What do I do in Therapy?

You’ve been feeling this way for a while now. It’s hard to get through the day without your emotions becoming overwhelming and distracting. You’ve tried everything you can think of to help yourself-talking to friends, reading self-help books, scrolling TikTok for suggestions, and even asking ChatGPT; but these solutions aren’t giving you the relief you really need.

You’ve thought about doing therapy before, but you’ve always talked yourself out of it. Is it going be how it looks in the movies? Are you going to be expected to lie on a couch? Are there going to be long, awkward pauses? Is the therapist going to be judging you the whole time, or thinking that you’re wasting their time because your problems “aren’t that bad?”

I’ve heard these concerns, and others, a lot from people who are new to therapy. It can be daunting to try something new when you are already feeling vulnerable. So let’s break down how therapy actually works-what you need to do and what you don’t need to worry about.

Here are a couple of basic things I would say to reassure you. Therapy is something that is for you. It is a service that is meant to meet your needs and expectations, not the other way around. If you are worried about trying to come across a certain way to a therapist, or feel like you have to say the “right” things, try to set that worry aside. Therapists are just people helping other people through creating a genuine, warm, professional relationship. It is our job to have “unconditional positive regard” for our clients, so we are not judging you-we’re on your team. That doesn’t mean we always agree with our clients-in fact, part of our job is to challenge you to help you grow-but it means you don’t need to be afraid of opening up and being authentic.

Let’s dive in to what a therapy session actually looks like, and what you will need to do to make therapy successful for you.

Identify some Goals and Be Prepared to Share

It helps if you come to your first therapy session with a description of what’s been bothering you, and what you want to achieve. Some questions that might help you prepare would be, “What is currently creating distress, or feeling differently than you would like?" and, “How would you know if you’ve gotten what you needed from therapy?”

The first session or two will likely include some history taking. Your therapist is going to want to explore not only what is happening in your life right now, but what might have happened earlier different parts of your life. This helps us start to identify patterns that might be showing up for you, and connect dots that you might not be able to connect for yourself. Be prepared to share about your past, and know that if there are questions that are difficult to answer, it’s OK to express that.

Talking, Reflecting, and Making Sense of Things

The next phase of therapy is often exploration, where you discuss reactions, patterns, and behaviors in an effort to better understand your inner self. This is the phase where what you get out of therapy is proportional to what you put into it. You don’t have to feel responsible for talking the whole time-in fact, therapy is most effective when it is conversational. It helps if you have a general sense of direction for the session, such as something that you noticed between sessions, but it’s OK if you need some help getting started. Your therapist can ask you exploratory questions to help you better understand yourself.

Learning Skills and Tools

A therapist’s job isn’t to make you feel better, it’s to help you feel better equipped to manage your distress. Sometimes there is a teaching aspect of therapy, where you might learn skills for effectively managing a triggering situation. Discussing and practicing these tools in therapy is an important part of the process, but it is only a small part of what actually creates change. You taking these tools and actively using them outside of therapy is where lasting change occurs. It’s OK to be honest with your therapist about what works and doesn’t work for you-not every skill is going to work for every person. But it might also be important for you to keep an open mind, and know that something that seems cheesy or silly might actually end up being helpful.

A Genuine—Professional—Relationship

Your working relationship with your therapist is unique. There probably won’t be another one in your life exactly like it. It is a relationship in which you are sharing a lot, and sometimes being pretty vulnerable, but the sharing only goes one way. You won’t know a lot about your therapist-and that is by design. We are not trying to be mysterious, we simply want to be a blank slate for you so that you can be your most authentic self.

The therapeutic relationship is also a safe space to practice assertive, respectful communication. I often tell my clients that if we work together long enough, they will likely experience feeling disappointed in or angry with me. While these feelings might be uncomfortable to experience, and may seem like a rupture in the relationship, there is actually opportunity here. Therapy is a safe space to practice expressing your feelings and working through ruptures in relationships. What might initially feel distressing can actually be therapeutic.

You’ve Got This

Hopefully by now it’s clear that the most important task you have in therapy is to show up and be yourself. While the goal of this post is to help you feel a little less overwhelmed by the prospect of starting therapy, it’s OK to still feel some nervousness about it. You don’t have to wait until you feel completely comfortable. Trying something new, even when you’re doing it scared, can be the first therapeutic step you take!