I think it’s safe to say that more people have considered seeking out therapy than ever before in the history of the industrialized world. Before the industrial revolution, communities and cultures regarded healing practices as commonplace and highly respected. Communities were thoughtfully invested in the well-being of every member and came together to support those in the group who required healing. This was a decentralized and stigma free approach to maintaining well-being. Take one look at society today and you’ll see that we have strayed very far away from that model.
Thankfully, we are seeing massive social shifts in the importance of mental health these days. It’s everywhere. I can’t adequately describe the delight I experienced when I saw the incorporation of a question prompt on Hinge (a popular dating app) that read “Going to therapy recently taught me…”. And as a therapist, I was excited when I saw how commonly app users chose to include that prompt on their profile. Not only were they including that prompt, they were responding to the prompt with real answers. Very few times did I see someone mock the question, as if to carry forward centuries of stigma placed on receiving professional help for your mental well-being. Welcome to the new era of acknowledging that mental health matters.
Therapy isn’t the only way to improve our mental health. Therapists don’t gatekeep mental wellness. Theoretically, you have access to mental well-being via countless methods. It must be said that engaging in those mental health promoting practices will realistically always be obstructed by larger social factors (namely, inequality) that make it hard to stay well. As a socially aware professional, I acknowledge that industrialized healing practices (i.e. professional psychological services) aren’t accessible. Describing all the ways they’re not accessible would take a 90 page essay. The shortest version of that essay might read “professional psychological services were created by and for those with wealth and privilege”. The last two centuries of psychological research and practice has subtly, and not so subtly, excluded various groups of people.
My predictions for 2023 and beyond include two movements, which are already well underway: (1) the decentralization of mental health support, and (2) creating a mental health knowledge base to work from that finally includes historically marginalized groups of people.
So in the spirit of accessibility and decentralization, let’s give some of the power back to you. If one of the barriers to initiating therapy is not knowing what to expect, here is everything you might want to know, but may not know you want to know, about getting therapy.
Note: I am a Psychologist and have received therapy several times throughout the duration of my life. I speak from the experience of both sides.
Click on each link to jump to that section or scroll down to read the full article.
The type of therapy is important and not important at the same time.
The credential/training of the therapist is important and not important at the same time.
Your therapist likely won’t tell you what to do, what to decide, or what the ‘answer’ is.
Frequency and amount of sessions depends on your needs and wants.
The end of therapy is just as important as the rest of the process.
1. Shopping around for a therapist is a good idea.
Finding the right therapist for you is like finding your next pair of shoes. You likely wouldn’t buy a pair of shoes before trying them on to see how they feel on your feet. If shopping online, you probably review the return policy in case they don’t feel good after you have committed to the purchase.
It’s normal to shop around for a therapist and very much encouraged. Doing this will increase the chances of you having a good counselling experience – one that you benefit from. When considering a therapist, find as much information as you can about them. Most therapists offer a free consultation call. This is a brief conversation that gives you a chance to experience what it feels like to talk to them, as well as ask any questions you may have to help guide your decision.
When reflecting on how the consultation call went, consider how you felt while speaking to them. On the continuum between feeling heard and unheard, safe and unsafe, understood and misunderstood, calm and escalated, where did you land during the call? Ultimately, we are more willing to be vulnerable and will get more out of the process if we are receiving care from someone who helps us feel heard, safe, understood, and calm.
Back to the shoe analogy… Sometimes a shoe feels like the right fit at first but over time you find that there is a nagging sharp edge that cuts into your heel. Or after wearing them for one season, your style preferences change and you no longer want to wear them.
The same goes for your therapist. After working with a therapist for a period of time, you may learn that there is something getting in the way of feeling like the fit is good. Or you have benefitted from them for one season of your life but they are no longer beneficial for your current season and the changes this new season has brought.
All this to say – If you start with a therapist, you don’t need to stick with that therapist. If you stay when it doesn’t feel right anymore, you likely won’t get what you need from the remainder of your time with them. You are allowed to transition to a different therapist.
2. Giving your therapist feedback is normal and encouraged, especially if you are unhappy with the care you are receiving.
Giving feedback, especially constructive criticism, is hard for the majority of people. You may fear hurting the other person or that it will impact how the other person perceives you. You may worry it will put an irreparable wedge between the two of you, lead to a decrease in the quality of your connection, and/or lead to the loss of the relationship entirely. These are all valid and legitimate concerns. Let’s be honest, sometimes these fears come true in our everyday relationships outside of therapy.
What’s different about the relationship with your therapist is that you are paying them. In return for what you are paying them, they hold the responsibility to show up for you in a particular way, including receiving you and what you say in a caring and nonjudgmental way. It is our job to put our ego aside, attune to you and your needs, and be responsive to what you express.
Naturally, people don’t like to admit that they have hurt someone. Therapists are no different because we are people too. Even with all of the focused effort we put into caring for you in a healing way, we will make mistakes. If and when this happens, trust me when I say that we want you to tell us. Not only do we want the chance to repair the damage we caused, we also want you to feel comfortable to express yourself when something is not okay with you, because that is just simply a good thing for mental health and the health of relationships in general. In fact, having the opportunity to resolve conflict and doing so in a constructive way actually makes your relationships significantly stronger.
Another situation to give feedback is if you don’t feel you are getting what you wanted out of therapy. There may be several reasons why you aren’t getting what you need or wanted. If you share this feeling with your therapist, you can collaboratively brainstorm what may be getting in the way of you getting what you need and find solutions together. Examples of solutions may be the therapist altering their approach, you altering your approach, or the therapist helping you find another therapist, health practitioner, or community service that may be better suited to what you are seeking.
Expressing feedback to your therapist is also a great way to practice speaking up about your feelings and needs if you struggle with this in your everyday life. If your therapist is attuned to you and responsive (as they are supposed to be), you will experience what it feels like to be heard. Hopefully this will help to internalize a belief that your feelings and needs are important and that you may not always experience a negative outcome by speaking up.
Lastly, pay attention to the way your therapist responds to your feedback. This is a great indicator of their capacity to continue supporting you in a way that will be helpful. Unfortunately, because therapists are human too, there is the potential for them become defensive or blameful, even though they are not supposed to. In the rare case that this happens, choose consciously if you think it will be right to continue receiving services from that person. I experienced this once before and although it was hard, choosing to walk away from that therapist taught me the exact lesson I needed at that time in my life.
3. Your therapist is not judging you.
The experience of feeling judged is painful. We would not want to be judged by anyone, let alone our therapist. You may be particularly worried about this because you know that you may be sharing not-so-pleasant parts of yourself and your behaviour with them.
The act of judging someone or something is a survival strategy born out of our ancestors’ need to evaluate if something or someone could cause injury or death (e.g. an animal, a neighbouring tribe member, a foreign berry, or a brewing storm, etc.). Our brains evolved to make lightning fast judgements about our surroundings. The ones who judged the quickest were the ones that lived long enough to pass on their genes. All people alive today carry this legacy survival strategy with them. So, in more plain words, everyone judges everyone else.
What sets us apart from our ancestors is that our brains have evolved to include a complex pre-frontal cortex that developed to be able to think with more nuance. A more complex and nuanced modern society requires a brain that can comprehend it. Not only does this part of our brain have the capacity to process more complex information, it is responsible for self-awareness. It allows us to reflect on our thoughts and judgements – the judgements that more primitive parts of our brain have created.
Another helpful way to understand this concept is distinguishing between automatic thoughts and conscious thoughts. Automatic thoughts/judgements arise in our minds without effort. These thoughts aren’t necessarily true or accurate. They are the brains best guess at giving you quick and correct information about your surroundings based off of all of the other information you’ve received in the past (correct or incorrect). Conscious thinking includes the act of thinking about your automatic thoughts and, when appropriate, challenging them. This type of thinking takes effort. The effort required to challenge our thoughts is one of the reasons why prejudice and discrimination is so pervasive.
Making a long story short, therapists are prone to making judgements and evaluations just like anyone else. The difference between your therapist and every other person is that they have a responsibility to challenge automatic thoughts that arise about you or your circumstances. If a therapist succumbs to their automatic judgements, we risk not understanding you accurately, and in the worst case scenario, saying or doing something that may hurt you.
Most therapists are highly empathic people. While I can't speak for every therapist, generally we enter this profession because we really care about people and their well-being. We enter into this work already believing that it’s important to challenge judgemental thoughts. On top of that belief, we know that we have to actively challenge our biases in the interest of you being able to have a good therapeutic experience. This is actually an ethical imperative for us. It is a standard of practice that is woven into every aspect of the profession. We put in extra work to check ourselves and our biases when interacting with you.
While you are never safe from people judging you, your therapist is much less likely to let automatic judgments guide the way they think about you and the way they treat you.
4. The type of therapy is important and not important at the same time.
It can be overwhelming to consider what the right type of therapy is to receive. You may have heard of acronyms like CBT (Cognitive Behavioural Therapy) and EMDR (Eye Movement Desensitization Therapy) to describe specific approaches. There are countless more. Therapists get extra training in these specific modalities and usually advertise them when describing their approach.
There is no one type of therapy that is universally and consistently better than the other. This finding has been replicated many times in empirical research. On a case by case basis, you may find that one approach works better for you because of your personality, life experiences, or the nature of the concern you are bringing into therapy. Just like ‘trying on’ therapists is helpful to find the right fit, testing out certain approaches might also be necessary before you find what works well for you and your current concerns. Before beginning with a therapist you can look up information online about the approach they use or ask them to describe it.
If you aren't sure what you are looking for and want to be on the safe side, I would recommend finding a therapist who uses what’s called an ‘integrative’ or ‘eclectic’ approach, which is a fancy way of saying they incorporate multiple approaches and/or tailor the approach over the course of their work with you according to what you need.
5. The credential/training of the therapist is important and not important at the same time.
Across Canada there are several titles used to describe a practitioner who delivers mental health therapy (e.g. Psychologist, Counsellor, Psychotherapist, etc.). Unfortunately, the titles don’t match up between provinces/territories. Your confusion is valid. In each province/territory, there is a different amount and type of training required to hold each of these titles. While they are all trained to deliver therapy, they are not all made equal. Lastly, not all titles are regulated under provincial government health professions acts, meaning there is no formal body that enforces accountability to a set of professional ethics and standards. A quick google search will help you find out if the title of the person you may receive services from is 'regulated' in your province.
One of the most common and unhelpful misconceptions held by the general public is that the more training the therapist has, the better they will be at delivering therapy. While there is clear logic to this claim, it ignores all the other variables that contribute to becoming a “good” therapist.
I have heard many anecdotes of people receiving extremely helpful services from someone with the most minimal amount of training. Likewise, I have heard equally as many anecdotes of people receiving extremely unhelpful services from someone who has many years of training under their belt.
The missing variable here is the qualities that a person holds that are less influenced by amount of ‘training’. This is the way that people show up when giving services. Their presence. The quality of attunement. Their communication style. Their energy. Although therapist training programs do attempt to increase these qualities in their trainees, the extent to which the trainees are able to integrate them varies according to their personal characteristics.
Moral of the story: You may miss out on an exceptional therapist and experience if you only pay attention to title and level/type of training in your search for a therapist.
6. The first session is nerve racking.
Therapy can be scary. Especially if it’s your first time. This is very normal. It is nerve racking to meet a stranger and, within the first 10 minutes, feel like you are expected to tell them the most vulnerable parts of you and your life experiences. You may have a shaky voice, worry about what they think of you, fumble your words, and be uncertain of what information you should share and in what order. That’s okay. We expect this to happen.
You can take your time with what you share. It is important to pay attention to whether or not you feel comfortable to divulge specific information. Even though the nature of the relationship means you may be more likely to share sooner compared to your everyday relationships, it is still important to share only at the rate you are comfortable with. Just like your relationships outside of therapy, you can start with something small or less vulnerable and see how the therapist receives it before diving deeper.
If you have been waiting a while to speak with someone or your feelings have been building up, you may become vulnerable even quicker than you think. I’d be rich if I had a dollar for every time a new client cries in the first session, saying “I don’t know why I’m crying” or “I didn’t think I would cry”. When entering into a therapeutic relationship, we hold a set of subconscious expectations that this will be a safe person and space to feel emotions, which automatically loosens our defenses. For this reason, I’d suggest expecting that crying in the first session is a possibility. Your therapist has seen it a thousand times. They will hold you gently in that moment (metaphorically).
7. It will take some time for the therapist to get to know you. Therapy isn’t a cookie-cutter experience.
You have lived a long, full, and complex life. You are a collection of millions of unique combinations of experiences, perceptions, thoughts, emotions, and behaviours. As a result, it will take some time for your therapist to get to know you in a way that will permit them to apply the appropriate approach and strategies to your concerns.
You should be able to walk away from the first session with something, whether that be a changed or new feeling, a different way of thinking, a realization, or a new strategy. But know that the priority is going to be getting to know you. The information that’s shared over each subsequent session will add to the therapists working understanding of you. Essentially, the assessment/learning period never ends. However, the further you get into the work and the more sessions you have, the more you can expect the focus to switch towards interventions and application.
This means that you may not feel like you are making as much progress as you’d hoped in the first few sessions. In this phase, I encourage you to trust that there is a momentum of information that is building that helps your therapist deliver interventions in an attuned and informed manner as time goes on.
8. Communicating your expectations is important.
If you have specific ideas, hopes, or expectations about what therapy will be like or what you want to get out of it, it really helps for us to know.
There are many misconceptions floating around in popular culture about what therapy is. Sometimes these misconceptions are perpetuated by folks close to us that we trust, like family members, which further solidifies the beliefs. If we operate from these inaccurate beliefs, they may get in the way of us benefitting maximally from therapy. Point #9 describes a few common misconceptions.
If you have questions or are confused by something that your therapist is saying or doing, don’t hesitate to speak up. This will give us a chance to correct any myths or misconceptions, as well as get to know more accurately what you want from the process.
Some folks have no expectations when beginning therapy and that’s okay too.
9. Your therapist likely won’t tell you what to do, what to decide, or what the ‘answer’ is.
We have all experienced moments in our relationships that we ask for advice (or don’t ask) and someone tells us what to do. While there are times when that is what we want and need, more often than not, it doesn’t feel right or good to blindly accept their instruction. This could be for multiple reasons. Maybe instead of advice you just want to be compassionately listened to. Perhaps it feels like the advice you are given doesn’t address the complexity of your situation. Advice receiving may cause feelings of being dismissed, misunderstood, belittled, or disempowered. Therapists know this. Which is why we tend to validate, ask questions, and only if appropriate, make recommendations for actions that may help you after we have heard and understood what you are sharing with us.
Since you are unique and complex (reflect back to point #7), not every recommended strategy or action will be helpful. Mental health skills and strategies are not one size fits all. This is one of the many shortcomings of mental health content found online. Ideas and suggestions put forth on social media are not tailored to you. The benefit of seeing a therapist is that you receive more tailored suggestions, you feel held (metaphorically) and understood, and you have the opportunity to address barriers in engaging in that new action/skill/way of thinking.
Importantly, a good therapist won’t tell you what to decide if you are facing a major life decision. It's not their life, and therefore, it would be an overreach. They also won’t have the magic ‘answer’ to a ‘problem’ that you want to be fixed. Understandably, people want things to be easy and simple. If what you were facing was easy and simple, you would have already figured it out on your own.
A good therapist will ask you questions that help you come to your own answers and conclusions. They will facilitate a space for you to understand yourself better so that you can choose what the right thing is for you to do, think, say, or believe. This is why good therapy is empowering, rather than disempowering. At the end of the day, you walk away feeling like you are the one who put in the effort and made appropriate adjustments in your life.
Therapists don’t have all the answers for every person who enters into our room for that first session, but we know how to get people there over time. We remind you how you know yourself best when given the tools to pay attention to what’s going on inside of you and your external environment.
10. Results/outcomes depend heavily on two factors: The relationship with your therapist and your commitment to the process.
We have established that the specific type of therapy doesn’t dictate success in therapy (point #4). So what does? The most agreed upon answer to this question, as evidenced by research, is the quality of the relationship with your therapist and the amount of investment you put in to the process.
First, let’s address the relationship with your therapist. When it doesn’t feel good to interact with someone, we unknowingly put up defenses in order to protect ourselves from the perceived threat that this relationship brings. If the relationship with your therapist doesn’t feel generally positive and supportive, you will not feel comfortable enough to let down your guard, be yourself, and express what needs to be expressed. This presents a huge barrier to you and your therapist directly and vulnerably addressing the concerns you are having in your life.
Having a good quality relationship with your therapist looks like: you feel good, heard, and understood while talking with them, you trust that they will receive you nonjudgmentally, and you believe you could come back from ruptures that may occur in the relationship. A good quality relationship with them is a necessary component to having a successful experience in therapy.
Second, let’s talk about the amount of investment you put into the process. You may have heard the phrase “you get out what you put in”. This is exactly what I’m talking about. If you only put in half of your total effort into the process, you will see that lack of investment result in less progress or gains in the change/healing you are hoping to achieve. If you are surprised by this statement, reflect on how much you were expecting that the therapist would be doing the work of change for you. You may see your therapist weekly for one hour. What happens in the other 167 hours of your week? This is the time where you are challenged to think about and apply what is being worked on in that one hour with your therapist.
You cannot do the same thing over and over and expect different results. If you want things to be different, you have to do things differently, whether that means spending more time reflecting, practicing tuning in to your emotions, challenging harmful habits, or any other practice theme that has come up in your sessions.
11. Frequency and amount of sessions depends on your needs and wants.
In line with the last point (#10), the more frequently you attend therapy, the more you will get out of it, up to a certain point. Most therapists suggest no more than once a week so that you have time to apply what is talked about in sessions in your day to day life.
There are three main benefits to coming regularly when you first start counselling:
You are capitalizing on your motivation to address your concerns, which is usually the highest when you first begin therapy.
Continuity helps your therapist get to know you smoothly. Significant periods of time between each session can make things feel choppy.
It builds momentum, which increases your chances of seeing progress sooner.
When it comes to amount of sessions to have, this will depend on many factors. One major factor is the type of issue you are experiencing. If you are working on how to cope with transitioning to a new job or city, this may take only a limited number of sessions spanning the time period of the transition. If you are working on how to navigate the impact of a harmful relationship that lasted 25 years, you can imagine this may take longer. There is no set amount of sessions that guarantees progress because every experience is unique.
Once you are beginning to feel like you are making progress, this is when you can re-assess how often you’d like to attend. If you want to keep that progress going, maintaining the same frequency is a good idea.
Naturally, as you begin to see lasting change and have met or surpassed your initial intentions, you may decide to end therapy. Some folks choose to have maintenance sessions, which are less frequent sessions (monthly or quarterly) that serve to keep you accountable to your growth/progress over time.
12. The end of therapy is just as important as the rest of the process.
If there is meant to be a formal and structured beginning to therapy, there is also meant to be a formal and structured end. Unfortunately, the ending of the therapeutic process is often overlooked.
There are many reasons why therapy ends. The reason we hope for is that you are satisfied with the progress you’ve made and don’t need/want therapy any longer. The ubiquitous goal of all therapists is for you to not need us anymore, which would suggest you’ve done exactly what you set out to do at the beginning of the process. Other reasons therapy ends could be financial strain, lack of time, schedule changes, or feeling like your therapist hasn’t received your feedback well (point #2). Know that you have the right to end counselling when you feel it is right for you to do so.
There are also many reasons why the end of therapy is overlooked. One of the biggest barriers to ending therapy adequately is the impact of pervasive ghosting culture ('ghosting' is the act of ending a relationship by, suddenly and without explanation, withdrawing from all communication). Sadly, the normalcy and art of explicitly ending relationships and saying goodbye to people in our lives has been lost. My take is that ghosting culture is bred from the fear of confrontation, fear of hurting others, and fear of losing connection to others. You don’t need to ghost your therapist because, in an ideal therapeutic circumstance, explicitly ending/saying goodbye:
will not lead to an unpleasant confrontation.
will not hurt us.
will not threaten your connection with us. You can re-book in the future whenever you’d like.
This is an opportunity to practice healthy and effective interpersonal communication with a person whose job it is to receive you well.
Generally, it is best to dedicate one session to the process of ending, especially if you have had many sessions. An ending session includes celebrating progress, summarizing the work to date, ensuring continuity of care within your network, and any other closing rituals that feel appropriate to the nature of the work that was done. Letting your therapist know in advance that you want to end therapy soon or enter into a maintenance phase will allow a smooth transition.
Being informed about therapy will set you up for success if you decide to start this journey.
Still have questions? Your curiosity is welcomed! Don't hesitate to reach out.
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