s difficult to know at the outset of therapy how long it will take. The Mayo Clinic article says the type of mental health issues you’re facing, their severity, how long you’ve been experiencing symptoms or challenges, and other factors all play a role in the duration of therapy.

How to Find the Right Therapist for You

It’s worth taking the time to find a therapist that you feel comfortable with. Not every therapist takes the same approach.

You can look online to find more information about a professional before you schedule an appointment. Understanding what you want out of your discussions may point you toward one therapist over another.

“Goodness of fit is everything [in therapy],” says Dr. Colleen Cira, a licensed clinical psychologist, in a NBC News BETTER article. “Research is clear that the #1 determining factor in whether or not a client gets better from therapy is based on how strong their relationship is with their therapist. If you don’t like your therapist, you’re not going to get better, regardless of how well-trained they are.”

Not every therapist takes the same approach. You can look online to find more information about a professional before you schedule an appointment. Understanding what you want out of your discussions may point you toward one therapist over another.

“You should know what you want to work on [when beginning therapy],” Dr. Cira says. “Do you feel really strong that you don’t want to focus on your past and only the present? Do you want to focus more on things that have happened to you in the past? Do you want someone to help you ‘solve’ your problems or someone who will really sit with you in your pain or both? These are all things you should ask yourself that will help guide your search.”

Once you understand what you want to get out of therapy, it may be time to start looking. You can ask you primary healthcare provider for a recommendation. You can also start your search for a local therapist using search tools provided by the American Psychological Association, American Psychiatric Association and Psychology Today. Be sure that any therapist you’re considering meets state certification and licensing requirements.

As you learn about different providers, look into their payment options. You can work with your insurance provider, if you have one, to find an “in-network” therapist who will work with your insurance to determine how much each session will cost.

What Happens Next?

As you progress in your therapy sessions, you can expect your therapist to give you information and tools to help you better cope with your specific challenges.

“Therapy is a valuable tool that can help you to solve problems, set and achieve goals, improve your communication skills, or teach you new ways to track your emotions and keep your stress levels in check. It can help you to build the life, career, and relationship that you want,” according to Dr. Gelb.

While the idea of therapy might be intimidating at first, breaking the process down into steps can help make it more manageable. If you run into roadblocks, try not to get discouraged. You – and your mental health – are worth it.

For more information on similar topics, please visit:

• Could Meditation Be Complementary Therapy for Anxiety? https://genesight.com/blog/meditation-for-anxiety/
• 5 Ways to Manage Anxiety https://genesight.com/blog/patient/5-ways-to-manage-anxiety/