What to Expect in Therapy
You’ve decided to get into therapy, found a therapist you want to work with, scheduled an appointment, filled out the intake paperwork, and now you’re wondering what to expect next. It’s normal to be a bit nervous, but you can also be proud of yourself for taking the first steps toward addressing the problem and starting to make changes. Sometimes knowing more about what to expect can be helpful in mitigating some of the anxiety. Here is some more information about what you can expect while participating in psychotherapy.
At your first appointment, be prepared to tell your therapist some details of the challenges you’ve been having, as well as some history about the problem and how it’s affecting your life. You can also expect to share some background information about yourself, your family of origin, current significant relationships, employment status, etc. During the first session, you and your therapist will discuss treatment goals and establish schedule for future sessions. If you’re using insurance, your therapist will assign an ICD10 Diagnosis Code to use for your work together based on the information you’ve shared.
During therapy sessions, keep in mind that your therapist only knows what you tell them, and their ability to help is limited when they don’t have all the information. I like to use the analogy of having a plumber come over to your house to fix your toilet, but when they get there, all you show them is your kitchen sink which is working fine but needs an upgrade. You spend all of your time, energy, and money talking about updating the kitchen sink, and never end up actually getting the problem with your toilet addressed. This is what happens when people spend their time in therapy talking about minor day-to-day frustrations. Getting support around those things can be helpful, but they’re not really addressing the issue that brought them to therapy to begin with. Sometimes people avoid talking about things that are uncomfortable, but that leaves the problem unaddressed and therefore unchanged. Therapy is a great place to challenge yourself and practice having those difficult conversations and learn to break that cycle of avoidance. Also, while in treatment, keep in mind that therapy is not “magic hour.” Your therapist can help you come up with tools and strategies to use, but they can’t fix your problems for you. Most of the “work” of change in therapy, implementing those strategies and using those tools outside of therapy sessions, is up to you.
You can always expect for therapy to be an emotionally safe place. Being a bit uncomfortable because you’re discussing emotionally charged or sensitive subjects is one thing, but your therapist should never make you feel unsafe, threaten you, or “force” you to do things you don’t want to do. All licensed therapists should abide by a professional Code of Ethics which guides their behavior. Each state also maintains conduct guidelines for licensed professionals in their Administrative Code. I am a Licensed Clinical Social Worker in the state of Texas (LCSW) There are also other types of licensure for therapists as well including Licensed Professional Counselors (LPC) and Licensed Marriage and Family Therapists (LMFT) and each state has separate licensure for each. If you believe that your therapist is practicing in an unethical manner, you can file a complaint with the licensing board which governs their profession in the state they are licensed in. Anyone who wishes to file a complaint against a healthcare professional in the state of Texas may call the Health Professions Council toll-free complaint referral system: 1-800-821-3205. This automated, statewide number routes a complainant to the appropriate licensing agency. Click the links below to learn more (opens in a new tab).
Social Work Code of Ethics (NASW)
Social Work Code of Conduct (Texas Secretary of State)
Marriage and Family Therapy Code of Conduct (Texas Secretary of State)
Licensed Professional Counselors Code of Conduct (Texas Secretary of State)
How to File a Complaint (Texas Behavioral Health Executive Council)
People often wonder “How do I know when I’m ‘done’ with therapy?” This is a complex and personal question that you can always discuss with your therapist. It’s also pretty simple in that, as with any medical treatment, you can chose to stop at any time. Most people choose to discontinue therapy once they’ve met the goals that brought them to therapy. Some people also unfortunately experience life changes that make therapy inaccessible to them which causes them to discontinue services even if they’d prefer to continue. Others stop coming to therapy because they feel like it “just isn’t helping.” Clients sometimes benefit from trying a different therapist or a different approach to therapy which might be a better fit if they find themselves in this situation. They can also reflect on the factors which are preventing them from making progress, including their own readiness for change and other barriers they might have to implementing the coping strategies and therapeutic tools discussed in sessions.
