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Congratulations! You've decided to prioritize your mental health and explore what therapy has to offer.

But there's a problem: what happens next? What type of therapists should you see? What type of therapy will work best for you? How do you find a therapist? How much will it cost? How long will you be in therapy? What is therapy like?

Don't worry! This guide will help you navigate the sometimes confusing mental healthcare maze so that you will be set up for success.

Chapter 1 How do you know when to seek help?

It’s important to know that you don’t have to have an official diagnosis of a mental illness or disorder (or even think you have one) to benefit from psychotherapy. In fact, you don’t even need to feel like “something’s wrong” to go to therapy. Lots of people choose to go to therapy to support and maintain their mental health. 

People go to therapy for all kinds of issues, including:

  • You have an overwhelming and prolonged feeling of sadness and helplessness, and you feel hopeless. 

  • Your emotional problems make it tough to operate on a day-to-day basis. For example, you may struggle to focus on work responsibilities, and as a consequence, your job performance suffers.

  • You behave in ways that harm you or others. For example, you may abuse alcohol or drugs. 

  • You want to improve your relationships

  • You need help navigating a messy divorce or breakup

  • You want help regulating your emotions

  • You get promoted to a senior position at work and want help managing the additional responsibilities

  • You want parenting support

  • You have an elderly parent that you care for and need help making decisions

  • You have a family member dealing with addiction issues

  • Your find out your spouse has been having an affair and need help to move forward

That said, most people decide to go to therapy when they notice changes in their behavior and want the advice of a professional. 

Common warning signs

According to Mental Health America, it is important to pay attention to sudden changes in thoughts and behavior. Here are some of the common warning signs of a possible mental health problem: 

  • You experience sudden changes in your sleep cycle 

  • Your appetite changes

  • You have trouble focusing and completing tasks

  • You become less productive at work or at home

  • You notice frequent shifts in your mood.

  • You develop feelings of apathy towards engaging with other people or in social events, parties, sports, etc.

  • You’re having nervous, or anxious feelings that don’t have any obvious cause 

  • You have unexplainable physical aches or pains–these are often a physical manifestation of common mental illnesses, such as depression 

Common warning signs for children

Here are some common signs or symptoms that a child may be struggling emotionally:

  • Developmental regressions in things like speech or language or bedwetting

  • Conduct problems including fighting, bullying, acting out, vandalism, or theft

  • Decreased interest in activities that they previously enjoyed

  • Prolonged bouts of sadness

  • Drop in grades

  • Loss of appetite

  • Substance abuse

  • Difficulty sleeping or excessive sleepiness

  • Extreme shyness

  • Excessive tardiness or absences from school

Common mental health disorders

Here are some commonly referenced mental disorders and symptoms:

  • Attention Deficit Disorder/ Hyperactivity Disorder (ADD/ADHD). Attention or difficulty staying on task, hyperactivity or constantly being in motion or talking, impulsivity (e.g., often not thinking before acting). 

  • Autism Spectrum Disorders. Impaired communication, cognition, social interaction, with various levels of restricted, repetitive behavior, focus, and actions. 

  • Bipolar Disorder. Recurring episodes of highs (mania) and lows (depression) in mood; changes in energy and behavior; extreme irritability or elevated mood; often an inflated sense of self-importance; risky behaviors.

  • Borderline Personality Disorder. Intense emotions and mood swings; harmful, impulsive behaviors; unhealthy relationships; low self-worth; an intense fear of being abandoned; aggressive behavior.

  • Generalized Anxiety Disorder (GAD). An overwhelming sense of worry; physical symptoms often include fatigue, headaches, muscle aches, trouble swallowing, trembling, twitching, irritability, sweating, lightheadedness, nausea, and hot flashes. 

  • Major Depressive Disorder. An overwhelming sense of sadness; loss of interest or pleasure in most activities; interferes with the ability to work, sleep, and eat; negative impact on a person’s thoughts, sense of self-worth, sleep, and energy-level.

  • Post-Traumatic Stress Disorder (PTSD). Relived trauma after experiencing a horrific event, through nightmares or disturbing thoughts; feelings of detachment, numbness, irritability, or aggressiveness.

  • Schizophrenia. Hearing voices or believing that others are trying to control the person; hallucinations and disorganized speech and behavior, causing individuals experiencing these symptoms to feel frightened, anxious, and confused (positive symptoms); lack of pleasure in everyday life.

Benefits of therapy

Research suggests that most people who undergo psychotherapy experience symptom improvement and improve their ability to function in their daily lives. In fact, it’s estimated that about 75% of people who receive psychotherapy benefit from it.

Many people think you have to have mental illness (or think you have one) or be in distress to benefit from therapy. In reality, many people can benefit from talking to a licensed therapist. In fact, many go to therapy as a preventative measure.

Therapists are trained to use clinically validated methods to help you develop healthy, more successful behaviors. There are many approaches to psychotherapy, such as cognitive-behavioral, interpersonal, and other types of talk therapy, that may help people work through their issues.

Many people think you have to have mental illness (or think you have one) or be in distress to benefit from therapy. In reality, many people can benefit from talking to a licensed therapist. In fact, many go to therapy as a preventative measure.

Therapy can be helpful for day-to-day issues, as well as:

  • Addictions

  • Anxiety

  • Depression

  • Obsessive-compulsive disorder (OCD)

  • Personality disorders

  • Phobias

  • Post-traumatic stress disorder (PTSD)

  • Schizophrenia

Chapter 2 What type of therapist should I see?

Therapists can have a variety of titles (counselors, therapists, clinicians, etc.). What they have in common is a master’s (MA or MS) or doctoral degree (PhD or PsyD) in clinical psychology or a related field and are licensed in the state in which they practice. 

There are many types of mental health professionals that are licensed to provide therapy to clients, including: 

  • Psychologist (PhD or PsyD), 

  • Licensed Marriage and Family Therapist (LMFT), 

  • Licensed Clinical Social Worker (LCSW), and 

  • Licensed Professional Counselor (LPC). 

While specific titles and specialties differ by state, these are the major categories of mental health professionals.

How do I know if I need to see a therapist, psychologist, or psychiatrist?

“Therapist” is a generic term that refers to any mental health professional trained to help clients deal with interpersonal problems. A psychologist specifically refers to someone with a doctoral degree in psychology. 

In the past, psychiatrists were more likely to provide therapy and medication. However, now most psychiatrists only prescribe medication and have not been trained to provide talk therapy. 

This means that if you are looking for a therapist, you would most likely be looking for a psychologist or other mental health professional such as a marriage and family therapist, social worker, or mental health counselor. (The differences between these specialties are explained below.)

If you or your therapist thinks you would benefit from medication, they can refer you to a psychiatrist or other licensed prescriber for a medication consultation.

Psychotherapist

This is an umbrella term for any professional who is trained to treat people for their emotional problems. 

Psychologist (PhD or PsyD)

Degree: Doctoral Degree 

Trained to:

  • assess a person's mental health using clinically validated tools

  • make diagnoses

  • provide individual and group therapy/counseling

Licensed Marriage & Family Therapist (LMFT) 

Degree: Master’s degree

Trained to: 

  • provide therapy/counseling for individuals, couples, or families, focusing on interpersonal relationships and foster healthy and productive relationships

Licensed Clinical Social Worker (LCSW) 

Degree: Master’s degree 

Trained to:  

  • make diagnoses

  • provide individual and group therapy/counseling

  • provide case management and support services

Licensed Professional Clinical Counselor (LPCC) 

Degree: Master’s degree

Trained to:  

  • identify cognitive, mental, and emotional problems

  • provide individual and group therapy/counseling

Psychiatrist

Degree: Medical degree 

Trained to: 

  • provide diagnostic assessment and treatment recommendations

  • most do not offer talk therapy

Can prescribe medication

Chapter 3 Therapeutic approaches

When you’re looking for a therapist and considering how important the type of therapy they practice is for you personally, you have a few options: Do you want to understand yourself better, to change the way you act, or to be supported? 

You don’t have to choose just one, it can be a combination of all three, but usually one is most important in terms of your specific needs. 

The following section briefly introduces some of the main types of therapy and how they are related. 

What is talk therapy?

Talk therapy or psychotherapy refers to many varieties of therapy. It’s an umbrella term for all therapy types that involve you discussing your mental problems with a professional. An example of talk therapy is cognitive-behavioral therapy or CBT.

Cognitive-behavioral therapy (CBT) 

Cognitive-behavioral therapy (CBT) is a type of talk therapy that focuses on changing the automatic negative thought patterns and replacing these thoughts with more realistic thoughts. CBT is considered as effective as medication for treating anxiety, depression, obsessive-compulsive disorder, post-traumatic stress disorder, and substance abuse.

Psychoanalysis and psychodynamic therapy

Psychoanalysis and psychodynamic therapy are based on the work of Sigmund Freud and are considered a type of traditional talk therapy. They focus on the psychological roots of emotional suffering and use self-reflection and self-examination as tools for discovery. Psychoanalysis looks at the interaction between the conscious and unconscious aspects of the mind and will use techniques like dream interpretation to better understand repressed emotions. This type of therapy is considered an intensive, long-term approach to healing.

Dialectical behavioral therapy (DBT)

Dialectical behavioral therapy (DBT) is a type of CBT that combines multiple strategies like mindfulness and emotional regulation to bring about acceptance and change. The specific skills emphasized in DBT include: 

  • mindfulness, 

  • tolerating distress, 

  • emotion regulation, and 

  • interpersonal effectiveness. 

While it is usually considered to be the treatment of choice for borderline personality disorder, it has also been shown to be effective for a variety of other issues such as addiction and depression to PTSD. 

Acceptance and commitment therapy (ACT)

Acceptance and Commitment Therapy (ACT, pronounced “act”) is a type of therapy that encourages a person to accept or embrace the thoughts and feelings they are having instead of running away from them. It uses strategies to stay in the present moment of what is being experienced, with the idea that acceptance and commitment will then facilitate a behavior change process. While CBT teaches people how to better control their thoughts, feelings, sensations, memories, and so on, ACT teaches them to just notice, accept, and embrace their private feelings.

Mindfulness-based therapy

Mindfulness-based therapy uses mindfulness practices like meditation and breathing exercises, while teaching people to let go of self-judgment. This type of therapy encourages consciously observing thoughts and feelings as a form of discovery and a way to let go of negative beliefs. 

Meaning-centered therapy

Meaning-centered therapy is a newer form of therapy used mostly by therapists treating those suffering from serious illness. It combines spiritual well-being and quality of life as a way to look at an enhanced meaning for a happier life, and ideally decrease or release suffering.

Eye movement desensitization and reprocessing (EMDR)

EMDR is an interactive form of therapy known to help people with posttraumatic stress disorder (PTSD). During an EMDR session, the client is instructed to recall distressing events while simultaneously tracking the therapist’s fingers (which are moved from side to side) with their eyes. The resulting stimulation is thought to trigger the brain’s information processing channels, enabling more adaptive associations to be made. Eventually, this pushes traumatic events into long-term memory. As a result, people become desensitized to the trauma and can lead a better life. 

Humanistic therapy

Humanistic therapy is a style of therapy that emphasizes a “holistic approach” to improving mental well-being. It involves learning more about your views and beliefs in order to develop true self-acceptance and recognizes a core belief that people are innately good with the ability to make the right choices for themselves. Humanistic therapy is used to treat depression, anxiety, panic disorders, personality disorders, schizophrenia, addiction issues, and relationship issues. 

Prolonged exposure therapy

Prolonged exposure therapy (PE) is a form of CBT that emphasizes reprogramming traumatic experiences to feel safe. By learning to sit with a past experience while repeating and recounting the traumatic memories, a person realizes it is safe and can then begin to heal. 

What about text-based and phone therapy?

Text based therapy is a newer form of therapy that is completely virtual. And while this type of therapy is operated by licensed professionals, there are some aspects of AI (Artificial Intelligence) that will guide the conversation. Whereas with phone therapy, you will talk directly with a therapist in real time over the phone. Keep in mind that most therapists offer phone sessions as an option.  

Chapter 4 Paying for therapy

Therapy is not cheap. In fact, the national median rate for a session of therapy in the U.S. ranged between $125 and $150. While there are ways to make therapy more affordable, cost remains the primary barrier to treatment. 

That said, don’t let the price of therapy stop you from reaching out. Many therapists offer reduced or sliding scale fees based on your income, and you might have benefits through health insurance that can help make therapy more affordable. 

Is therapy covered by health insurance?

It’s estimated that about half of therapists in private practice accept some insurance. While some therapists have 100% of their clients pay with insurance, some only reserve a few slots for insurance clients. 

This means that it may take a bit more effort to find a therapist that accepts your insurance and is also accepting new clients. 

What is an “in-network” therapist vs an “out-of-network” therapist?

If you want to use your health insurance to help pay for therapy, you essentially have two options: to see a therapist who is “in-network” or one that is “out-of-network”.  

  • An “in-network” therapist has a contract with a specific insurance company and has agreed to provide services at a specific price to the insurance company’s members. I

  • If your therapist is “out-of-network”, this means that you are responsible for the full payment at the end of each session. Your therapist then gives you a “superbill” or invoice that you would submit to your insurance to get a portion reimbursed. Your insurance may still reimburse a portion or all of the cost of your therapy, depending on your plan’s benefits.

There are pros and cons to using your health insurance to pay for therapy. But the first step to deciding if you should use insurance is to call the number on the back of your ID card to confirm your coverage. 

Calling your insurance company

Here are the key questions you need to ask:

  • Is there a yearly limit or a deductible you need to be aware of? 

  • Do they cover 100% of costs or just a percentage? 

  • Do you need a physician referral before you are eligible for coverage? 

  • Are there certain therapists who they will or will not cover (i.e., do they need to have certain credentials)? 

  • Are there co-pay options or will you have to pay upfront first then submit receipts for reimbursement? 

By contacting your insurance company first, they can let you know what they cover under your health plan and direct you to professionals in your area that are approved providers. 

Paying out of pocket

How much does it cost to go to therapy without insurance?

The other way to pay for therapy is what’s called “self-pay”. This means exactly as it sounds self (you) pay, as opposed to using your health insurance. Some people prefer this option simply because it gives you more control. When you pay, you make the calls, not the insurance company. 

Another reason people choose to “self-pay” is for privacy reasons. When you pay, no information is exchanged with your insurance company, therefore everything stays between you and your therapist. 

The obvious downside to “self-pay” is not everyone can afford to pay $135 for 50 minutes of therapy every week. However, to help make self-pay therapy more affordable, some therapists offer a sliding scale rate.

What is a sliding scale rate for therapy?

A sliding scale rate is a reduction in the total costs based on the recipient's financial needs. If your income is below a set amount, and/or you have a large family, you may qualify for a lower rate.

To find out if this is an option, all you have to do is ask: “Do you offer a sliding scale?” Don’t be afraid to ask; this is a very common question that therapists get asked all the time. 

Ways to make therapy more affordable

Here are some other ways to make therapy more affordable:

Consider seeing a pre-licensed mental health professional

If you live in an area that has a university or you have access to a mental health clinic that offers therapy sessions with pre-licensed professionals, you could be in luck. Pre-licensed therapists charge about 30% less.  

What does it mean if a therapist is pre-licensed? 

In many states, if a therapist is pre-licensed, it means they are enrolled in a master's degree program but are still under the supervision of a licensed therapist. 

Consider text therapy 

Using text therapy can help reduce what you spend on mental health resources. There are several options to choose from that may work for an individual looking for affordable therapy sessions. Many providers have unlimited text options and audio or video chats, depending on the plan you choose. 

Two popular text therapy providers are Betterhelp and Talkspace. Both offer a subscription service for as long as you need with various monthly plans. 

Check if your work offers an EAP

An EAP is an Employee Assistance Program that many employers offer to their employees. EAP providers typically deliver immediate and short-term services, referrals, and confidential assessments or follow-ups.  

EAP services are at no cost to you, but they are not a long-term solution, unfortunately. You could talk to someone through the program and receive a long-term referral that will match your budget. 

Try a low-cost therapy service 

Low-cost therapy services are out there for individuals looking for affordable therapy rates. Many non-profit collectives aim to provide mental health services for those who need them but have limited financial resources. 

Open Path Collective is one of these nationwide networks that bring together qualified mental health professionals to benefit those individuals, couples, families, and children who need it most. 

See if you can use an FSA or HSA to pay

If you do not have health insurance that covers mental health providers, other options might. A Flexible Spending Account (FSA) and a Health Spending Account (HSA) are two choices you can use to pay for therapy sessions. 

There can be specific restrictions for each choice that your employer determines beforehand. Some HSAs will allow you to funnel a portion of your pay into it to save for large bills or medical expenses. FSAs will expire from the employer if you do not use them within a specified time. Be sure to explore both options if you have them available with your employer. 

Consider group therapy

Individual therapy visits can be expensive. A licensed therapist can charge anywhere from $100 up to $250 an hour or more for private appointments, depending on location, their qualifications, and experience. One way to benefit from a therapist's knowledge and get help is to join a group therapy session. 

Costs can be a fraction of what you would pay privately, but you will still receive the same educated advice, and others who have the same obstacles as you may also have similar questions. A group setting can be a terrific way to connect with others who face similar situations and keep your therapy costs lower. 

The takeaway

Therapy does not have to cost a fortune to be effective or successful. There are many options for individuals with a reduced budget or who do not have access to mental health benefits. Finding the help you need should not put you in financial distress. 

If you are struggling with some issues and have concerns about cost, be sure to explore all the choices available to you. Affordable therapy is out there for people who need it. 

Glossary of insurance terms

Authorization

Authorization is a process when a patient requires permission (prior authorization) from their insurance company before receiving certain treatments or services. 

Coinsurance

Coinsurance refers to the amount (typically a percentage) a patient pays the healthcare provider once the patient’s insurance has paid its portion (based on their benefit contract). Usually, the patient must have met their deductible before coinsurance kicks in.

Copayment or copay

A copay is a fixed fee that the patient pays the therapist for the services or treatment received. 

Deductible

The deductible is the amount that the patient will pay out-of-pocket before their healthcare benefits kick in. Once you’ve reached your deductible for the year, then your insurance company may cover a larger portion of your health care costs.

Explanation of Benefits (EOB)

An EOB is a statement the insurance company provides after processing a claim received from a provider. The EOB lists the total charges (amount billed), allowed amount, non-covered charges, the amount paid to the provider, and any co-pay, co-insurance, and deductibles the patient pays. 

Superbill

A superbill is an itemized invoice used by healthcare providers that outlines the services a patient received from the provider. It is used when a patient sees an “out-of-network” provider but is still eligible for some reimbursement from their insurance company. The provider may give the patient a paper copy of the superbill to submit to their insurance company for reimbursement. Some providers do what’s called “courtesy billing” which means they will submit the superbill to your insurance on your behalf. 

For additional information, check out the article How insurance works by Mental Health America.  

Chapter 5 How to find the right therapist for you

Before starting therapy, you may wonder “will this actually help me?” The severity of the problem being treated, your belief that the process will work, the overall effort you put into treatment, and the therapist's expertise are all factors that could impact your success in therapy.

However, the therapeutic alliance (the relationship between you and your therapist) is by far the most important predictor of success, and it's your assessment of the therapeutic alliance that counts the most. 

That’s why it’s so important to find a therapist that’s a good fit. Here are some things to consider as you begin your search.

Things to consider when finding a therapist

  • Think about logistics. You may find a therapist you immediately connect with, but they only have openings during the weekdays, when you have to work. Affordability is also important. 

  • Talk to friends and family. Asking a trusted friend or family member for referrals is a great way to get some possible options. 

  • Consider what is important to you. Depending on your personal preferences, you may prefer to see a therapist that is like you in terms of gender, age, etc. 

The process 

It is common for people to search online directories, ask a friend or family member for a referral, contact your primary care provider for a referral, etc. when searching for a therapist. 

It’s recommended that you identify more than one potential therapist in your search . 

Once you have identified a few therapists, it is often useful to have a phone consultation or preliminary meeting to assess general fit. Some therapists require these brief calls, but the good news is that they are usually free.

Requesting consult calls 

A consult call with a therapist is a brief conversation, usually under 15 minutes, used to determine if there is a good fit between you and the therapist you are thinking about working with. 

The goal of these calls is for you to learn more about their professional style, personality, and practices. This is a great chance for the therapist to learn about you and what you’re looking for, as well as for you to ask questions you might have for them. 

Most therapists offer these calls for free. 

When you call a therapist in a private practice, you will probably reach their voicemail. Be prepared to leave a message similar to these:

  • Hi, my name is John Smith, and I am calling to inquire if you are currently accepting new clients. I'd like to get some help with my PTSD, and I was wondering if I could ask you a few questions? I would like to use insurance; have Blue Cross PPO insurance. Doctor Stephanie Jones referred me. I would love to learn more about your practice.

  • Hi, my name's John Smith and I'm looking for a therapist to help me work through my anxiety and some issues I've been having with my spouse. Would you mind if I asked you a few questions about yourself and your practice?

  • Thanks for calling me back. I'm interested in seeing a therapist because I’m having some problems in my marriage, and I'm doing a little research to find a therapist who would be a good fit. Could you tell me a little about yourself and the way you work?

If you don’t hear back, don’t take it personally. They probably are not accepting new clients. (This is why it’s important to contact more than one.)

What is a consultation call like? 

The therapist may ask about your reasons for seeking therapy and, if so, will be especially interested in knowing what caused you to seek therapy now. 

Besides being asked questions, you will have the chance to ask questions yourself. Since getting a sense of fit between you and the therapist is the main goal of this conversation, it is worth your while to find out more about how the therapist tends to work. 

Here are some questions you might ask:

  • What type of therapist are you? (psychologist, licensed professional counselor, social worker, etc.)

  • Are you experienced in treating [topics or concerns that you want to address in therapy]?

  • Do you have a particular approach, expertise or training? 

  • Do you accept insurance? 

  • If so, which insurance plans do you accept? 

  • How much do you charge per session, and will I be responsible for a co-pay? 

  • What times are you available to see me? 

  • What happens if I need to cancel or reschedule a session? 

  • Can you walk me through what a typical session with you looks like? 

  • How frequently do you recommend we meet? 

  • Will I be able to contact you outside of business hours? 

  • Will I be able to contact you in an emergency?

  • How soon can I expect to notice signs of feeling better? 

  • How long will I be in therapy? 

After you’ve asked all your questions, let them know what your intentions are going forward—whether you’d like to schedule a first session or if you’re going to first talk to a few more therapists and will call back if you decide to move forward with them. 

Here are some examples of what to say at the end of the call:

  • I think that’s about all the questions I have. Thanks very much for your time and I’ll be in touch soon. 

  • Thank you so much for taking the time to chat with me. If it’s okay, I’d love to schedule a time to come in for a first session. 

  • This has been really helpful. I really appreciate you taking the time to answer my questions. I’m going to think about things a bit and I’ll call you in the future if I decide I’d like to schedule a session.

How long can you expect to be in therapy?

The simple answer is it depends on a lot of factors. You won’t find a ton of guidance on therapy duration from the American Psychological Association (APA), the go-to association for this kind of information. 

They provide an easy-to-understand fact sheet with some guidance, like:

  • 50% of people need 15-20 sessions to feel improvement, and 

  • for co-occurring conditions, expect to be in treatment for 12-18 months.

In the U.K., the National Institute for Health and Care Excellence (“NICE”) takes a more straightforward approach. For example, for treating depression, NICE recommends 16–20 sessions of talk therapy. 

Research on therapy duration exists, but most of the studies only focus on a specific disorder and/or treatment. That being said, here are some studies that are commonly cited on this topic. 

  • A 2010 study in the American Journal of Psychiatry found that 7.92 sessions was the average number of therapy sessions attended for treatment, and here’s the distribution by session number.

  • A 2001 study in the Journal of Counseling Psychology found that patients/clients saw the largest benefit between sessions 7 and 10, as indicated by self-report surveys. 

Some people and therapists choose to continue therapy over extended periods, even years. The purpose of long-term therapy is thought to achieve more complete symptom remission for some.

What can you expect from therapy?

A therapist will usually encourage you to share what's been going on in your life, what's on your mind, what's troubling you, or what you'd like to explore at the start of a session. He or she will listen to you with encouragement and without judgment. This is your chance to be vulnerable and authentic, to express exactly what you've been dealing with, what brought you to therapy. 

Everything you share in session is completely confidential. Every therapist and every client is unique, but in the beginning the goal is really to get to know each other so that I can truly understand what is preventing you from being the best version of yourself. 

What do you do at your first therapy session?

The initial session with a therapist will be focused on establishing a connection, getting to know one another, defining goals, and providing you with a sense of hope for the future.

Your therapist will start by having you fill out some paperwork if you haven’t already done so. It’s very important that you read everything carefully. 

Then your therapist will probably review the responses from your intake paperwork and find out more about the reason for your visit. Be as honest as possible, keeping in mind that the conversation is confidential, and that your therapist is interested in helping you to feel better. 

Most therapists take notes during sessions to document and track your progress, especially at the first session. They often will note the significant dates, names of important people, and descriptions of your symptoms.

Sometimes, especially in telehealth sessions, your therapist will look away to jot down a note. This is very common and doesn’t mean they aren’t listening to you. Sometimes clients are bothered by this because it may come across as though your therapist is not listening or distracted. 

Questions your therapist may ask include: 

  • What are your current life circumstances? 

  • Have you had any therapy before? If so, when and what was your experience like? 

  • How’s your health? 

  • What medications are you currently taking?

  • How much alcohol do you drink? 

  • Do you use any recreational drugs? 

  • Do you have any family history of depression or substance use?

  • What are your symptoms? 

  • How have you tried to manage them? 

  • What are your goals for therapy or counseling? 

  • How can I be most helpful to you at this time? 

Your therapist will also go over their practice policies and information about the confidential nature of your sessions.

Remember, the first session is just a starting point. It’s simply an opportunity for you and your therapist to get to know each other, so be prepared to do a lot of talking.  

What should I say in my first therapy session?

Your therapist will guide you through your first session, so there’s no need to worry about keeping the conversation going. Whatever comes to mind is always the best bet.  

If there’s something weighing heavy on you that feels important to share, speak up. Remember, there’s no right or wrong here, so your answers should be truly how you feel. And if you don’t know, it’s okay to say that too.

Is it okay to cry in therapy?

Not only is it okay to cry in therapy, but it is very welcomed. Emotional tears are the body’s way of releasing certain stress hormones and can be very cleansing. 

Crying not only helps you let go on the emotional level, but it literally cleanses your body physically. Remember, a good therapist will not only hold space for you during that time but will encourage you to explore the deeper place within yourself that these tears are coming from. 


Find a therapist

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