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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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Going to Therapy: What You Can (and Should) Expect

October 25, 2011 37 Comments by Ashley @ Nourishing the Soul

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Despite having been one half of hundreds of therapeutic relationships over the years, I work hard to remember that for many individuals who sit down in my office, this could be the first time that they’ve entered into this experience.

I recognize that making the decision to go to therapy isn’t an easy one. It usually comes on the heels of deciding that something significant in one’s life isn’t working as she thought it should. Sometimes what isn’t working is incredibly profound, and touches nearly all aspects of her life. Or it may seem on the surface to be minor, trivial even – but hits on such valued parts of an individual’s life so as to push them into my office. Whatever the reason that someone decides to enter treatment, it’s a big decision and one that is never taken lightly.

So if you’re that person – you’ve decided to allow a trusted professional to help you make important changes in your life – you might want to know what to expect. While sitting down in a stranger’s chair is never easy, per se, being armed with an understanding of the process is key to developing the trust that is vital to the process.

Here’s what you can – and should – expect when starting therapy:

1. You’ll be asked why you’re there. It may sound obvious, but the therapist will want to get a thorough understanding of what brings you to treatment. Even if you’ve alluded to “relationship issues” on the phone, he will want to hear in your own words (and in more detail) how you think about the problem, and why you’ve chosen to get help now. Even if you think that certain parts are irrelevant, share them. It helps the therapist to help you if he has a richer context in which to understand the issue that concerns you.

2. You’ll be told about your rights as a patient. The therapist will spend some time letting you know about what you can expect from her and the process of therapy. She’ll likely explain that you can expect your information to remain confidential and secure, unless you are at risk of seriously hurting yourself or someone else. She should generally also let you know things like her fees, cancellation policy, how you can access your records, and more. The specifics will be based on the laws of your area and the specifics of her profession.

3. You’ll learn about the nature of the therapy relationship. The therapeutic relationship is quite different than other relationships that we are used to. When you think about it, it can actually seem a little strange. You’re pouring your heart out to a person who just met you recently and you know nothing about. But certain therapeutic boundaries are in place for a reason. You should be able to trust that you will not have to take care of your therapist’s needs and feelings. You’ll learn, likely quickly, what your therapist’s style is when it comes to this. Some may disclose some personal information about themselves, and you’ll need to decide what you feel comfortable with.

4. You’ll learn about the therapist’s approach. There are more styles and approaches of therapy than we could possibly discuss here, but they often fall along a continuum of directiveness. Some therapists will take a more active approach, asking you to do things like monitor and challenge thoughts and feelings and experiment with changing your behavior. Others will spend time helping you to develop insight into your patterns of functioning and work to provide a new relationship experience via the therapy itself. Others will do a bit of both. While it’s not always important to know precisely how things are working (in fact, it can sometimes steer you off course to get caught up in the details), you should check in with yourself to determine how comfortable you are with the therapist’s style.

5. You’ll be invited to ask your own questions. I encourage you to use this space to really be a savvy consumer. Questions that can be helpful to ask include: What kind of license do you have to practice? Do you have a supervisor or will you be consulting about my case? Have you worked with others who have my issue? What can I expect from therapy? Can I call you between sessions if I need to? How will I know if things are improving? If the therapist avoids these questions or doesn’t give you the answers you are looking for, I suggest proceeding cautiously.

It’s important to remember that the effectiveness of therapy is based heavily (very heavily, in fact) on the therapeutic relationship, so it’s vital to feel a good fit is in place. If you don’t initially, however, that might not mean the therapist isn’t for you; it could mean that you need to give the process time. Unless there is a significant issue, I always encourage patients to give a therapy relationship at least a few weeks for trust and rapport to develop. If these things don’t happen, I urge you to seek a therapist who will meet your needs. Remember, this is your treatment and your mental health.

If you’ve been to therapy, what has your experience been like? What would you ask a new therapist?

NTS-Medium

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36 Comments

  1. Lori Lynn
    3 years ago

    I went to therapy for 2 1/2 years, and probably would have continued, but moved to a different area, and thought that I would be okay without it. After about a year, I decided to seek out counseling again, and recently started with a counselor. I have learned that you have to put into it what you want to get out of it. You have to be honest with yourself (and your counselor), and that can be a bit tough. There are a lot of things that I’ve thought, but never said, and for some reason it can make a difference when it’s said aloud.

    Reply

  2. PTC
    3 years ago

    I started going to therapy 4 and a half years ago. I absolutely LOVE my therapist. I feel like we’re a perfect fit. She totally gets my sense of humor and has a sense of humor herself, which is what I need! I have a very hard time talking so she’s good at dealing with that and allows me to kind of “warm up” with some small talk. I wish I could just go in there and talk, but I don’t know what to talk about and it’s extremely hard for me to talk. I’m working on it though. She also lets me email her whenever, which I try not to do because I don’t want to bother her. She says she doesn’t mind. I’m sure she wouldn’t mind if I called her if I needed to also. She did call me one time because I was freaking out about something, so she called to chat with me fora bit.

    Hmm, I don’t know what else. I really like her and working with her.
    PTC recently posted..Car meltdown

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  3. Marthe
    3 years ago

    I realize I’ve been particularly unlucky, as I’ve had to have “the first session” with 6 different therapists this year. Some therapists had to change jobs, got sick, had to transfer me for other reasons, and with the rest, I just didn’t feel any chemistry with them.

    So I guess my experience is that it takes time to find the right one.

    Most first sessions have been like you describe here. One thing I particularly found valuable was that one of the therapists started the first session by saying that “the more you let me in on, the better I can help you”. I found this to be a very welcome and trust-inviting opening, and I’ve kept this in mind when meeting new therapists since then.
    Marthe recently posted..The Freedom Experiment Facebook Page

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  4. Andrea Owen
    3 years ago

    I’ve had the same therapist on-and-off for 18 years. I started seeing her when my parents got divorced right after I graduated high school. She saw me through that, through my first marriage, through my divorce, and so much more. I can’t tell you how great it was to have a trusted professional I could go to when I felt like I would fall apart. She made me feel normal when I thought I was crazy. Nothing I said phased her. I haven’t seen her as a patient in a few years, but I call every once in a while just to check in. I also send her Christmas cards because she said she loves to see my kids :)
    Andrea Owen recently posted..Ask Andrea: October Edition

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  5. Alex @ Raw Recovery
    3 years ago

    In the last year alone, I have seen 11 therapists (due to eating disorder treatments) and out of those 11 I only found 3 who I trusted and were helpful. The very first therapy session I ever had 6 years ago was not a good one. The therapist spent the entire time talking about her experience in college and how no one thought she would make it and then she did. I found myself at 16 playing the role of the therapist saying, “That must have been really tough”. I walked out and had made zero progress, had found out nothing about therapy, and had no idea that this was so very wrong. I wish I had your website as a resource back then! I did eventually find a therapist in high school who had a CBT approach and she saved my life. However, after doing phone sessions with her while away at college and then seeing her during the summer, she started getting very complacent in our relationship and I felt I wasn’t getting anywhere. For me it has been crucial to find a therapist who can balance compassion and empathy with work, and pushing me when I need to be pushed. I was just diagnosed with Borderline Personality Disorder and will shortly be going to a DBT residential center in CA. I’m very hopeful that working with a new therapeutic approach will be helpful. For those of you who are just trying out therapy, don’t give up hope on the first session! Meet with the therapist a few times and if you don’t feel it’s a match, don’t be afraid to meet with others! You’ll likely have more success and stick with therapy longer if you feel comfortable with your therapist. That’s my opinion at least.
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  6. PTC
    3 years ago

    By the way, I was EXTREMELY nervous the first time I went. Were you guys? I wanted to die. (Not really)

    Ashley, Chicago was great. Weather was great! I wish I could have experienced more of it, but I was working. I did get to go to the 95th floor of the John Hancock building for an event one night. AWESOME view!! Had the deep dish too. I didn’t freak out too much from that.
    PTC recently posted..Back from Chicago

    Reply

  7. TheByzantine
    3 years ago

    My belief is that treatment plans are an essential attribute of therapy. Frankly, I do not understand why so many professionals do no formulate the plans with the client. The input of the client helps to achieve a better result often more quickly.

    As one who frequents a mental health forum, I am amazed at how many have no idea about what they are trying to accomplish. I also do not understand the reluctance of professionals to talk about and include treatment goals the client feels are important. Why the secrecy?

    Reply

  8. Robin
    2 years ago

    I’ve been seeing a therapist for about eight months. She’s the first out of a long string that I’ve been honest with. With all the others I smiled, acted on my best behavior and generally bored everyone out of their minds. I’ve yelled, cursed, and cried with my latest counselor. I don’t really “like” her, but I do trust her; I didn’t used to.

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