Have you ever wondered what happens in therapy? I’ve talked to some people who have some hesitation about therapy because they aren’t sure what to expect, don’t want to waste their money in case they don’t like it, are afraid it will be weird, and many other reasons.  There isn’t a single way of doing therapy so it’s a bit difficult to predict for certain what your therapy session might be like but I will try to describe what you might encounter in an “average” therapy session during beginning, middle, and ending stages of therapy.

The first time you meet with a therapist is a bit different from later sessions. Going into the first session you might feel a little anxious about it, wonder how you are supposed to act, if you will like the therapist and if they will like you, if you will say the right thing, and maybe even worry that the therapist could judge you.  All of these thoughts and feelings are “normal” and common.  I’ll tell you a secret: The therapist also might be a little nervous!

Once you’ve arrived at the therapist’s office you will either check in with the receptionist if there is one or have a seat in the lobby area until your therapist comes to meet you. They may have you start working on filling out the initial paperwork there, they may have sent it to you in advance so you’ve already filled it out, or they may fill it out with you during the first session.  Once your therapist takes you to the therapy room they will probably introduce themselves and then will pretty quickly get into some administrative stuff.  They will talk to you about their practice policies, cancellation policy, privacy, mandated reporting issues, fees (which you probably agreed upon before the first visit), and maybe a little bit about their therapy philosophy.  Once all of the paperwork is signed and you understand the policies the therapist will likely ask you what brought you to therapy, what your therapy goals are, if you have ever been diagnosed with a mental illness, all of these questions (and more) are the start of taking your history and starting to build an idea of who you are, what you want, and what kind of assistance you require.  Some therapists will ask you a lot or a little about your past, your family, your childhood etc.. other therapists will focus more on what is going on in your life right now and not ask very much about your past.  This is largely determined by the therapist’s modality (the type of therapy philosophy they work with IE:Cognitive Behavioral Therapy).

For the therapist, the primary goals of the first therapy session are to start building a relationship with you (called joining) and to start being able to build a clinical picture of you.  The process of joining, getting to know each other, and creating a full clinical picture might take up most of the first 3-5 sessions and since you don’t know the therapist well you may be reluctant to open up enough to really get into “the hard work” of  what brought you to therapy so it’s possible that you will talk more about what is going on in your life and your past during this time.

For some kinds of therapists there is an organic unmarked transition from beginning therapy into middle stage while for others the transition might be clearly defined by something like the therapist presenting you with their idea for a treatment plan and a schedule or structure they propose to follow.  There is no one way that is right but there might be a right way for you.  If you do have a preference about structure, this is something you may want to talk about before or during the first session.

Middle stage therapy is where the “real work” is done.  You have established a relationship with your therapist, you know what to expect, you trust them, and all of these things open you up to the process of healing that you came in search of. Sessions during this time vary a lot between therapists but on average it will start with a “check in” where you talk about what has happened in the last week.  After that you or the therapist will guide the conversation into whatever work you will do. At the end of each session your therapist will probably have some way to help you compose yourself if you became upset and otherwise bring the session to a conclusion.  Some therapists think of therapy as being a “container” for your work and if they share that belief they may have some regular ritual or other way to bring you back to your regular life and leave your work at the therapy office. Whatever type of therapist, if you become upset during therapy you have the right to stay at the office until you calm down enough to safely make it home.  Hopefully your therapist will have ways to help you calm down and regain your composure.

At the ending stages of therapy the session format will likely be similar to middle therapy but it will additionally start to include conversations about the end of therapy– what needs to happen, what the process will be like, how you can take care of yourself, and whatever else you need to do to prepare for the end of therapy.

I hope this helps answer some of your questions and concerns about therapy. I welcome you to add to this with stories about your therapy experience, how you conduct sessions, and/or any questions or concerns you have about starting therapy.