What Happens in Therapy? 3 Misconceptions and Clarifications

Maybe you’ve seen a movie or show with a scene of an individual seeing a counselor. Maybe you’ve heard someone say “you should go to therapy?” or “therapy was really helpful”, but you’re not sure what exactly is involved. What happens in a therapy session? What do you do exactly?  

The idea of therapy or counseling perhaps brings to mind an image of someone lying on a couch, talking freely and a “shrink” saying “mmmm” and not much else. We all may remember something about Sigmund Freud from our psychology classes. Freud created “Psychoanalysis”, a particular type of therapy. Psychoanalysis made popular the idea of laying on the couch while talking freely. However, while there are still those who follow the psychoanalysis modality, laying on a couch is not common anymore. Therapies have also evolved to provide much quicker and more effective relief than was common with psychoanalysis.

What Is the First Session Like?

The first session is typically about establishing a connection, gathering information, and setting the stage for future work together. If you are seeing a therapist in-person you’ll go to their office at the appointed time. The meeting will most likely start on time because it is billed by the hour and often therapists see a client starting every hour. No waiting around for your appointment to start, like at the doctor’s office. Therapists are skilled at starting and ending sessions in a timely manner. The therapist may have an office administrator who will greet you, but commonly they don’t have someone at the front of the office. Wait until your time starts and they will come out and get you. Therapists’ offices tend to be inviting, relaxing and comfortable. They often have couches, soft chairs, blankets, pillows, and fun artwork and personal touches on the walls. Some may even offer beverages or snacks.

Often therapists meet online these days. If that is the case, they will send you a link to enter the appointment virtually. In this case you have the option of remaining in your comfortable clothes and have the items around you that are comforting and supportive. Meeting virtually has become very popular because it cuts down on commute time, makes meeting more convenient and enables more comfort in your environment.

The therapist will likely start by introducing themselves and explaining the structure of the session. They may also go over confidentiality and any other important policies. There might be some paperwork to fill out, such as consent forms or intake questionnaires. This helps the therapist understand your background and what brings you to therapy. Often these papers are sent to you prior to the first session. This enables the therapist to save time and get to know you better on the first session.

The therapist will likely ask you questions about your current concerns, your personal history, and your goals for therapy. This is to gather information and get a sense of what you're hoping to achieve. The therapist will work on building rapport with you, creating a safe and supportive environment where you feel comfortable sharing. They may ask about your strengths, hobbies, or interests to get to know you better.

Depending on the approach, the therapist might start exploring your thoughts, feelings, and behaviors in more depth. They may ask about specific situations or experiences to better understand your perspective.

Towards the end of the session, you and the therapist may discuss goals for therapy. These can be short-term or long-term objectives that you want to work towards. Finally, you'll discuss what to expect in future sessions, including the frequency of sessions and any homework or exercises you might do between sessions.

Common Misconceptions About Therapy

1.     Therapy is just a place for venting

It’s often thought that therapy is just a place to talk and “get everything out”. Perhaps you have a friend, a hair stylist, a bartender or another person who are there to listen to you. That’s great if you do! But therapy is not just venting or sharing all your thoughts out loud. Yes, a therapist is trained to actively listen, hear, understand and give feedback on your talking. But that’s not all they do. If it was, it probably wouldn’t be worth the money you pay. (If you have a therapist who only listens to you vent each week without doing anything else, you probably should find a new one.) A good therapist will not only listen but will help you solve problems and equip you with the necessary tools to move forward.

2.     Therapy is only for very serious problems.

Therapy isn't just for those dealing with serious issues. People may see a counselor for small issues as well as major problems. Often therapists have their own counselor as well. Therapy can be like a toolbox for anyone navigating life's twists and turns. It's about exploring, growing, and finding your own path to a happier, healthier you.

3.     I can solve all my problems on my own.

Is this your mentality most of the time? Do you love DIY projects? Maybe you’ve fixed your own dryer, lawn mower, and car. Maybe you’ve troubleshooted health issues and found answers. Perhaps you’ve read countless books looking for answers to everything under the sun. And all those things are helpful. Solving your problems yourself has its place. Yet, there are some things that you can’t solve without outside help. Maybe you’ve tried for many years, doing things your own way, yet still find yourself stuck. It’s useful to have an outside perspective to help you see your life differently. Licensed therapists have years of specialized training, at minimum. They have a wealth of knowledge and information about psychology, the human mind and how to heal. They are trained in theory and techniques that are highly researched and shown to be extremely effective in helping people overcome their problems. So, unless you are planning on dedicating years of your life to receiving the same training, a therapist can be a life-changing resource and save a lot of heart-ache and effort.

What Does a Therapist Actually Do?

You may be wondering, if a therapist doesn’t just listen to me talk, what do they do? And what will I have to do?

Each therapist has a different personality, approach and theoretical orientation which will affect the details of the sessions. However, in general, a therapist will help you work towards the goals that you collaboratively set. These may be goals related to how you feel, specific things you want to accomplish or how you wish to relate to other people.

Therapists are goldmines of coping skills, communication techniques, and problem-solving strategies. They have many resources to help you manage stress, regulate emotions, and improve relationships. Therapists also provide education about mental health conditions, relational dynamics, coping mechanisms, and other relevant topics to assist you with knowledge and understanding.

Therapists empower you to take ownership of your life and make positive changes. They encourage autonomy, self-reflection, and personal growth, guiding you towards greater self-awareness and self-efficacy.

A good therapist can intuitively help you understand the roots of distressing issues in your life and help you reach resolutions.

Therapy is a collaboration between you and the therapist. You’ll have to put some work in to see the positive effects. This may mean you will need to attend consistently, engage, reflect, and provide accurate information. Often therapists will give homework to complete in-between sessions, but many do not give formal homework. It’s up to you to implement the techniques, skills, and tools you learn. Some progress may be seen naturally as you explore your concerns, but you will also have to be intentional in your own healing.

 Specialties that A Therapist Can Provide

Not only do therapists provide general skills and strategies to achieve goals, there are many specialty types of therapy to treat specific issues.

Trauma and PTSD is often treated through specific therapies (like EMDR, Eye Movement Desensitization and Reprocessing) that target memories to desensitize them and change negative beliefs that are held about oneself.

Eating disorders and disordered eating may be treated through therapies like Acceptance and Commitment Therapy which help provide a holistic approach focusing on developing psychological flexibility, enhancing well-being, and promoting values-based living. Treatment can help you cultivate a healthier relationship with food, eating, and your body, ultimately moving towards recovery and a more fulfilling life.

Anxiety can be treated through Mindfulness, ACT, and EMDR. Coping skills like breathwork, grounding, addressing lifestyle habits and mindset shifts are all helpful in dealing with the present symptoms. EMDR can assist in pulling out the roots of anxiety and undressing underlying beliefs, thoughts, and emotions. ACT and Mindfulness can help change how anxiety is viewed and shift the fear base.

Summary

In summary, the first session with a therapist is used for introduction, gathering information, and defining goals for ongoing sessions. Some misconceptions about therapy include the belief that therapy is just for venting, therapy is only for serious problems, and your problems can be solved on your own. While each therapist’s approach is unique, therapy commonly includes learning coping skills and strategies for communication, as well as learning how to manage stress and gaining self-awareness. Therapists also use specific research-based modalities, such as EMDR, ACT, and Mindfulness, that are designed to address specific issues.