What to Expect When You Start Therapy

Okay, you’ve made the call, had a brief chat with the therapist, and set up an appointment. It was really hard to do, especially if you’ve never been in counseling before. When you think of therapy, you may think of mental illness, of the stigma of seeing a shrink, and you’ve never thought you would be doing it yourself.

But you’ve been in such pain, emotional anguish, or conflict. Nothing that any of your friends or family members have done or said has really helped. You feel like sh–.

So here you are, in the waiting room at a therapist’s office.

Why Do I Have This Knot in My Stomach?

There can be such an intensity to the anxiety of facing your own inner world and sharing it with someone that you have physical symptoms as you wait to be seen by your new therapist. It’s often a stomach ache, but it could be chest pain, tingling in the arms, hotness in the face, just about anything.

You may think, “How will this therapist react to what I say? Will I be judged? Will she understand me? Will I be taken seriously?” Or, “What will happen in there? Will I cry? I don’t want to cry. How can talking to someone in a room really help me? Is he smart enough to be able to help me?”

Or you may not be able to think at all because you are overwhelmed by the prospect of being “seen” by a professional. The waiting room is really hard.

Into the Therapy Room

You walk in. Where are you supposed to sit? How are you supposed to start?

You look at the face of your new therapist. There is something about her demeanor that makes you know that it’s okay to be in the therapy room with her. You start therapy.

Therapy Begins

Therapists have many different styles, theoretical orientations, and techniques. You can expect your therapist to ask what has brought you in for help. As you respond, she will ask for clarification, often focusing on the emotional aspect of your story, something you may not be used to.

As she responds and probes, she is teaching you about therapy. About its concern with your inner life–its focus on internal conflicts, distorted thinking patterns, discarded or unfelt emotions. You find it difficult but at the same time comforting.

The comfort is this:  There is a place in the world for your feelings.

Silence is Golden

A conversation with a therapist isn’t like a normal conversation. Yes, there is back and forth, maybe some jokes, questions and answers. But there are other things that make it different. Silence is one. Most therapists are not afraid of periods of silence. You might find this unsettling at first. People generally like to fill the air with words.

In therapy, silence is a fruitful time in which you can gain access to your feelings and thoughts—maybe important feelings and thoughts long stuffed down and put away. These feelings and thoughts may be very informative, even healing.

More Than Talk—Noticing the Nonverbal

Many therapists are trained to notice not just what you say, but what you do in the session. Your therapist may notice when you sigh or clench your jaw—signs that you are anxious and are showing your anxiety in the striated muscles. When you are discussing a traumatic event or conflict, she may ask you where in your body you feel it. The purpose of this kind of questioning is to help you get in touch with anxious feelings and push through them  to the heart of your feelings. As your inner life is given space to express itself, healing can begin and emotional pain can diminish.

After the First Session

Whew! That hour was probably difficult. It may have flown by, or it may have felt like forever. At the end of your first session, you should feel some hope that things can get better. You probably feel relief that you got a lot of what has been bothering you out there—for you and your therapist to see and be curious about. Getting those hard feelings out may also make you feel emotionally drained, even physically exhausted.

The Rhythm of Therapy

Your therapist will probably suggest that you have a session at least once weekly, maybe more if you are experiencing a crisis. There is a rhythm to this kind of emotional discovery and healing. Fewer than once a week, at least at the beginning of therapy, just doesn’t give you the opportunity to develop the rhythm needed to get to your core issues and find solutions.

Part of your healing will come through your relationship with your therapist. Interacting with her will help you discover new ways of being in relationships with other people. Your therapist will be a consistent force in your life while you are in therapy, helping you adjust your rhythm of being to a healthier pace.

In some ways starting psychotherapy is like learning to play a musical instrument. Once you start, you have to set aside time to focus on the instrument—your emotions/mind. Therapy increases your emotional repertoire, which in turn allows you to be more yourself and enjoy the music of life through improved acceptance of self and relationships with others.