The other week, my husband and I were invited to dinner with some friends.  During the course of the discussion, they mentioned that all of their grown kids were either in therapy or considering it.  They wondered whether this was a parenting success or a parenting failure.  Both of them are in the mental health field.

The fact that going to therapy could be considered a parenting failure is an example that speaks to the question at the heart of this.  Does going to therapy equate failure somehow?  What I see in my office are people who come to an, often, reluctant conclusion that they just can’t deal with their troubles by themselves.  When the conclusion truly is—therapy is one resource they can employ to help them sort things out.  And that the ability to ask for help–taking time out for themselves for self-care—is an act of strength that they perhaps do not know they have.

As of 2016, 43% with any identified mental illness in the U.S. have not sought out services from a therapist in the past year. For those with serious and persistent mental illness, 64.8% sought out a therapist within that past year.

More and more of us have become savvy about doing our online research.  We search for what we think is wrong with us or for our diagnosis and we look into different treatments to determine what would be best.  But research really has shown that one of the most important factors for a positive outcome is the relationship between therapist and client, or the quality of the therapeutic alliance.

Finding a therapist with whom you feel comfortable and connected can be a barrier in it of itself.  Who wants to start over again and again until you find the right person? And when beliefs such as “I should be able to handle my problems myself” or “there must be something wrong with me if I need to talk to a therapist” may be circulating in the back of your mind, the process can seem daunting.

However, here are some steps that you can take before starting therapy and during the first couple of sessions that can get you started on the right foot.

Before the first session

Ask for a brief phone consultation so you can get a sense of how you might feel in the session with this therapist.  First impressions do not always match up, but you can determine whether a therapist is open to taking the time to talk to you.

Here are some questions to ask:

  • What are the therapist’s credentials/ licenses?
  • How much expertise does this therapist have in working with the issues you are experiencing?
  • What are the therapist’s approaches to working with these issues and have they been proven effective?
  • What are the fees and is the therapist an in-network provider for your insurance plan? Make sure you also check with your insurance because many providers can only give you an estimate of what is covered.

Therapy goals 

I have always heard, “start with the end in mind” when embarking on a large task.  Often, we come into therapy just knowing that we feel bad and we want to feel better.  We may not know why we feel lousy and how we can start to feel better.  And that is normal.  However, as a clinician, I always ask my clients what their therapeutic goals are and to help them expand and get clear on what feeling better looks like for them. However, the clearer you can be about what your goals are in therapy, the better.

Here are some questions you can ask yourself as you are getting started:

  • What are your symptoms and how are they getting in the way of full functioning and thriving in your life?
  • What would you like to be able to do in your life that you have a difficult time doing or are unable to do now?
  • Imagine finishing therapy, how would you know that your therapy was successful? How would you know that you feel done?


What to expect from your therapist

The first few sessions are about getting to know you: how you see your life, your issues, your symptoms, your strengths–both your internal and external resources.  Your therapist should ask you about what you are hoping for from therapy and from the therapeutic relationship.  He/she/they may ask you about your past therapy experiences (if any) and what made them successful or not.

Your therapist may also initiate a conversation about the role of the therapist and mutual expectations.

Ultimately, you want your therapist to be a deep listener and to be able to get you.  You need to believe that your therapist, at the heart, understands you, has hope and faith in your ability to heal and grow even when you do not.

Take an active role

I let my clients know that I am led by them.  Their role is to come into therapy prepared to talk about what is important to them.  I also let my clients know that what happens in between sessions is more important than what occurs within our sessions.  My clients’ lives are where they experiment with new routines, push themselves a bit past their comfort zones and basically try things out that may help them move forward in their healing.

I feel honored when my clients share the details of their lives with me, feel safe enough to be vulnerable with me.   I take it seriously and I feel awed at the strength and resources I see in my clients every day.  Seeking therapy signifies some level of hope and trust that healing is possible. At some time in our lives, we all could use someone outside of our friends and family to sit beside us as we grieve, to bear witness to all that we have done to address our challenges and to help provide a wider lens with which to view our experiences.