What to Expect When Starting Therapy

The process of starting therapy, whether out of necessity or curiosity, can bring about a variety of feelings: new, daunting, scary, exciting, nerve wracking, among others. It is normal to have a lot of questions about the process, such as:

• What to expect

• If you “deserve” or “even really need” therapy

• Whether the therapy you’re engaging in is right for you

• Whether your therapist is right for you

• If you’re doing therapy “right”

In this blog, we are answering some of these questions, explaining the process of treatment, and normalising that it is a different experience for all who undergo it.

Starting therapy

Individuals start therapy for a diverse range of reasons, yet typically there is a presenting problem that gets them through the door.

This problem might be new or something that has been there for a long time. It might be something that has become too big of a problem that it can no longer be ignored. It might be that this initial reason is actually just a symptom of a greater issue that will later become the focus of therapy. It might be the desire for self-reflection and self-understanding to support them in their connection with themselves and engagement with the world.

Regardless of the presenting problem, anyone starting therapy is welcome. There is no better or worse reason, nor best or worst time, to begin therapy.

Even though it is common to have a reason to begin therapy, there is no need to have all your concerns “figured out” by the first session. Many individuals begin treatment without a plan or expectation of how they should be. It is normal to not have a plan, or to not know where the session is going to go. It is normal to not know what to talk about, and to be nervous about being in the session.

Note that no one has to have everything figured by the first session. It is the therapist’s job to support you on this journey and help you figure it all out with time.

Staying in therapy

It may seem like the first session is the hardest part of therapy, yet there are several reasons that may prevent the maintenance and consistency of therapy.

Within the first few sessions, for example, clients may find a variety of reasons to stop returning to therapy. These can include:

Feeling uncomfortable feelings before, during, and after the sessions

It is common to feel uncomfortable after a therapy session, drag your feet before a session, or want to leave in the middle of a session. There are many reasons why this is the case. One of the primary reasons for this is due to the uncomfortable emotions that emerge during a session, or in anticipation of the session.

Therapy requires clients to share a lot about themselves. It can elicit uncomfortable emotions or memories from the past. It can encourage painful self-reflection. It can force individuals to discuss their emotions when they have never done so before. This can lead to, what is colloquially called, therapy hangovers:

• Feeling tired after a session

• Feeling nervous about what you’ve shared

• Feeling stirred up or angry at people in your life, yourself, or your therapist

• Feeling regretful about what you’ve shared

These feelings are incredibly normal and can lead individuals to want to avoid treatment and their therapist altogether. It may feel uncomfortable but manageable to push through these feelings, however, it may lead to ending treatment. This might mean it is not the right time to pursue therapy at this moment, which is also ok to realise.

Not feeling comfortable with the clinician

Research has indicated that the goodness of fit with a therapist is one of the strongest predictors of success in therapy. This suggests that it is incredibly important for a client to have a strong alliance with their therapist. It is hard to know, however, whether or not a therapist is the right one for you. One of the ways to discern this is by considering whether they have qualities and values that you agree with.

The qualities of a good therapist are, to name a few examples:

• A non-judgemental approach

• Feeling a sense of comfort and safety in their office

• Compassion & empathy in their responses

• Someone you believe is an attentive listener

• Someone that has availability to see you (without weeks and months between sessions)

These qualities are important to look out for when choosing a clinician. You may not feel an instant connection with the therapist, as all relationships take time, however, you may notice these qualities that indicate to you that your therapist will be respectful and compassionate at baseline.

Sometimes it quickly becomes clear that the therapist is not a good fit for you, other times it can be unclear. If it is unclear after a few sessions, it is recommended that you speak to your therapist about your concerns with them. Seeing how they respond and engage in this conversation might help you make a decision about whether you want to continue with this person. You could also have an initial appointment with someone else in the meantime and make a decision from there. You can always return to a former therapist if you trial a few and decide they felt like the best fit.

Not noticing immediate change or progress

It’s normal to not want to continue with therapy if no progress is being made. It can be difficult, however, to know whether progress is occurring or not at the outset of treatment. Things to think about when considering your progress in treatment are:

Progress can be covert

Despite wanting to see major changes immediately, progress is typically slow and initially noticed in the small things. Instead of looking to feel better within the first sessions, look for things like:

• Increased awareness into your feelings, e.g. greater capacity to notice your anxiety in the moment or after an anxiety attack

• Changes to how you relate to others

• Changes to how you view the world, e.g. greater patience in traffic, an improved outlook on the future

Progress is rarely linear

One day you might feel like you have made progress and another you might be feeling right back to where you started. This is normal and to be expected. Expect to feel worse before you feel ultimately better.

Consistency matters more than speed

Attending therapy once a month, or missing several sessions in a row will not support growth in treatment. According to studies on the topic, consistency in therapy allows for the greatest progress at the quickest pace. This is due to having greater trust with the therapist, less time between sessions to go back into old habits, and have greater exposure to the therapy process.

Personal openness to change

Clients typically feel open and ready for therapy when they begin treatment. However, once you begin therapy you might feel:

• Feeling uncomfortable about talking about yourself

• Feeling uncomfortable talking about emotions, something individuals may not be well practiced in

• Feeling worried that you have said “too much” or overshared

• Feeling worried that your issues or concerns aren’t “valid” enough to warrant being in therapy

• Feeling awkward being emotional in front of a stranger

• Feeling as though the questions being asked were outside of your comfort zone

These feelings can lead to a lack of openness in therapy and cause clients to have slower progress. It is normal for this to occur, as one can only make progress if they feel comfortable, to an extent, and trusting of their therapist.

Trusting relationship with your therapist

Therapy is all about trust, and trust with a clinician cannot be rushed. You may want progress quickly and to jump straight into the traumas of your life. It is the job of the therapist, however, to measure if the client is ready for this and to guide the pace of treatment.

It is encouraged that clients speak to their clinician about the progress they see. The therapist can help the client identify areas in which progress is being made that may not be overtly noticed or support the client in knowing why progress is not being made.

What therapy is not

Therapy has many misnomers. The primary stereotypes that should not be anticipated in therapy are:

• A place to receive advice quick solutions;

• Not for “fixing” you;

• Not just for crises or in the moment “solutions.”

Advice giving

Therapy, as stated above, is a collaborative process. Whilst the therapist will provide suggestions or recommendations of techniques or activities to try, they will not be quick solutions to an issue. The primary role of these recommendations is to support in developing greater insight or new coping skills, rather than an instant solve to a greater concern.

“Fixing you”

Unlike in the medical field, individuals can never be psychologically broken. There is, therefore, no intention to “fix” someone in therapy. This is because there is no single specific way an individual must be in the world, so there will be mold to shape the client back into being. In therapy, we build insight, notice patterns, identify emotions, and support behaviour change. None of this involves being “fixed” into the person the client once was, rather they develop into who they will be with these new shifts.

Not just for crises

Whilst it is common for clients to seek therapy in the middle of a crisis, it is not the most ideal time to begin therapy. It is understandable that when in crisis, therapy is pursued to help manage difficult emotions. This can be supportive, however, it is present moment focused and does not allow for lasting change to occur. To allow for this lasting change and prevent a crisis in the future, therapy would need to continue to when the client is out of survival mode and ready to be engaged in greater self-exploration and change.  

Overview

If this blog clarified anything for its readers, it is:

• Normalising that everyone experiences therapy differently

• There is no one perfect way of doing therapy

• It is important to speaking to your therapist about the concerns you have about therapy, as they may be able to help resolve this with you.

If you have any questions or comments, or would like to make a first appointment to see what the initial phases of therapy are like, please contact us at info@bluedoortherapy.com.au or use our contact form.