Talk the Talk: 10 Tips for Starting Therapy

A friend of mine recently told me about her experience of starting psychotherapy. She said she would have liked a list of pointers to help her understand what she was getting into before she started. That sounded like a good idea to me.

It’s not uncommon to want a few signposts when we start a journey. Inspired by her, here are 10 things I think might be helpful to you if you’re new to, or thinking about, therapy.

1. Do it for yourself.

One reason I find therapy doesn’t go well for some people is that they’ve entered into it for somebody else’s benefit or they’ve been ‘told’ to attend. If you’ve reluctantly engaged in therapy, or you’re doing it out of duty, or obligation, you may not get the best from the process. Generally it’s better to come into therapy through the understanding that even though others may benefit from you having treatment, therapy is a personal choice because it’s right for you and you alone.

2. Not all therapy is, and not all therapists are, the same.

In my opinion (and I’ll say this over and over) there’s not one way to ‘do’ therapy. At the moment CBT is the flavor of the month, but that doesn’t mean it’s a better approach than, say, gestalt or psychodynamic. More often than not, it’ll be the therapist who makes a difference to you, not his or her approach.

All therapists will be different due to our different personalities, how we look, and how we interact. You may find that one therapist is too quiet for you, too talkative, or wears heavily patterned shirts that distract you. Whatever our differences, it might be good for you or it might not, but you can always change therapists or therapy. We don’t take it personally if you don’t get along with us.

Just because some people swear by one type of therapy or therapist, it doesn’t mean it’ll work for you. My advice is to call a few therapists before you see them. See how you react to their voice, the information they tell you and your gut feeling. The first therapist I saw was very scary over the phone. I decided to see them because I thought if I could deal with them for an hour, I could deal with anything. Best decision I made.

3. Don’t rush the process.

At its heart, therapy is about learning to be comfortable with being vs. doing. At the beginning of therapy we’re often ‘doing’ therapy: talking about things, recounting, explaining. Soon we learn to go further inward and begin ‘being’ and exploring what it means to be us in relation to our world. This transition can be a quick or a slow process; there’s no right or wrong way to do it.

One of the best things I recommend for anyone just starting therapy is not to work so hard at being the good patient. This isn’t a job interview — you don’t need to impress me. Just be you, the way you are now, and in time you’ll discover what really being you is all about.

4. Not every session will be the same.

Get used to the idea that some sessions might feel satisfying with ‘breakthroughs’ or ‘eureka’ moments, while others might feel mundane and frustrating. As with all things, there is an ebb and flow to therapy.

5. Be open and honest. 

Therapy is about realism. It helps to talk through events, feelings and thoughts as they really are and not modifying what you say because you’re worried whether the therapist will be ‘able to take it’ or if they’ll have some ‘judgment’ about you. Facing your difficulties and negative views authentically will help make your therapy more successful.

6. Things can get worse before they get better.

Talking about, and learning that one’s own life might be dull, frustrating, painful or average can be a difficult process and often demoralizing at first. More often than not, I see people become more depressed or more anxious before they move forward and become healthier. Sticking with the process is important. Once we throw light into those dark areas of our lives, we can then start to face the world more realistically and with grace.

7. Let’s talk about sex.

I don’t know how many times patients have been reluctant to talk about sex. I know you might feel a little shy or uncomfortable about this subject, but please talk about sex, as it’s usually in the mix somewhere in why you feel how you feel.

8. Self-esteem and self-worth are not the same things.

You want to feel better, and often people talk about wanting to gain self-esteem through therapy, but don’t be fooled: That is a surface-level human condition. Self-esteem is a bolstering of one’s own view of self through gaining confidence in one’s own abilities.

However, the more satisfying goal is to work on gaining self-worth. Self-worth is accepting that one has worth and value no matter how good or bad we are at some task or other. Through a healthier understanding of our totality we will gain the ultimate goal of therapy of unconditional self-acceptance; this is when we can fully realize and accept our self for who we truly are – the good, the bad and the ugly… and a million things in between.

9. It’s not being selfish to talk about yourself.

I’ve covered this topic in other articles, but there’s a big difference between taking care of one’s self and one’s needs and being selfish. Selfishness is lacking any consideration about others and profiting by this. Self-care is about making sure that we’re well and healthy so that we are more available to help ourselves and others. In therapy the focus is on you and the goal is for you to be well. You, you, you. Get used to it.

10. Money.

On the whole, therapy costs money. There’s no way around this. As a therapist I’ve put in thousands of hours of time into my profession, and this is how I make a living. If I don’t get paid to do my job, I don’t get to work with you or anyone else, and that’s the cold truth.

Sometimes patients tell me that I (or another therapist) only care because they are paying for my time, but this is not strictly true. Of course you have my full attention because you are paying for my time, but that has nothing to do with the level of care you will receive from me. I (and I’m sure the vast majority of my colleagues) do this work because we genuinely care and want to help people live a happier, healthier life.

It’s also true that money is the stitching that binds us together for the length of time you attend therapy and pay for my time. Money often can be an issue in therapy, but I will say that paying more for a therapist’s time doesn’t mean you will always get better results. As in point 2, choose your therapist based on what your needs are and whether you feel comfortable with him or her, and not on how much he or she charges.

I hope these points help you in your therapy journey. I’d be interested if you have any points of your own which you could share with others. If so, please add them in the comments section below.