Going to Therapy for the First Time: What to know
Maybe it’s that extra 20 pounds you just can’t lose. Perhaps you’re struggling with infidelity. Or maybe you’re unhappy in your job, and need some guidance in figuring out what career will really make you happy. Or, it could be that you’re struggling with depression or anxiety.
If any of the above situations applies to your life, counseling could be helpful. So what’s stopping you? The way counseling (often used interchangeably with the word “therapy” — the differences between the two have more to do with the certifications of the provider) is portrayed in movies and TV shows can paint a “no way, that’s not for me” picture. But in reality, while there’s often a couch or a comfy chair, therapists are not detached, distracted listeners who charge an arm and a leg for an hour of their time. And just because you receive counseling doesn’t automatically mean that something is wrong with you, says Jeannie Bertoli, Ph.D., a relationship expert and counselor.
“People think, ‘I have to be in crisis,’ or, ‘The intensity of the issue has to be so bad that I go to therapy,'” Bertoli tells HuffPost. But often, people can benefit from therapy for something as simple as needing help reaching a specific goal.
It’s also easy for people to get hung up on the cost of therapy — which can run the gamut from $80 to $200 for a 50-minute session. “Therapy is expensive, but it’s an investment and you should be getting a return on your investment,” Bertoli says. “There are other things that are expensive, that we don’t question the finances of so much,” such as hiring a good attorney if you’re going through a divorce.
“But aren’t therapists just people you’re paying to listen to your problems?” you may ask. Bertoli explains that while compassionate listening is an important part of the counseling process, therapists have master’s and doctorate degrees and have spent years studying how people change, relationships, work environments, conflict resolution and communication. “We spend years living in those systems and training in those systems so we can help you get to that part of yourself to … understand the things that are driving your habits and choices,” she says.
OK, I think I want to try therapy out. Where do I even start?
The first step to starting therapy is to find a therapist. If cost is an important factor, you could ask your insurance company for a list of therapists who would be considered in-network. However, some therapists purposely choose not to be part of those insurance panels, notes Danielle Adinolfi, MFT, a Philadelphia-based therapist. But some may offer sliding scale prices. “So say your insurance will cover half the cost [of an in-network therapist] and sessions are $120, … the therapist will see you for that reduced price,” she explains. While not all therapists offer this option, it never hurts to ask.
You could also try searching on the Psychology Today directory, which has a list of mental health professionals.
However, Bertoli notes that it can be hard to find someone who is specialized in your particular issue by searching on a large database. Therefore, referrals from friends and family could be a good way of finding someone, as could a simple Google search for “weight loss therapist” or “divorce therapist” or “____ therapist.”
What happens if you find someone who seems to be a good fit for your particular problem, but is in another city or state? Bertoli says that tele-therapy is common nowadays — providing another level of privacy and convenience for people — so consider checking with that person to see if they offer phone or Skype sessions.
How do I find someone who is the best fit for me?
Bertoli suggests making a list of three to five potential therapists, whether those names come from Google searches or friend and family referrals. Then, contact those therapists, and ask them the same three to five questions each. The questions can be specific to your particular issue — for instance, if you’re struggling with weight loss, you could ask “What’s your theory about why people don’t lose weight?” — or something more general, like “What’s your theory about why people some people change, while others don’t?”
“You’ll sense in that way, ‘Am I comfortable with this person? Do I think they’re telling the truth?’ You’ll sense if they’re a match for me,” Bertoli says.
Most therapists will do a quick, 10- to 15-minute consult on the phone with clients before the first session, where you can get a feel for if the person will be a right match. And oftentimes, after the first session, it’s pretty clear if the therapist-client relationship will work or not, Adinolfi says.
Some people want to have a speedy experience, where the problem is solved in six sessions or less. If this is you, then you should look for a solutions-focused therapist, Adinolfi says. (However, you can’t expect that all problems can be solved in a short period of time, as some situations take longer periods of time to sort through.) Meanwhile, other people can end up going to therapy for years, either because the situation has never been resolved, or because they like being able to come in for an hour each week to talk about life — which is where the “I’ll be in therapy forever!” misconception comes from.
“But if your issue is something simple, they [therapists] won’t keep you for the sake of keeping you. We want you to walk out the door so you feel like there’s some sort of resolution,” Adinolfi says.
In addition, Bertoli notes that just because a therapist offers three to five sessions, doesn’t mean you should expect for your problems to be resolved in three to five sessions. She says she often sees clients for an average of six to 12 months — though this is only an average, and the amount of time someone is in therapy is highly individualized.
What can I expect in my first session, and how can I make the most of it?
A default first session of therapy will be just that — the default for that individual therapist, Bertoli says.
“Some therapists do a first session by getting an assessment of the current problem. Some will do background, so they’ll understand your childhood and any medical issues. Some will just listen and say ‘Uh huh’ a lot, and will be a more passive therapist, and some will really engage with you about what’s going on right now, and get to the depth of it,” she says. “So when you go in, you will get the default, unless —unless — you prepare.”
And by “prepare,” Bertoli means coming in with an idea of what you want to get out of therapy.
Indeed, Adinolfi says “I always recommend people have something to talk about. Therapy is about you: You’re the boss, and people forget that. Our job [as therapists] is to guide people to where they want to go.”
The important thing to remember is that the therapist-client relationship is exactly that — a relationship.
“You’re the co-creator of this relationship. If you go in saying , ‘Here are my goals, here are my expectations, my preferences for how to proceed, what matters to me the most,’ — if you go in prepared and not looking to take a backseat … you will have the most success,” Bertoli says.
In addition, it doesn’t hurt to discuss your “hot buttons” with a therapist — actions or words by both the client and the therapist that could harm the relationship. (For instance, from a therapist’s standpoint, a perpetually late client could be a serious annoyance.)
“You could say, to a therapist, ‘What would I do that could make you mad?’ And then they ask you” the same question back, Bertoli says. “It’s one of those questions that people don’t ask, and it goes both ways: ‘What could a therapist do that would piss off a client?’ And that could be anything from, ‘If you ever blame me for my husband’s infidelity, then I’ll never listen to you.'” Knowing information like this can help to preserve the relationship between therapist and client, and also help the therapist better understand what’s going through the client’s head.