Need to know
In many areas of life, a bit of preparation can do a lot to lessen anxiety and help you make the most of what lies ahead. Not only does that include planning for adverse events like storms, power failures or earthquakes (an ever-looming threat in my state of California), but also prepping for exams, presentations, athletic events, job interviews or any other situation where you would want a positive outcome.
Relatively few people, however, think about preparing for psychotherapy. In this Guide, I will explain why it’s a good idea, and offer specific suggestions for how to prepare – whether you have recently chosen a therapist and are booking your first appointment or you’ve already gone through the intake process and are just getting started. While psychotherapy is not fraught with danger like earthquakes or other natural disasters, completing some simple steps as you’re getting started with therapy will give you a better sense of what to expect, and it can improve your chances of a positive and productive experience with your therapist.
Why you should take the time to prepare for therapy
Unlike in many other relationships, therapists are dedicated to helping the patient without any expectation of reciprocity. The relationship is protected by laws and ethical codes to ensure the unequivocal prioritisation of a patient’s needs. And for many people, therapy is neither free nor easy to access. Given all this, the idea of having to exert effort before your first appointment may seem a bit confusing; you might wonder if the therapist is the one who should be doing most (if not all) of the preparatory work. Whether that’s your assumption or not, let’s think about how taking a more proactive stance could yield better results than relying solely on the actions of your therapist.
When people contact me to enquire about psychotherapy, they commonly ask how long it will take to get better. My response is always the same: ‘That depends on you.’ Every therapist-patient pairing is different, and both individuals are vital to what they accomplish together. Decades of research have highlighted the crucial role patients play in yielding better therapy outcomes when they come prepared and willing to work, and when they have a sense of what to expect. This actually makes a lot of sense, given that every patient brings expertise on their unique life experiences. Even when symptoms look the same across different people, as is often true with anxiety, depression and other psychological problems, I rely on each patient’s input to know how to best help them. When therapist and patient collaborate, their pooling of knowledge, innovation and resources leads to creative problem-solving and more personalised and meaningful – and thus more effective – treatment.
Even a small expenditure of effort in advance of starting therapy can yield big dividends in how much you get out of it in the end. Taking agency in life – starting with your therapy – is therapeutic in itself. Many people feel hopeless, helpless and demoralised by the time they start (or restart) therapy. This often follows years of struggling, which can erode one’s confidence and core sense of self. Also, for many people who are approaching therapy for the first time, the idea of confiding in a near stranger and sharing personal and family ‘secrets’ can be intimidating, anxiety-provoking and even taboo within certain cultural groups. While it’s important to honour one’s personal, family and cultural values, starting off with an openness to venturing outside what is familiar can open the door to emotional support and behavioural change, ultimately alleviating suffering. By assuming an active role in your own healing process, you’re taking important first steps on the road to the life you want to have.
Many individuals who start therapy do so for specific concerns like depression, anxiety about impending life changes, or lasting effects of a traumatic event, though that certainly does not define everyone seeking help. For example, you might be feeling discouraged about not being able to find an intimate partner in life, or you may be experiencing increasing job stress that is causing you to feel overwhelmed and unhappy. Some people simply experience a vague sense of malaise and desire a more meaningful and fulfilling life.
Whatever the reason you are choosing to venture into psychotherapy, the guidance that follows can help you take on a greater role in the type of experience you will have, potentially leading to more fruitful outcomes. I have worked with many different individuals of varying ages and backgrounds and with a range of presenting problems over my decades of clinical practice. The patients who come prepared – with a sense of what they are struggling with and what they want to get out of therapy – are the ones who tend to have an easier time engaging in treatment, and usually achieve quicker and more lasting progress.
What to do
List your reasons for getting help
An initial step to take when you are getting ready for therapy is to consider what is motivating you. Maybe a loved one is encouraging (or pressuring) you to get help, or perhaps your employer has noted that you’re having some difficulties in the workplace. Or you might have decided on your own that it was time to explore therapy. Regardless of where the initial suggestion comes from, it’s important to have some degree of self-motivation.
Writing down a list of pros and cons about starting therapy can be quite helpful in clarifying your own reasons for getting help. For example, say you have been feeling depressed and are having difficulty getting out of bed and caring for your new baby (and yourself). In this scenario, while your spouse may have been the driving force behind scheduling your intake appointment, this exercise would help you realise that one of your most important personal values is being a good and loving parent, and being better able to act in line with that value (pro) with the help of therapy would likely be a strong motivator. At the same time, perhaps it is challenging to find affordable childcare to free up time to participate in therapy (con).
Though it could be easy to get derailed by the cons in your list, remember that what’s most important is how these variables impact you, your relationships and your life. So, while arranging childcare can often be a daunting task, especially if one is on a tight budget, it is likely painful to berate yourself for feeling overwhelmed and inadequate as a new parent. Moreover, sorting through any disadvantages can act as a springboard for problem-solving potential obstacles. Returning to our example, the unaffordability of childcare might lead you to lean on friends, relatives and neighbours, while creating opportunities for strengthening these connections and ‘giving back’.
Reviewing the pros, of course, underscores why therapy is worth the effort and the potential expense or inconvenience, which can help to propel you forward when therapy gets tough – which it does, at times.
Start to define your problems further
One way that you can help the therapist get to know you and understand how best to help you is to be as descriptive as possible in defining your problems. This applies even if you are seeking support for more ‘generic’ problems such as feeling underconfident. Thinking in behavioural terms is a useful way to do this. What would someone see if they were observing you struggle with the challenges that are bringing you to therapy? Sticking with the example of underconfidence, you might ask yourself: what does your underconfidence look like? In what types of situations do you experience self-doubts, and how does it affect you? What feelings arise and what thoughts enter your mind? How do you cope? As you can see, the more you are able to spell out your experience, the more complete a picture you can paint for your therapist to help them understand you – which increases the likelihood that they will be able to help you.
Since I work from a predominantly cognitive-behavioural framework, the process of collaboratively deconstructing problems in this way with my patients is a crucial aspect of every treatment plan. However, even if you are going to see a clinician who embraces a different theoretical approach, such as family systems or psychodynamic therapy, identifying the different ways your problems impact your thoughts, feelings and behaviours can reveal the problematic coping patterns that keep you ‘stuck’, and can provide valuable clues for tackling larger difficulties. By thinking about specific examples of your inner experiences in varying contexts, you and your therapist will also learn about potential triggers and how they impact you – for instance, withdrawing from friends because of embarrassment about unreturned texts, or difficulty getting work tasks done because nothing ever seems ‘good enough’. The information that emerges will make it much easier to figure out the treatment targets that will lead to emotional relief and improved functioning.
For now, you might try taking a few minutes to write down your description of the problems you’ve been experiencing. If we return to one of the earlier examples of why you might be seeking help in the first place (struggling at work), the idea would be to spell out how you are struggling at work. It could help to be inclusive here, noting things like recent difficulty with falling asleep or waking up well in advance of your alarm clock going off. Details like these could shed light on why someone is irritable and unfocused at work or making uncharacteristic errors. This may uncover potential treatment options such as improving sleep hygiene to yield better mood, energy and focus.
In describing your problems, try to think beyond listing basic symptoms. While lists of symptoms can be useful, they don’t reveal much about how a problem manifests in each person or how that person’s life is negatively impacted. So, when patients report that they’re depressed or overwhelmed, or that they always overthink things, the question I ask more than any other is: ‘What does that look like?’ Answers might include: ‘Since my spouse left, I’ve been showering and brushing my teeth only once or twice a week’, or ‘I’ve been so stressed about upcoming job layoffs at work that I’m yelling at my kids all the time.’ These sorts of answers can give the therapist a clearer sense of what direction to take in treatment planning because the signposts are detailed and person-specific.
Once you’ve reflected and written a bit more about what the problems look like for you, you can take these descriptions with you (or have them in mind) to help inform the therapist during your initial appointment.
Think about your goals for therapy
Mapping a course for success begins with knowing where you want to go, and it’s never too early to think about your personal ‘destination’. While your therapist can help you refine therapy goals, and these often evolve and change as treatment progresses, it’s still useful to contemplate goals on your own ahead of the initial (or ‘intake’) appointment. If you’ve defined your problems using detailed language, then certain therapy goals might crystallise naturally. Try answering the question: ‘What does getting better look like for me?’ A useful way to think about this is: if your therapist and you are successful, how will your life be different than it is now, once treatment ends?
Based on some of the problems mentioned in the previous section, examples of initial goals could include: ‘Focusing more on self-care and hygiene’ or ‘Managing my work stress more effectively so it doesn’t impact my home life and my relationship with my kids.’ A helpful thing to do when developing goals of any type is to think about them in terms of measurable outcomes, so that you will be able to recognise when you are achieving them. These outcomes could involve increasing positive behaviour (eg, ‘showering and brushing my teeth daily’) or decreasing problematic behaviour (eg, ‘yelling at my kids no more than once or twice a month’). When goals are framed in this way, there is little doubt about what you and your therapist are working toward.
Depending on the type of therapy a clinician offers, they may or may not incorporate explicit goals as part of their clinical practices. But when it’s time for your initial appointment, you can ask your therapist how they view goal-setting, and discuss your definition of ‘getting better’ to see if you can reach mutual agreement on what that would look like.
Your goals could also help inform how you track progress after therapy begins. Regardless of your therapist’s treatment approach, you will want to reach an agreement with them about benchmarks to verify that therapy is working. Clarifying what you are working toward will also help you shift course if any roadblocks arise. While certain measures of symptoms might be suitable for this (eg, logging the intensity and frequency of panic attacks; monitoring mood to ensure depression is subsiding), it’s also important to focus specifically on what you are aiming for in treatment (eg, ‘I want to be able to speak up when others aren’t respecting my personal boundaries’; ‘I want to spend more quality time with my partner’; ‘I want to be able to ride the subway to work without panicking’). Be sure to discuss these ideas at your initial appointment and seek agreement from the therapist that they are able and willing to help you pursue your identified goals.
Seek clarity on the therapist’s treatment approach
Before you start therapy, the therapist is still largely an unknown entity, which might cause some anxiety or discomfort. One way to mitigate this before a first appointment is to spend some (more) time examining a therapist’s online profile; many therapists nowadays have professional websites that offer a wealth of information about their education and training, areas of expertise, and philosophy of care and approach to doing therapy.
Preparing additional questions about how the therapist will approach your problems can provide further clarity. For example, will the therapist be teaching you proven skills to help you improve your ability to manage distress and emotions? Or will they predominantly focus on your past and help you develop insight about problematic behaviours (but not teach you how to change them)? While some of this information can be gleaned from therapists’ websites, don’t be afraid to ask how much experience they have treating your types of problems, as well as for ideas on how they will tackle your specific problems. You will want to let them know if you are interested in learning skills to improve your situation, and to ask what those may be and if the therapist is able to teach them to you – or, if not, whether they could refer you to clinicians who can do so. (For example, dialectical behaviour therapy is a proven, skills-based intervention for problems of emotion dysregulation.)
Also reflect on what has and hasn’t been helpful for you previously, either when you have sought assistance from others in the past or while coping on your own. Prepare to share that information with your new therapist to avoid pursuing ineffective interventions, and to potentially enhance the effectiveness of your treatment plan.
Ask about the therapist’s office policies
Prior to, or during, your intake appointment, it’s useful to enquire about office policies. For example, it’s a good idea to ask about the therapist’s fee structure (if you are paying for therapy yourself) and whether you will be billed for missed appointments that are not cancelled within a set timeframe. If you’re in the US, it’s important to ask if your clinician accepts your insurance and, if not, whether they will provide you with monthly statements or other documentation that you can submit for possible reimbursement from your insurance plan. Your clinician will typically inform you up front about payment options (eg, credit cards, electronic submission, cheques) but ask if they don’t mention it.
You will likely also want to know the extent of your provider’s availability. Many therapists are not available to communicate between sessions, though some provide crisis management and after-hours phone support. You can ask if your therapy will include those types of services and what the terms are (eg, frequency, additional costs).
Approach therapy with an open mind
If you have no prior therapy experience, it’s natural to be curious about what to expect during the first appointment. While clinicians vary in treatment methods, philosophy of care, business practices, personal style, expertise and so forth, there are some fairly common denominators within the profession. Many of us have a quiet waiting area with reading materials, where you might encounter other patients when you arrive for your appointment. The offices where therapy sessions happen differ, of course, but typically they are set up with comfortable chairs and/or sofas, and the therapist has an easily identifiable place to sit (eg, there might be a notepad or water bottle). The ubiquitous box of tissues is a good clue for your available seating options.
The intake process focuses on identifying areas that you want to work on and getting to know each other a little to see if you both are a ‘good fit’ in terms of interpersonal style and the therapist’s ability to help resolve your problems. I (and many of my colleagues) send out a comprehensive packet one to two weeks before the first scheduled appointment, including details about my policies and procedures, a questionnaire to illuminate a prospective patient’s personal and family history, and some general measures to screen for psychological conditions and symptoms such as depression, anxiety, attentional problems and trauma-related problems, among others. While forms like these can be somewhat tedious to fill out, and you might need to take breaks while you’re completing them, having this information in advance helps a therapist to structure the intake to best meet your specific needs. This makes it much easier to agree on whether or not to enter into a therapeutic alliance and proceed with treatment.
All therapists are committed to helping you. We rely on what patients tell us in order to comprehend their experiences and to maximise our effectiveness in working with them toward improving their lives. If you are new to therapy, it may feel awkward or embarrassing to reveal intimate details about yourself to a veritable ‘stranger’ during your first few sessions. This can be especially relevant within certain families and may run counter to certain cultural values. While it’s our job to help you get acclimated, that isn’t going to translate into instant comfort during the intake process. Give yourself time to adjust and do your best to be forthcoming and direct with your therapist, including letting them know if this is new and difficult for you.
Try to remember that we strive to be nonjudgmental, compassionate and professional – and we are fallible and may not always succeed. Let your therapist know if you are not feeling heard, seen or respected, and what would feel more supportive. See if the therapist is able and willing to adjust their style to your request; if not, that might suggest that seeing someone else could better suit your needs. Similarly, once you are engaged in treatment, you’ll want to reflect on whether you are progressing toward your goals (especially if the therapist is not initiating that discussion). Remember that change can take time, so give yourself one to three months to determine if the therapist and treatment they are providing is right for you. If not, enquire about potential treatment plan adjustments that could propel you forward. If your therapist is not open to this and you find that you are not getting better – as defined by your initial ideas on how to assess progress – then you might decide it’s time to move on to a different clinician.
The steps I’ve described can help you know what to expect and start off your therapy experience more effectively by being a driving force in your own treatment. But change does not happen overnight. For most people, the problems bringing them to therapy have developed over the course of years, and tackling them takes time and effort – though it is usually very achievable. Know that you are worth it, and be proud of yourself for considering therapy and taking these steps.
Key points – How to get ready for therapy
- It’s worth taking the time to prepare for therapy. Some preparatory steps before you start will give you a sense of what to expect, and can lead to a more positive and productive experience with your therapist.
- Therapy is a collaboration. Being proactive in this process is an expression of agency and self-efficacy, which is, in itself, therapeutic.
- List your reasons for getting help. Whatever initially prompted you to seek therapy, make a list of your reasons for getting help, as well as any difficulties involved in going to therapy that you can problem-solve.
- Start to define your problems further. Be as descriptive and specific as possible so you’ll help the therapist understand your experience. This will provide a better picture of what underlies your problems, which will inform decisions about how best to tackle them.
- Think about your goals for therapy. Consider how you want your life to be different when therapy comes to an end. It can be helpful to think of goals in terms of measurable outcomes, such as increasing positive behaviours or decreasing problematic ones.
- Seek clarity on the therapist’s treatment approach. There are many different types of psychotherapy and professional disciplines. If you feel uncertain, prepare questions for the therapist about how they will approach your problems and work with you to resolve them.
- Ask about the therapist’s office policies. Enquire about basic policies and procedures so there are no surprises about payment or therapist availability, and don’t hesitate to ask about any other aspects of treatment that need clarifying.
- Approach therapy with an open mind. It can sometimes feel awkward or embarrassing to open up to a therapist for the first time. Give it some time and try to be forthcoming and direct. If you’re not feeling properly heard, let your therapist know.
Learn more
Why you might be asked to do ‘homework’
Like most things in life, what you get out of psychotherapy directly depends on what you put into it. If you’ve written down ideas about how to define your problems and therapy goals, and you’ve thought about ways to track progress, then you are clearly motivated and improving your chances of having a positive experience. One of the most important attributes shared by all my patients who have achieved successful outcomes in therapy is willingness: the willingness to do what it takes to get better. Sometimes this involves actively working on your problems outside of the sessions to augment what you and your therapist are focusing on during your appointments.
In fact, a core feature of cognitive behavioural therapy and a number of other evidence-based therapies (such as acceptance and commitment therapy or dialectical behaviour therapy) is the expectation that patients will complete mutually agreed-upon tasks between sessions. Depending on individual needs (eg, if someone has had negative experiences in school), this may or may not be labelled ‘homework’. Nevertheless, various tasks are often necessary to build on the work that is done in a session. Since people typically struggle for years before coming to therapy, the idea of spending, say, 50 minutes weekly to tackle problems in sessions seems quite insufficient, especially since therapy usually does not go on indefinitely.
Homework offers an excellent bridge to successful outcomes. When learning new ways of coping, it’s important to practise skills in real-life situations to help you assimilate and master them, to see if they are improving your situation, and to identify potential problems and brainstorm solutions if the skills are not working as planned. Monitoring progress in your skill-building might include things like logging thoughts and emotions, enumerating completed job tasks that you’ve been avoiding, or tracking panic attacks or substance use, and is often completed on a weekly or monthly basis.
Ideally, both therapist and patient generate ideas about what will be useful, and decide collaboratively on assigned tasks and frequency. Homework review then becomes a regular feature of sessions and further informs choices about the therapy going forward.
To give you an example, many of my patients experience shame about the things they struggle with, such as depression, anxiety, attention deficit or trauma histories. People feeling shame generally cope with it by becoming self-critical, and it’s not uncommon for them to start berating themselves when they can’t get something done on time or when they become distraught and overwhelmed by their emotions. To interrupt this ineffective response pattern, we often agree (as part of their homework) to have them notice and let go of their harsh self-referential language, while also writing down at least one thing about their day that could be considered an accomplishment – eg, ‘Even though I was depressed and felt like staying in bed, I got up to make my kids breakfast’, or ‘I managed to call the bank and worked out a payment plan for my credit card bill.’
Reducing self-criticism and establishing a growing log of personal achievements are stepping stones to reducing shame, mitigating distress, and building self-compassion – critical aspects of any treatment plan. Once we tackle these roadblocks, then therapy can shift to enhancing behaviours that contribute to quality of life, such as looking for a romantic partner, increasing contact with friends and coworkers, and engaging in more fulfilling activities.
Links & books
The website of the Anxiety and Depression Association of America (ADAA) offers self-help resources, videos, educational materials, blogs and webinars to help you learn about various problems (such as anxiety, depression, OCD or PTSD) and ways to get support.
The book Healing Emotional Pain Workbook (2022) is a step-by-step resource for tackling problematic coping behaviours with the help of evidence-based tools.
In this Q&A, the licensed psychologist Joan Davidson and I – co-authors of a book on transdiagnostic treatment – discuss why a focus on psychological processes, as opposed to diagnostic labels, is a more fruitful approach to psychotherapy.
To learn more about different types of therapists and therapy – especially if you have yet to fully commit to seeing a particular clinician – consider checking out the Psyche Guide ‘How to Choose a Therapist’ (2021) by Kate Smith.
Save
Share
Post
