What to expect from counseling, therapy, and psychotherapy
Ok, so you’ve found some potential therapists that seem great, you’ve scheduled some free consultations, but maybe you have a ton of additional questions. Totally normal! I’ve created this brief “What to expect” guide for you. While every therapist works a little differently, this should help give you a brief overview of what the process generally looks like.
FAQs about the first few sessions
What do we do in the first session?
Often the first session is spent getting to know each other. There will probably be some paperwork to fill out and go over. Your counselor will then ask for some background information about your life, growing up, and your current situation. They’ll likely ask specific questions about what’s currently happening with you.
Will we talk about goals?
Yes! Sometimes there might not be time to get to this in the first session, but generally speaking, you will discuss your goals during the first few sessions. This helps determine what strategies and techniques your therapist will use during counseling with you.
What if I don’t know what I want to work on?
Perfectly ok! Your therapist will help you figure that out over the next few sessions. And sometimes this changes over time- also totally normal.
Will my counselor tell me what’s wrong with me?
Some folks come in asking “What’s wrong with me,” when they’re really asking if there is a name for what they are experiencing. If you are using insurance for therapy, your therapist has to provide a diagnosis in order to bill your insurance. Some counselors have varying viewpoints on sharing a diagnosis with their clients, but it is certainly within your rights to know. Please ask- you have a right to be informed about what information is going in your medical record. If you are not using insurance, a diagnosis is not required, so speak to your counselor about how they handle this.
Will my therapist judge me?
No! Trust me, we have heard it all. Even when working with people who have different backgrounds, religions, political opinions, or values, your counselor should never judge you. Bring it up with them if you feel that way, and if you continue to feel judged, it’s time to find a new therapist.
Do I have to tell them everything?
What you share is totally up to you. While it can help to be completely open in your treatment, it takes time to trust this complete stranger and open up about your feelings, traumas, and history. It’s ok to say “I don’t feel comfortable sharing that.”
Will my therapist tell anyone else what we talk about?
For the most part, no. Whether you are seeing a counselor, social worker, or psychologist, we are all bound to confidentiality. That means we can not share information about you or your work together without your prior written consent. There are a handful of exceptions to this rule, and your therapist should discuss these with you at the first session and have them as part of their written consent forms.
Court order by a judge. While this doesn’t happen often, if you are involved in the legal system in any way (including divorce, custody, etc), if a judge orders records or information, we have to comply with this. Most therapists will work to continue to ensure your confidentiality to the best of our abilities, but please let your counselor know up front if you have legal involvement.
Reason to suspect previously unreported abuse or neglect of a child, the elderly, or a disabled person. Some of the particular laws about this vary from state to state, but all mental health professionals are mandated reporters, meaning we must report suspected child abuse. If you have specific questions regarding this, speak with your therapist.
Current intent to harm yourself. If you are in immediate crisis, your therapist wants to keep you safe. They will discuss crisis planning with you if you are having thoughts of hurting or killing yourself.
Current intent to harm others. Most therapists have to follow laws that require us to report if someone makes an immediate threat to another person. This is more than just “I’m so mad I could slap my boss,” but rather a serious intent to take the life of another person.
What if I see my therapist out in public?
Counselors need to keep your confidentiality even in the grocery store! If they don’t bring this up, certainly ask how they handle it. You should get a response along the lines of “if we see each other out in public, you are free to approach me, but I will not say anything first, and it is perfectly ok to ignore me.” Even if you are in a large city, like Charlotte, there’s always a chance you run into each other out in the world. Your therapist will continue to protect your confidentiality no matter what.
Can I be friends with my therapist?
Unfortunately, no. As counselors, we have to avoid what is called a “dual relationship.” This means that your therapist can not be a friend. This ethical guideline is to protect you, the client, from being taken advantage of.
What happens next in therapy?
The details of this will depend on your particular therapist, but generally after the first session or two, you’ll start digging in to the work!
Whether you are in North Carolina or South Carolina, I hope this helps you find the right therapist for you. If you are still feeling stuck, or have additional questions, feel free to fill out my contact form for a free 15 minute phone consultation. I’d be happy to hear about what you’re looking for and direct you to the right person. If you are looking for support as an autistic or ADHD adult, you can find out more about that here. And if you are feeling stuck in therapy, and need help breaking through a plateau, you can read about Brainspotting Intensives here.
