Starting Therapy—and Ending It, Too

Let’s talk about what it’s like to start therapy. Starting anything new is scary, and therapy even more so. How do you know who you can you trust?

A personal recommendation for a therapist is always best; otherwise, look for someone whose location is convenient and ask to meet so you can get to know each other. Different approaches abound, which can be confusing, but what matters most is your gut feeling when you meet the therapist. Is this someone who feels right to you? Chemistry is important, for both the therapist and the person looking for guidance. I usually know sometime during the first session if there is a connection.

What will happen when you meet? Although therapists all probably have our own ways of doing things, initial interviews don’t vary that much,  so I’ll tell you a bit about how I work. I will encourage you to explain why you are seeking treatment, help you feel a bit less nervous, and ask you to tell a bit about yourself. Have you been in treatment before? Why now? Are you on medication? And, of course, I will want to know how you came to see me. How did you get my name? If the therapist asks anything that makes you feel uncomfortable, be sure to say so. That’s an important theme in treatment: speaking up and communicating your feelings and needs.

Just as the therapist has many questions, so do you, and you should make sure you ask them. Some typical questions are:

• Is there really something wrong with me?
• Will I change in ways that I don’t want?
• Will I be in the therapist’s power?
• What if I’m embarrassed, or if I have nothing to say?
• Will you, the therapist, know what I’m feeling even if I don’t say anything?
• Will you tell me what to do?

You might want to ask the therapist if she has encountered problems like yours before and if he or she feels he can be of help. Are you curious how long treatment will take? That’s not easy to answer, but beware of people offering a “quick fix.” Also, like most therapists, I probably won’t tell you what to do: it’s your life, and you must decide things for yourself—that is not in my power, nor should it be. I’ll look over your various options with you, and we’ll weigh their benefits and risks together. However, if I feel you might be in danger, then I’ll tell you loud and clear.

If you’re worried about the cost of treatment, say so; many therapists have special rates for students or others. Ask if you can meet briefly for a low-cost consultation. You can also check training institutes and schools, which may have lower rates.

People also often have specific worries. They might think something like these: Sometimes I have weird thoughts. Does that make me bad or crazy? Also, I heard you have to say everything and I might not want to. What if I have a bad thought about my therapist and she gets mad at me?  I don’t want people to think I’m bad. I’m not bad. I’m not crazy, either. Will my partner leave me if I start treatment? I’ve heard that happens a lot. Anyway, isn’t therapy just for people who are too involved with themselves? It’s kind of selfish, isn’t it! What will my friends, mother, father, etc., think? Maybe I’ll just ask my friends for advice.

It is hard to picture yourself talking to a stranger—it’s much easier to just talk to friends, except they often get tired of listening. Also, their advice doesn’t always sound that great. They have problems, too, and sometimes they just tell you what you want to hear. A therapist is more able to tell you what you need to hear, and to put it in a way that is relatively easier to hear—even if it’s something you don’t want to. Also, try not to worry about the effect of your words, thoughts, and feelings on the therapist. We’re trained to both speak and listen with smart hearts and kind ears.

Once you’re in treatment, then what?  Do you tell people or not? That’s up to you. If you do decide to tell someone, like your close friend or relative, do you tell them everything that happens in your session? You might let people know in a general way what’s up, but really: this time is for you. It’s private, and it’s better to keep it that way, so you can make up your own mind about things.

Finally, how do you know when it’s time to stop? This is a decision that you make after careful consideration, both alone and with your therapist. Have you accomplished what you set out to do? Has anything else come up? Talk it over, then if it’s time to say goodbye, a good practice is to set a target date for the last session, perhaps in a few weeks or more, whatever feels comfortable. Remember, ending a successful treatment is part of the process and makes your therapist feel good, too, even if you both might feel sad when you say goodbye.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Lynn Somerstein, PhD, RYT, Object Relations Topic Expert Contributor

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