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What Happens in Therapy?

Updated: Jan 8


Graphic of women laying on couch recieving therapy text aying "What happens in therapy eliminate the uncertainty and  find out what to expect in your first few sessions

Going to therapy can be a scary task if you don’t know what to expect. Everyone knows how therapy works though, right? The common perception is that you go into a dimly lit office, sit on a fancy couch, and talk about your feelings! Many people have this idea of therapy because it's often portrayed that way in TV shows and movies. But is that an accurate representation of therapy in real life? While TV and movies are entertaining and can evoke strong emotions, their depictions aren’t always accurate to life. Doctors are rarely at a patient's bedside 24/7, lawyers usually don’t have cases that can be conveniently wrapped up in one episode, and I highly doubt firefighters deal with nearly as many love triangles as Station 19 would like you to believe. While these shows are based on reality, they don’t necessarily reflect it. While bits and pieces of reality are used when a character visits their therapist, there is a lot more that goes into real-life therapy. Having an idea of what to expect can take away some of the uncertainty around starting therapy. Let’s learn what a typical therapy session might look like and address some common concerns!


What happens during the first therapy meeting?


women recieivng therapy

Here is what happens when starting therapy. When starting therapy, the first few sessions will focus on you and your therapist getting to know one another. This can include learning how you process information, what you hope to gain from your sessions, and the best way to help you on your journey. In the first session, you can expect your therapist to address formalities, paperwork, and practice policies. Therapists usually start out by explaining the legal requirements, such as mandated reporting and confidentiality. All therapists are mandated reporters; this means they are required by law to report if a client may be a danger to themselves, a danger to others, or if they suspect abuse. They will also explain your right to privacy and confidentiality along with any practice-specific policies. While this session may feel like an orientation that you would rather skip through, it's essential to listen and understand the information being shared.

During this session, your therapist may address some other crucial points to remember, such as setting realistic expectations. You may also ask questions about the process and your expectations during this session. It’s important to remember that therapy isn’t a magic overnight fix. It is common for patients to want results after one or two sessions; however, setting unrealistic expectations can hinder your healing journey.


What will I be asked?



After the first session addressing formalities and expectations, the subsequent few sessions revolve around questions and discussions that will help your therapist understand your situation. This information allows the therapist to create a foundation to build on while creating your personalized treatment plan. Below are examples of questions you may be asked. Remember, each therapist is different, so the questions may vary.

  • Introduction and Background:

    • What brings you to therapy today?

    • Can you tell me about your current situation and the challenges you're facing?

    • Have you been to therapy before? If yes, what was your experience like?

  • Personal History:

    • Can you share some background about your family, childhood, and upbringing?

    • Are there any significant life events or traumas that have impacted you?

    • What is your current living situation?

  • Emotional and Mental Health:

    • How would you describe your current emotional state?

    • Are you experiencing specific emotions such as sadness, anxiety, or anger?

    • Have you noticed any patterns in your mood or behavior?

  • Physical Health:

    • Do you have any medical conditions or take any medications that might affect your mood or emotions?

    • How are your sleep, appetite, and overall physical health?

  • Social and Relationships:

    • How are your relationships with family members, friends, or significant others?

    • Are there any conflicts or challenges in your social life?

    • Do you have a support system in place?

  • Work and School:

    • What is your current employment or academic situation?

    • Are there any stressors related to your work or school environment?

    • How do you generally feel about your work or school life?

  • Coping Strategies and Resources:

    • What coping mechanisms or strategies do you currently use to deal with stress or difficult emotions?

    • Are there activities or hobbies that bring you a sense of fulfillment or relaxation?

    • Do you have any spiritual or religious practices that are important to you?

  • Goals and Expectations:

    • What are your goals for therapy? What would you like to achieve?

    • What are your expectations from therapy and from me as your therapist?

    • Is there anything specific you hope to learn or explore during our sessions?

  • Safety Concerns:

    • Do you have any thoughts of harming yourself or others?

    • Do you have a history of self-harm, suicidal thoughts, or suicide attempts?

    • Are you currently in a situation where you feel unsafe or threatened?

Will I have to talk about upsetting things?

Some people avoid therapy because they are not ready to discuss certain subjects and worry that the therapist will expect them to. Therapy is meant to be a tool to help you heal and grow. Your therapist isn’t going to push for anything that might negatively impact your healing. Your healing journey is exactly that: YOUR healing journey. You set the pace for your sessions. If you are uncomfortable or not ready to talk about something, your therapist will not force you to explore it further. Your therapist may provide coping skills to help you manage the feelings the subject brings up or encourage you to explore the topic independently until you’re ready to discuss it.

What if I Don’t Know What to Say?


It’s normal not to know where to start your therapy journey. Luckily, that is what your therapist is there for! Just like your doctor wouldn’t expect you to know how to perform your own surgery, your therapist wouldn’t expect you to know how to begin your therapy journey on your own. Therapy does include a lot of self-work, but you are not expected to get there on your own. Your therapist is there to help guide you through each step of the process. You don’t have to attend therapy knowing precisely what you will say. Each session is unique and will flow differently. This means there is no “right” or “wrong” thing to say!

Take the Leap Anyways!



It’s normal to feel apprehensive about doing something new. It’s normal to feel nervous or scared. It’s okay to be worried or anxious. Therapy is a place to work through these feelings, so do it anyway. Do it scared. Do it, nervous. You can do it!



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