Beginning therapy can be a daunting experience for many people. It often requires navigating new emotions, transitions, and changes in your life that you may not have expected or been prepared for. While therapy can provide a safe space to explore these feelings, it’s normal to feel overwhelmed at the thought of starting therapy for the first time. However, with the right therapist and approach, therapy can become an invaluable tool to help you grow and improve your mental health. In this blog article we will discuss what you should expect when beginning therapy as well as how to find a therapist who is right for you.
If you are new to therapy, you may be feeling the following concerns:
1. Feeling uncomfortable talking to a stranger
2. Fear of judgment or criticism
3. Uncertainty about therapy’s effectiveness
4. Vulnerability associated with opening up
5. Difficulty expressing thoughts and feelings
6. Anxiety about therapy costs or insurance coverage
7. Embarrassment about mental health issues
8. Worrying if therapy will help your situation
9. Concerns about privacy
10. Not knowing how to find the right therapist
Here are some thoughts on each of those concerns that will hopefully help demystify what therapy is like and help you see yourself get started.
1. Feeling uncomfortable talking to a stranger
It is completely normal and understandable to feel uncomfortable talking to a stranger about your innermost thoughts, feelings, and experiences. You may find yourself feeling awkward, embarrassed, or even overwhelmed when having to share with somebody you don't know yet. It is important to remember that therapy sessions should be a safe space for you to express yourself without fear - but we don't expect that you feel that safety right away! The hope is that you feel safe enough in the beginning to take small steps forward. If it's feeling intolerable or if your interactions with the therapist aren't showing that there's room to move to safety, it's totally ok to try with someone else. This may be a sign to you though that attaching may take time and you may need someone to really take a slow pace with you, giving you space and time to build a relationship together.
2. Fear of judgment or criticism
It's important to remember that you may feel judged or criticized because you're judging and criticizing yourself and can't imagine that anyone else would not be judging and criticizing you. So, of course that's not going to be something you can just stop feeling right away; it may be important to push yourself to share these fears with your therapist and hear how they respond. Therapists are real people with real reactions, but a good therapist is going to metabolize their feelings before responding and have it be more about you than about them. In therapy, the therapist should make it clear that their goal is not to judge you or tell you how they think you should live your life; instead, they are there to empower you to know yourself and create a life that aligns with your values, intentions, and goals.
3. Uncertainty about therapy’s effectiveness
That makes sense! You don't want to invest in something that doesn't work! Fortunately, there is a wealth of literature showing the efficacy of therapy to help so many people. Of course, there are so many variations to type of therapy (what is called "modality" or "approach") and what is being "helped" so when looking through research, you may get confused because you don't totally see exactly yourself in those research studies and outcomes. One of the consistent findings in research about therapy's effectiveness is that therapy outcomes are strongly influenced by the relationship with the therapist. Having good rapport is just the starting point for how crucial the relationship is in affecting positive change for the individual. Another thing to consider is that being "helped" is subjective. For some people this means they actually feel better (have less distressing symptoms), for others, it is that they have better interactions in relationships, and for others, it is that they are no longer overwhelmed by compulsive reactions towards emotional triggers from their past. There are so many different outcomes that honestly, can be difficult to measure in a research study. Consider asking about this in your consultation if it feels like a sticking point to getting started.
4. Vulnerability associated with opening up
Honestly, I think this is a bonus to therapy. You get to be vulnerable! What a gift - when it can be in a space that is protected and cared for and supported and contributes to growth. I think vulnerability is a power that we get to grow into, but I understand that you may have been taught that being vulnerable is weak or that you're just "bad" at being vulnerable. So, it'll probably take time to be vulnerable - maybe you'll be really skittish or defended for a while. And that's ok. We can take our time. It's more important that you have a new experience with vulnerability being accepted rather than just forcing yourself to intellectually decide to be vulnerable and have it just stay all in your head (and not get to your gut).
There are going to be parts of starting therapy for the first time that will just be scary vulnerable. The first call. The first time logging on or showing up. The first time saying something out loud that you never have said before. All these things take courage and build that vulnerability muscle and give you more nuance on understanding what it's like to be vulnerable, and when to step more into vulnerability when it makes sense.
5. Difficulty expressing thoughts and feelings
It can be difficult for any new therapy client to learn how to express their thoughts and feelings, especially if it's something they're not used to doing. So, it is important to remember that your therapist doesn't expect you to be skilled at something you've never learned before and you won't be bad at therapy if you can't name all your emotions on day one. Again, this is an outcome that we hope to help you with, so of course there's going to be a process of growing into this.
Many people find that expressing their thoughts and feelings is intimidating because it can bring up unresolved issues and require them to actually confront these thoughts in their mind and feelings within their body. Your therapist is aware of this and can be a partner in helping make this more tolerable. They can give you skills to manage the distress that comes up; they can give you space as you learn to be with it; they can respond in a way that's different from how others in your life have responded to you in a way that can be corrective and healing.
6. Anxiety about therapy costs or insurance coverage
Yes, therapy is a large financial investment; and in the U.S. healthcare system, there are limitations on having support towards this expense. First, know the facts about how much each therapy session costs.
For in-network providers, this means calling your insurance company and hearing specifically from them how much you have to pay all on your own to reach your deductible and then after that, how much your copay will be to your therapist. I'd encourage you to not assume that therapy will cost you nothing and to be sure to ask your insurance if there are any future limitations that may limit your access to care (e.g., session limits, frequency limits, etc).
For out-of-network providers, you have two options. If you want to pay totally out of pocket and not include your insurance company at all, this is a right and a privilege you may take on. You would just need to know how much each therapy session costs, how many sessions a week/month you will be having, and how long you intend to be in therapy for. That's your new therapy budget.
If you want to utilize any out-of-network benefits through your insurance company, then I recommend the following:
- Call your insurance company and hear specifically what your out-of-network deductible is (how much you have to pay out of your pocket to get any coverage)
- Find out how much the insurance company deems "allowable" for your therapist (e.g., psychologists / doctoral level clinicians typically have a higher "allowable" than masters level clinicians). If your therapist charges $180 and the "allowable" is $140, that means that the insurance company is valuing that therapist's work at $140 and you (the client) will absorb the difference (regardless of what your benefits will cover).
- Find out how much your insurance company will then cover of their "allowable" amount after your deductible is met. So, if they allow $140, they may then cover 50% of this. So they will pay $70 and you will pay $70 plus the $40 that was over their allowed amount. Or, if they pay 80%, they will pay $112 and you will pay $68 for the remaining up to the $180.
- Find out if there are any out of pocket maximums in your benefits plan. This means that after you've paid a certain amount of money in one calendar year, your insurance company will cover the rest at a higher percentage. For example, if your insurance plan lists $6,750 as your out-of-pocket max, then once you've paid $6,750 from your deductible and out of pocket costs, then they may cover the remaining up to 100%. This is cool! However, the "allowable" amount will still apply, this out of pocket max is typically quite high, and many insurance plans have unlimited out of pocket max is typically quite high, and many insurance plans have unlimited out of pocket maximums for out of network benefits so you may not have the option to benefit from this.
- And then submit your superbills! Your insurance company should have an online portal where you upload your superbill (the detailed receipt of your month of sessions that you get from your clinician) and then they will send you an explanation of benefits of what they covered. It's common they deny it from the beginning because there's an error like they don't have your therapist in their system, they're missing a diagnosis code, they're missing the location code, etc. So, please know this is normal and you may need to try again.
This is obviously all very confusing and frustrating. If finances are limiting, you may want to inquire about "reduced fee" options (or sliding scale fees), which is when a therapy provider reduces their fee based on your need (or income level), or find a lower-cost option through community mental health centers or student/interns who typically charge lower fees.
While finances play a large role in what may be possible, it's important to remember that therapy is an investment in yourself and that making this investment can pay off enormously in terms of improved quality of life over time. It can have life-long effects on you, your family, and your future. and the subsequent influence of those in your world. Some people find a lot of empowerment when they can invest in themselves this way.
7. Embarrassment about mental health issues
Fair, there can still be a stigma around mental health. This may be something you have to work through in therapy while you're struggling about feeling this way toward yourself, and also inviting another person in to witness really uncomfortable and personal feelings, experiences, and issues. It is important to remember that therapy should never be something you feel ashamed of doing. It does not mean you're sick or broken or unwell, but rather it can be a commitment to yourself to growth, health, and being well. And if you are struggling with mental health symptoms and concerns that are having a big impact on your life, you may just need some help right now. You're not the first one or last one to need help and it takes great strength and courage to acknowledge this. Your therapist isn't going to make fun of you for reaching out and supporting yourself in this way.
Your therapist is probably in therapy too - whether it's because they're healing or because they value the support therapy can provide for everyone.
8. Worrying if therapy will help your situation
Therapy is not a one-size-fits-all solution, and each individual's experience in therapy will be different. There are different approaches, different theories, different strategies, and what helps your friend or partner may not be the best fit for you. But, it probably won't solve all your problems. It may not change your situation right away. There may be something else going on that therapy can't solve. Things will probably feel a little worse before it feels better. And I am confident that therapy will help you in some way and oftentimes this leads to greater changes in other areas of your life.
9. Concerns about privacy
When it comes to therapy, privacy is a major concern for many who are just starting. It's important to know that your therapy sessions are confidential and private. Your therapist will not talk about you or your therapy sessions to anyone else unless you have given them explicit permission to do so. Even in the rare case where they may need to share information to protect you or others from harm, they will do their best to involve you so that you are not blindsided.
Also, you may have concerns about digital privacy. How is your health information protected; how is your data stored? All of these things are important and hopefully your clinician has answers for you. You can read more here about my approach to privacy in therapy, as this can give you some thoughts to reflect on yourself and questions you can ask your therapist if you have concerns.
10. Not knowing how to find the right therapist
Yeah, this can be hard and can take a while! "Right therapist" means different things to different people. What are your priorities?
- Expertise -- Do you care about your clinician's degree or education? Do you want your therapist to have advanced training in a particular issue that you're working through? Do you want a particular type of therapy?
- Financial -- What's your budget? How much can you reasonably afford for therapy? It's likely that it will hurt a little, but it shouldn't be so taxing that it negatively influences your livelihood or makes you resentful to your therapist.
- Being in network with your insurance -- Consider also if your insurance ever changes or your therapist leaves that network - would you stay with the therapist?
- Availability -- Is it necessary that you have appointment time that is at a specific time of day or day of the week? Consider if your schedule or your therapist's schedule ever changes - could you adapt?
- Time frame to get started - Are you in need yesterday? You may consider crisis services. Are you feeling stable and would like to prioritize fit? Consider getting on someone's waitlist or trying out a few therapists as you get a sense of what works for you.
- Office / Online - Do you want to go into the office? Do you want the option to switch between virtual and in person? Keep in mind that each state dictates license requirements and you are limited to see a provider who is licensed in the state that you are physically located in at time of your session.
It's possible that your therapist will be a perfect fit in all of your priorities, but it's also likely that you may have to compromise a little.
Many providers offer a first "consultation" which can be either a phone call or a full session at no cost to you. Take advantage of this consultation so at the very least you can hear their voice and feel out if you imagine that maybe at some point you could consider starting to get to the point where you could trust them :)
Getting Started
This is not an exhaustive "get started" guide but I do hope it helped demystify the process a bit. Since you're here, you can start with Relational Psych. Our process is to schedule a free 15 minute call with our care coordinator, Ally, who will ask you a little bit about what you're looking for and consider who she thinks is the best fit for you. Then, you can have a call with them to check vibes and/or just schedule a first session to get started. You're never locked in and you're allowed to be nervous.
We also have a few podcast episodes that relate to this topic:
- How to Get Connected with a Therapist at Relational Psych - this is a conversation with Ally (our care coordinator) and reviews a lot of what I wrote about here while emphasizing how we do things at Relational Psych.
- What is Therapeutic Fit and Why Does it Matter? - This is a conversation with two of our therapists about this idea of "fit" and speaks more about how to feel this out in the beginning of working with someone.
- What Should I Expect From My First Therapy Session? - This gets into some of the boring and some of the cool details about that first session. The logistics of filling out paperwork, and meeting your therapist in person for the first time, and setting goals.
We're here to help however we can in the process. If you have concerns that aren't listed here, please let us know and we can do our best to make therapy an option for you. It seems like you're interested, so it's probably a good time.
