Therapy Involvement

Therapy Involvement

Concerns About Therapy    

"Is it normal to become really anxious before a therapy appointment?" 

It is completely normal to be nervous or anxious before attending a therapy session, especially your first one. Many people do not know quite what to expect from their first session and feel some ambivalence or apprehension about beginning the process of counseling. 

For some, the feelings of anxiety last beyond the first session and may occur before the appointments during the initial phase of therapy or recur at various points in the treatment when addressing critical issues.  This anxiety is understandable because people often share and explore things in therapy that are extremely personal and important to them and this may trigger some feelings of vulnerability.

"I don’t know what to expect from therapy…"

Ask your therapist what to expect during the first session when you schedule the appointment. Most often, a therapist’s office is set up a little more like a living room (with couches or comfortable chairs) than a typical workplace environment or doctor’s office. The therapist usually has some paperwork for you to complete that is much like the paperwork would receive at any doctor’s visit. The paperwork is used to gather demographic and insurance information.  Paperwork will include a statement of understanding that reviews the limits of confidentiality and fees for services, HIPAA information and perhaps a release to speak with other treatment professionals such as your primary care physician or psychiatrist.

You will be asked about your presenting issue, which is the reason you are seeking therapy. Your therapist may ask a number of questions about your symptoms and your psychosocial history (emotional, familial and relationship) The therapist will likely summarize her first impressions of your presenting issues and outline a general treatment plan (for example weekly therapy and/or referrals to other resources such as support groups) You should feel free to ask any questions or state specifically what you are looking for out of counseling. 

The first is about information gathering, where the therapist may ask many questions in an effort to get to know the client and assess the presenting issues. The second phase is the meat of the treatment and this is when the therapist and client collaborate to make positive changes in the client’s thinking, self-care, emotional regulation, communication, support network, etc. The third phase is termination and this occurs when the client is feeling much better and the client and therapist begin to process the end of treatment.

"I am afraid of revisiting painful memories or disclosing embarrassing issues"

You do not need to share all of your inner secrets at your first session, nor should you. The beginning phase of therapy is about building a trusting therapeutic rapport and relationship. You can share things at a rate that feels comfortable for you. Numerous times, I have had clients indicate that they experienced a bigger trauma in the past (like childhood sexual abuse or rape,) that they are not ready to address. This is a healthy way of being open and honest with your therapist, and also setting boundaries and pacing the therapy at a rate that feels comfortable for you. 

 As you establish a stronger therapeutic rapport and when your therapist knows you are ready, you can collaboratively work together to address those experiences. Many clients report feeling tremendous relief that sharing those experiences wasn’t as difficult or scary as they thought and they are able to process those memories in a way that is more manageable. If you have a significant trauma background, select a therapist who specializes in trauma and treatment modalities such as EMDR.  Again, your therapist is not there to judge you and you can improve your prognosis in therapy by sharing as much as you can when you feel ready. The beauty of therapy is that it is a confidential relationship and you do not need to see your therapist outside of sessions. The therapy office can be your own safe place to share these experiences without judgment. 

"I worry that my therapist is going to expect changes that I am not ready to make"

Many people fear that their therapist is going to expect them to immediately abstain from any self-sabotaging coping mechanisms such as substance abuse, self-harm or eating disordered behaviors, for example. They might also worry that the therapist is going to want them to end a dysfunctional or abusive relationship that perhaps they are not ready to leave. Therapists are trained to meet the client "where they are at," meaning they respect where clients are at in the process of change. 

Furthermore, therapists know that people only change when they are ready and when they want to change. Often, negative relationship patterns or self-sabotaging behaviors will likely continue during the first phase of treatment, or they may recur at various points in the therapeutic process. This is normal and clients are expected to be open and honest, because it will help them the most to share these behaviors or relapses.  

"I felt worse after my therapy session and am nervous about the next"

Understand that it is normal for things to get a little worse before they get better during the initial phase of therapy.  Deciding to do the work is a daunting task that requires courage and commitment. Typically the first phase of cleaning out a closet is pulling a bunch of things out and spreading them around the room. Similarly, the beginning of therapy is an information gathering period.

Just like the beginning phase of cleaning out a closet, the beginning phase of therapy can be overwhelming. People might wish that they just left things alone because they might be feeling even more of a mess now. This is a normal phase and understand this is an anticipated part of the process. In therapy, we are eventually able to let go of some things, and rework what is left so that the person (like an organized closet) is functioning and feeling better.   It is also normal for these negative or worsening feelings to get triggered at various points in the therapeutic process, especially if you and your therapist are hitting on some core issues. Some resistance and defensiveness on your part is normal, those feelings are there to protect you. However, you can work through them by expressing them to your therapist and continuing in treatment knowing that relief and growth are on their way.

Above all, congratulate yourself on beginning in therapy and doing your mind, body, and spiritual work. You are working on healing and evolving, which will deeply and profoundly improve your life and positively influence those around you. Reframe your nervousness as excitement because you are taking forward steps on the path to healing, wellness and achieving your best self personally and professionally. 


Common Questions

How can therapy help me?

A number of benefits are available from participating in therapy. Therapists can provide support, problem-solving skills, and enhanced coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, body image issues and creative blocks. Many people also find that counselors can be a tremendous asset to managing personal growth, interpersonal relationships, family concerns, marriage issues, and the hassles of daily life. Therapists can provide a fresh perspective on a difficult problem or point you in the direction of a solution. The benefits you obtain from therapy depend on how well you use the process and put into practice what you learn. Some of the benefits available from therapy include:

  • A better understanding of self, goals and values
  • Developing skills for improving your relationships
  • Finding resolution to issues or concerns in life
  • Learning ways to manage stress/anxiety
  • Balancing anger/depression and other emotions
  • Improving communications and listening skills
  • Changing behavior patterns to healthy ones
  • Discovering problem resolution in your family
  • Improving self-awareness and boosting self-confidence


Do I really need therapy? I can usually handle my own problems.

Everyone goes through challenging situations in life, and while you may have successfully navigated through other difficulties you've faced, there's nothing wrong with seeking out extra support when you need it. In fact, therapy is for people who have enough self-awareness to realize they need a helping hand, and that is something to be admired. You are taking responsibility by accepting where you're at in life and making a commitment to change the situation by seeking therapy. Therapy provides long-lasting benefits and support, giving you the tools you need to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face. 

Why do people go to therapy and how do I know if it is right for me?

People have many different motivations for coming to psychotherapy.   Some may be going through a major life transition (unemployment, divorce, new job, etc.), or are not handling stressful circumstances well.  Some people need assistance managing a range of other issues such as low self-esteem, depression, anxiety, addictions, relationship problems, spiritual conflicts and creative blocks.  Therapy can help provide some much needed encouragement and help with skills to get them through these periods.  Others may be at a point where they are ready to learn more about themselves or want to be more effective with their goals in life.   In short, people seeking psychotherapy are ready to meet the challenges in their lives and create change.  


What is therapy like?

Because each person has different issues and goals for therapy, therapy will be different depending on the individual.  In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session.  Depending on your specific needs, therapy can be short-term, for a specific issue, or longer-term, to deal with more difficult patterns or your desire for more personal development.  Either way, it is most common to schedule regular sessions with your therapist (usually weekly).
It is important to understand that you will get more results from therapy if you actively participate in the process.  The ultimate purpose of therapy is to help you bring what you learn in session back into your life.  Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process - such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their

What about medication vs. psychotherapy?

It is well established that the long-term solution to mental and emotional problems and the pain they cause cannot be solved solely by medication. Instead of just treating the symptom, therapy addresses the cause of our distress and the behavior patterns that curb our progress. You can best achieve sustainable growth and a greater sense of well-being with an integrative approach to wellness.  Working with your medical doctor you can determine what's best for you, and in some cases a combination of medication and therapy is the right course of action. 

Do you take insurance and how does that work?

To determine if you have behavioral health coverage through your insurance carrier, the first thing you should do is call them.  Check your coverage carefully and make sure you understand their answers.  Some helpful questions you can ask them:

  • What are my behavioral health benefits?
  • What is the coverage amount per therapy session?
  • How many therapy sessions does my plan cover?
  • How much does my insurance pay for an out-of-network provider?
  • Is approval required from my primary care physician?      


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