Starting Therapy: A Guide to Finding Your Path to Mental Wellness

Starting therapy is exciting and can also be a little intimidating. Choosing the “right” therapist can be challenging. It can feel like trial-and-error sifting through listings. It can be an especially daunting task if you’re experiencing anxiety and/or depression. If it feels like a challenge, you aren’t doing anything wrong!

Trying therapy is courageous, and it’s completely normal to be nervous, or even to realize that you’re not quite ready for therapy. Finding a therapist you connect with takes a few steps, and there are additional factors like social stigma and insurance coverage that make the task even harder. I wish I could make all that easier in a blog post. I can’t wave a magic wand, but I do have insight on the process as a clinical social work grad student, and more importantly, as someone who goes to therapy. 

What I can do is reassure you that you are brave for taking a step in finding a therapist! Working with a therapist who really gets you can be a rewarding, deeply enriching, healing experience. In this blog post, I'll guide you through finding the right therapist, preparing for your first session, setting goals, caring for yourself between sessions, and answering common questions about the process.

Finding the Right Therapist for You

If you’re able to choose from a few therapists on a website like Psychology Today or Zen Care, you can get a sense of what type of therapist might work best for you. Maybe you’d feel more comfortable with a therapist of a specific gender, or someone who specializes in queer spaces. Or maybe you’re more comfortable with someone of the same race, ethnicity or religious background as yourself.

I recognize that being able to choose a therapist who’s similar to you is a privilege and might not be possible. There are resources available to specifically find therapists of color and queer therapists. Explore sites like Therapy for Black Girls, Black Men Heal, LatinxTherapy, Asian Mental Health Collective, and LGBTQ+ Healthcare Directory for vetted lists of therapists. 

Remember, the therapeutic relationship is just that, a relationship. There is plenty of research that indicates that the most important element of therapy is the relationship itself, beyond specific modalities (i.e. CBT or ACT, etc.) (Stubbe, 2018)

Working through how you communicate and feel towards your therapist can be useful in figuring out relationships in your daily life. What comes up in the therapy office, usually comes up in your daily life and vice versa.

In the therapeutic process, there might be ruptures, i.e. instances of disconnect. For example, maybe your therapist says something that doesn’t resonate with you. Working through these ruptures can be healing, especially if you haven’t experienced a healthy relationship where conflict was resolved directly and compassionately.

In any case, the therapeutic space should feel comfortable and safe. It should be your time. If you don’t feel like the therapist you’re working with really gets you and respects who you are and your goals/interests, there are plenty of fish in the sea. You can change therapists. I know I’ve felt disconnected from a therapist in the past, and didn’t want to offend them by switching. But I did, and I’m glad I did. I found a therapist I connect with, and the experience shifted my capacity for growth. 

Setting Goals and Preparing for Therapy

As you go into therapy, it can be helpful to reflect on your goals. What would you like to work on? Maybe social situations are anxiety provoking, and you’d like the space to talk those feelings through. Maybe you are interested in processing trauma. Maybe you feel stuck or unsure in relationships. Maybe you feel career burnout. You can have more than one goal! And as you get started in therapy, your goals might shift. That’s normal! But it is helpful to reflect on your goals and how you’re implementing change in your daily life throughout the therapy process. 

Between therapy sessions you can consider journaling, and/or observing your interactions in your daily life (without judgment, when possible!). Going to therapy, sitting with difficult emotions and reflecting on your relationships is exhausting work. All sorts of emotions that you can’t predict might come up. This is normal. It means the process is working!

For survivors of harm, this can be especially true. Having a safe relationship where you feel seen can be a new, unsettling experience. You might not trust the process right away. That is also normal. It’s something you can discuss with your therapist, if that feels safe. 

Here are some common questions and answers going into therapy: 

What’s the difference between a therapist, psychologist and psychiatrist? 

Therapists, counseling psychologists, psychiatrists and psychiatric nurses are all mental health professionals who’ve received advanced training and licensure. Their areas of focus and expertise diverge, however. Therapists are clinical social workers (LCSWs), marriage and family therapists (LMFTs), Licensed Associate Professional Counselors (APCs) and Licensed Professional Counselors (LPCs) who work with individuals and/or groups to develop coping skills and process emotional and relational challenges.

Psychologists have further training in diagnostic testing and research and can also practice therapy if they are licensed. Psychiatrists are doctors who prescribe psychotropic medications. Psychiatric nurses can also diagnose mental health conditions and prescribe medications. Having a dedicated integrated care team, including a primary care physician, psychiatrist and therapist can benefit some individuals, but isn’t always feasible or wanted/needed. You, as the client, are the only one who gets the last say on what you want and need! 

How do I know if it’s “working”? 

There’s no hard and fast rule to know if therapy is working. Sometimes, like a lot of things, it’s easier to see if it’s not working. If you don’t feel safe or understood by your therapist, you should absolutely find a new therapist. Healing isn’t linear. You should feel understood and respected in therapy. The experience should feel safe and like you have agency to disclose what’s on your mind at your own pace. 

I feel uncomfortable. Is the process uncomfortable, or is it really not working for me?

Being vulnerable, sharing and sitting with difficult emotions can be uncomfortable. It isn’t always something we have a lot of experience with. The therapy space is your time. It can be uncomfortable to feel seen and understood by someone in a one-way conversation. Your therapist shouldn’t overshare about their lives; the idea being you don’t have to hold the weight of someone else’s emotions and experiences. Sometimes therapists will share what’s called, “selective disclosure”. They might share a small anecdote about their lives, such as if you’re a parent and they are too, or if they’re a big basketball fan and so are you, to establish trust and connection. 

If you feel uncomfortable in the therapeutic relationship, beyond the discomfort of opening up, you should absolutely consider finding a different therapist. Trust your intuition. Your therapist should be someone you feel comfortable with, which sometimes means asking for clarification, and advocating for yourself when something doesn’t work for you (i.e. if your therapist suggests worksheets, which is a common approach to some modalities like CBT and DBT, but you would rather free-write/journal). 

How do I “break up” with a therapist?

So, you don’t like the therapist you’re working with, or you feel like you’ve made enough progress in therapy to put the brakes on sessions? Ending therapy, or “terminating treatment,” can be difficult whether you met with your therapist for one session, or 100 sessions. The therapeutic relationship is a relationship at the end of the day.

Saying goodbye can be painful, especially for survivors of relational harm. Ideally, the topic of termination is something you feel like you can openly discuss with your therapist. It can be as simple as “I don’t think this is working for me right now and I would like to end treatment.” Or, “I feel like I’ve made progress and think I’d like to end treatment.”

If you’ve worked together for a while, your therapist will probably suggest a few more sessions to wrap up your work together and highlight your growth and strengths. As always, therapy is for you and only you can decide when it is best to end things. You might feel a mix of emotions leaving therapy, that’s to be expected! 

You're Already on the Right Path

Whether you’re just starting to think about therapy, or you’ve tried therapy before and you’re looking for a new approach, or a new therapist, congratulations! Looking for therapy takes initiative and courage. You decide when to start, when to end, what treatment and what therapist is best for you. Of course, there are limiting factors beyond any of our cultures (insurance). But, there are resources available to find the best possible match. 

Additional Resource:

CPTSD Foundation: https://cptsdfoundation.org/

References

Stubbe, D. E. (2018). The therapeutic alliance: The fundamental element of psychotherapy. 

Focus, 16(4), 402–403. https://doi.org/10.1176/appi.focus.20180022