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?

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.

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 a treatment that involves talking with a trained mental healthcare professional to help identify and work through the factors that are affecting your mental health or may be triggering your mental health condition,” according to the Cleveland Clinic.

“The goal of psychotherapy is to eliminate or control disabling or troubling thought and behavioral patterns so you can function better. Psychotherapy can be short-term or long-term depending on your symptoms and condition. There are several different types of psychotherapy, including:

• Cognitive behavioral therapy (CBT)
• Interpersonal therapy (IPT)
• Mindfulness-based cognitive therapy (MBCT)
• Dialectical behavioral therapy (DBT)
• Problem-solving therapy (PST)
• Psychodynamic therapy”

Different kinds of professionals offer various forms of therapy, including:

Therapists. “A therapist has a master’s degree in a mental health-related field such as psychology, counseling psychology or family therapy. They’re qualified to evaluate a person’s mental health and use therapeutic techniques, such as talk therapy,” according to the Cleveland Clinic website.

Psychologists. “A psychologist has a doctoral degree (PhD), typically in clinical psychology, and often has extensive training in research or clinical practice. Psychologists treat mental health conditions with psychotherapy (talk therapy).”

Psychiatrists. “A psychiatrist is a medical doctor who can diagnose and treat mental health conditions. They can prescribe medications and other medical treatments,” according to the Cleveland Clinic.

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.

“At the beginning of a session, the therapist typically invites you to share what’s been going on in your life, what’s on your mind, what’s bothering you, or whether there are any goals you’d like to discuss. You’ll be invited to speak openly. The therapist will listen and may take notes as you speak; some, like myself, take notes after a session. You won’t be criticized, interrupted or judged as you speak. Your conversation will be kept in the strictest confidentiality. This is a special, unique type of conversation in which you can say exactly what you feel – total honesty – without worrying that you’re going to hurt someone’s feelings, damage a relationship, or be penalized in any way. Anything you want – or need – to say is OK,” she says.

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 Verywell Mind.

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.

“Nancy Beckman, PhD, a licensed clinical psychologist and professor at the University of Chicago, says she will often ask ‘what brings you in?’ because the answers will determine the treatment plan she develops,” according to Oprah Magazine. “Expect to answer questions about how long you’ve been struggling with a particular issue, and perhaps jump into life and family history. Uber specific answers (‘I’ve felt depressed since my mother’s death,’ for instance) or general explanations (‘I feel overwhelmed, and don’t know where to start’) are both helpful.”

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.

Therapy Doesn’t ‘Fix’ You

It’s best not to think of a therapeutic relationship as a tool that could or would “fix” you. After all, you’re not broken in the first place. You can think of conversations with your therapist as a way to work together toward your mental health goals. Those goals may evolve over time.

Jessica A. Gold, M.D., M.S., an assistant professor in the department of psychiatry at Washington University School of Medicine in St. Louis, says this in SELF:

“Like the conversations in any relationship, what you discuss in therapy initially might be more general until you get more comfortable. Your goals might also start off as more surface level (e.g., “I want to sleep better”). But what comes out over time through your work together could be a deeper, causal understanding of these symptoms (think: I’m not sleeping because I experienced a trauma and am having nightmares from it), which in turn, could alter the goals for therapy, what improvement would look like, and might even change the type of therapy someone receives,” she says.

Progress Happens Gradually

As your conversations continue, you might see gradually signs of changes in your daily life.

“Ultimately, successful therapy means that your symptoms seem better managed or are decreasing, and you feel like you’re accomplishing your current goal(s) or raising your self-awareness outside of therapy,” Dr. Gold writes. She says your therapist will help you look for signs you are making progress. Some signs are more obvious than others.

“If you went into therapy symptomatic of a mental health issue, like anxiety issues, you can look at whether your symptoms have decreased (or are gone completely), or if they are interfering with your day-to-day activities less frequently. For example, you might feel less anxious, you might have less frequent panic attacks, or you might be sleeping more hours a night.”

Progress might not be linear, according to Dr. Gold. And since no two people experience the same mental health issues, there’s no one timeline that will predict when you see progress.

How to Find the Right Therapist for You

It’s important to work with licensed therapists. It’s worth taking the time to find one that you feel comfortable with.

“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 the “Find a Therapist” tool from Psychology Today.

How to Find Affordable Options

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.

“Insurance varies among people, but there are some plans, especially Preferred Provider Organization (PPO) plans, that can cover all or some of your therapy sessions if they are in-network,” says financial educator Berna Anat in an article on Prevention’s website. “Others, like Health Maintenance Organization (HMO) plans, tend to be more limited in scope.”

A first step can be to call your health insurance company to determine if therapy sessions are considered covered benefits. Make sure that the therapist you are thinking of seeing is in your network; otherwise, you may be facing steep out-of-network costs. Many insurance providers have a list of in-network providers you can review and research from there. You might find an option that is more affordable than you thought.

“Initially, I worried that therapy would be far too expensive for me,” writes Jonathan Borge in Oprah Magazine. “But after several calls with (patient) insurance representatives, I realized that affordable practitioners do exist – you just have to dig around.”

Finally, check in with your insurance provider to determine if you will need to provide co-pays at the time of your visit and if therapy sessions count against your annual deductible.

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.

That was true for Jonathan Borge. “My therapist has taught me certain rituals that help me overcome the daily brunt of depression and anxiety. Often, she’ll suggest I practice mindful breathing, journaling, or work on altering potentially damaging behavior (not sleeping, having too much wine),” he writes in Oprah Magazine. “This helps me, and when I’m feeling overwhelmed, I know which baby steps to take in order to cope.”

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/