How to Start Therapy
Katie Bellamy, Licensed Clinical Professional Counselor (LCPC)
Whether you’re brand new to therapy or you’ve navigated finding a therapist before, we hope this is a helpful guide on how to start therapy. First of all, congratulations! It’s not always easy to not only recognize when we need support but to follow through on finding that support - good for you for being open to therapy and for self-advocating for the care you deserve.
How Do I Know I Need Therapy?
People often think that starting therapy means there is something wrong, maybe even crisis-level wrong with them or their lives if it’s come to the point of therapy. While we certainly need mental health support when we’re in crisis and when we really feel unwell, it can also be helpful and important to start therapy for other reasons. You may start therapy if:
You can’t manage your mental health symptoms
You feel more anxious, depressed, or irritable than usual
You want to understand your mental health
You want to improve your overall wellbeing
You want to understand yourself better
You want support with making a decision, setting goals, remaining accountable
You are trying to make or are going through a life change - these are oftentimes endings (breakups, sobriety, discontinuing certain behaviors) or beginnings (a new move, job, school, etc).
You want to understand and heal from trauma
And many more!
As you can see, there are so many reasons someone may start and continue therapy. Ideally, therapy can both remain a constant and grow and change along with our healing journeys. For example, you may start therapy because your symptoms feel unmanageable and you need help learning to cope with depression, anxiety, or other mental health symptoms.
Once the therapy has helped with symptom management, the focus of therapy may then shift to other topics, goals, or concerns. Oftentimes, it’s when we feel in balance and stable that deeper healing work can then take place, if that’s a goal you have for therapy.
How Often Should I Go to Therapy?
Most therapists will recommend you start with weekly therapy sessions. Therapy sessions are typically 45-60 minutes and going weekly will help you build rapport with your therapist. Weekly sessions will kick things off and help you feel safe with your therapist and help your therapist get to know you.
As you progress, you and your therapist may discuss frequency of sessions - sometimes sessions may need to increase or decrease. If weekly therapy is not effective, you may be a candidate for twice weekly sessions or a higher level of care, like intensive outpatient programming.
If you’re progressing and feeling more stable, you and and your therapist may discuss decreasing to every other week or even monthly.
How Do I Find a Therapist?
Finding a therapist can feel like a major task, especially since we are typically in search of a therapist when we are feeling a bit unwell, off, or symptomatic. Here are a few ways you may search for a therapist:
Your doctor/primary care physician may have referrals for therapists
Google searching for a therapist in your city (or state if you’re open to telehealth) will bring up local therapists
Google searching therapists with a specific modality you’re interested in along with your city/state will bring even more specific results
Other healthcare providers you interact with may have recommendations for therapists - chiropractors, acupuncturists, dietitians, nutritionists, massage therapists, doctors, nurses, hospitals all likely have resources to share
Your school or company will likely have mental health support embedded or resources available - schools/universities/colleges may have mental health support services within as well as outside resources and your workplace may have an Employee Assistance Program (EAP) they can connect you with.
What Do I Say When Reaching Out to a Therapist?
Once you have found a therapist (or two or three) you may be interested in working with, you’ll reach out to see if you think they might be a good fit. They’ll also be interested in hearing a bit from you in order to assess if you’ll fit into their area of expertise or if they should refer you to someone else.
Most therapists and therapy practices will have a contact form on their website - you may be able to directly schedule a consultation call or submit an email inquiry. On the consultation calls or email inquiry, you’ll want to provide enough information so they can assess if they are best to support you but don’t feel like you need to share anything you’re not comfortable sharing. The steps after contacting are typically:
Setting up a consultation call -
The therapist will likely ask you a few questions such as why you’re seeking therapy, if you’ve been in therapy before, if you have any safety risks, and what you’re looking to accomplish in therapy.
This is also your opportunity to “interview” the therapist - you can ask them questions about their general experience, their modalities/approach to therapy, their experience with any specific symptoms you’re experiencing, and any other information that would be helpful to know.
Discussing logistics -
In addition to the topics above, the consultation call will also typically involve logistics, such as if the therapy is in-person or online therapy, the cost per session, and if you have corresponding availability for therapy sessions. Some therapists accept insurance and would need to go over your insurance benefits. Other therapists do not accept insurance and can provide the information on their self-pay rate, if they offer a superbill (which you can submit to your insurance for reimbursement), and if they offer sliding scale therapy.
Completing registration forms -
If you both felt that the therapy is a good fit, the next step would be to complete registration forms. The therapy registration forms typically involve completing general information (like demographics) as well as a bit about your mental health history, consent to treatment, and other relevant permissions and consents.
Setting your first session -
Once the forms are complete, it’s time to schedule your first session!
How Do I Prepare for Therapy?
First of all, remember this is your hour - it’s important to show up and invest in yourself and yet don’t feel like you need to over-prepare, overthink, or that there’s a right or wrong way to do therapy. Therapy can look different for different clients and with different therapists so take your time and feel free to explore different options.
Some people enjoy journaling throughout the week and reflecting on these entries before coming into therapy. Others may use a symptom or thought tracker so they have an accurate representation of their week leading up to therapy.
You can try jotting down reflections or awareness throughout the week that they want to be sure to process in the coming weeks. You may also benefit from homework each week and then reflecting on that. And other people benefit from simply showing up and processing whatever is top of mind in the moment.
What Do I Talk About in Therapy?
Many people start therapy with a specific goal, issue, or problem in mind. However, as mentioned before, that may not be the case. Also, once you feel you’re making progress on your presenting problem, you may feel unsure of where to go next. A few things you may talk about in therapy include:
Current stressors, triggers, symptoms
Past or present trauma
Past or present relationship stressors
Your goals, ambitions, dreams
Barriers to your goals aka what’s holding you back
Patterns of behavior
Patterns of emotion
Coping skills
Psychoeducation (a fancy word for your therapist teaching you about relevant topics, strategies, information related to what you’re going through)
What’s going well in life (yes! Talking to your therapist about your successes, what you’re excited about, how well you’re doing is all part of therapy, too!)
How therapy is going - you may occasionally review your goals and progress, discuss what’s working for you and what isn’t, ask for any change in approach or frequency, and set new goals
Will I Get a Diagnosis in Therapy? Does My Therapist Take Notes About Me?
If your therapist accepts insurance, you will receive a diagnosis code and they’ll complete a note after each session. In order to bill insurance, all medical services need to have a corresponding diagnosis code. In therapy, your diagnosis currently comes from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Insurance also requires a progress note be written after each session as well as a treatment plan and discharge summary once you complete therapy.
For therapists who don’t take insurance (like us at Bellamy & Associates), you may or may not receive a diagnosis. Therapists are required to follow our Code of Ethics, which includes ethically treating mental health needs. For us, diagnoses are only when it is beneficial to the client and/or therapist.
For example, some clients find it helpful to know their symptoms qualify them to receive a diagnosis and provide validity to their experience. Similarly, a therapist may use the DSM criteria to help conceptualize a case and understand best practices for treatment.
Our personal belief here is that not all mental health symptoms/needs require a diagnosis. Therapy as it’s generally understood is a very Westernized, medicalized model of care - we prefer to balance out this approach with understanding that the human condition, suffering, pain, symptoms, and experiences do not always neatly fall into diagnostic criteria. As such, we may be informed by diagnoses, generate treatment plans and notes to ensure we are treating ethically, but not use them strictly or absolutely.
What If I Don’t Like My Therapist?
You should feel safe and supported in therapy. Of course sometimes when we are processing challenging emotions, discussing memories, wanting to change behavior, and being so vulnerable, it’s natural to feel discomfort. However, feeling discomfort is different than feeling unsafe - in order for therapy to work, you need to feel fully safe with your therapist.
You may generally feel safe and yet still feel like something is missing or you’re just not clicking with a therapist - this is totally ok! Sometimes it takes a few tries to find someone who feels like a fit. That said, as long as you’re safe, it can be helpful to let your therapist know if a certain approach or dynamic is feeling off.
Sometimes we need to switch therapists but sometimes a change in approach can also do the trick. Again, this is your hour - feel empowered to let your therapist know if something feels off, if they said something that didn’t sit well with you, if you’re not feeling like progress is happening, or if you feel like something needs to change.
You don’t need to have the answer - your therapist can guide that part; feel empowered to self-advocate and use the therapy relationship as a way to practice speaking your needs.
How Do I Stop Therapy?
While you can of course ghost your therapist, it’s not exactly the healthiest (for you or them!). Of course if your therapist has caused you harm, you can stop and even report them to their licensing board. However, in most cases, folks may stop therapy for a variety of reasons. You may want to stop therapy if:
You feel you’ve accomplished your initial goals and don’t want to/aren’t ready to set new ones
You’re moving
You want to try a new approach or specialty with a new therapist
You want to pause therapy and return at a later time
You want to incorporate other healing modalities instead
Finances have changed
Priorities have changed
Ideally, you and your therapist will make a plan for termination. Therapy is different than other healthcare services in that you develop a deep relationship with your provider and they witness you go through challenges, successes, and the most intimate parts of your life.
Termination is an important part of the therapy process because it allows the time and reflection needed to transition from this level of support to whatever comes next for you. If you’re feeling ready to stop or pause therapy, it’s helpful to let your therapist know and they can help create a termination plan - you’ll collaboratively decide the number of sessions left and how you’d like to use those sessions so that by your last session, you feel ready to take the next step in your journey.
Can I Do Therapy With You?
If you’re interested in working with any of the therapists or coaches at Bellamy & Associates, you can contact us now. We’ll schedule your consultation call and look forward to answering any questions and getting you started!
