What You Can Actually Expect From a Therapy Session, Straight From a No-Nonsense Therapist

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After college, when I was living on my own for the first time, I decided to try therapy. Everything around me was new, and all the uncharted territory led me to feel small and uncomfortable. But I was also a 23-year-old who wanted to talk about dating, and my therapist, a referral from a family friend, seemed to only wanted to poke fun at that based on my perception our first appointment. I left feeling frustrated, annoyed, and belittled. And I never went back.

But, here’s the thing: That’s not what therapy typically looks like—it shouldn't anyway, at least. It’s also not you lying on a sofa, clutching a box of tissues, staring up into space while being incessantly asked, “How does that make you feel?” Since the notion of therapy is often fraught with confusion and misconceptions, it's time to set the record straight. Here, psychotherapist Lori Gottlieb—whose new book, Maybe You Should Talk To Someone, follows her journey as a therapist who also goes to therapy—answers all your Therapy 101 burning questions, from how to find the right therapist to what to expect from that first session and how to know if it's "working."

You asked, she answered: Find your Therapy 101 cheat sheet cheat sheet.

First therapy session? Here are common questions, answered
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1. How do I even begin to find a therapist?

To start, scan Psychology Today to get a sense of a given therapist, learn what their areas of specialty are, and also their general vibe, says Gottlieb. Word of mouth helps too, and you can ask a friend’s therapist for a referral to someone who hits less close to home. “I’ve had so many clients come to me and say, ‘My friend is looking for a therapist, can you recommend someone?” she says. “And I absolutely do.”

2. Are there clear signs my therapist is The One?

Think of therapy like dating: Once you get to know someone, your feelings will become more clear. You just have to give it time. “In the very first two sessions, I might see very clearly what this person is doing relationally, but I probably won't mention it," says Gottlieb. "I'm trying to make sure they feel comfortable, so that when I do feel ready to help them, they're ready to receive it.”

After a few sessions, Gottlieb recommends asking yourself a few questions to check in: “How do you feel in the room with this person? Do you feel like this person gets you? Do you feel like this person is understanding you, hearing you?” And if the answer is a resounding no, speak up: “If you aren’t clicking, don’t assume that’s what all therapy is like,” she says. “Talk to your therapist about it. It’s not awkward! Sometimes, you find out there's something you guys can address. And, sometimes, you find out that, hey, it's just not the right fit.”

3. Should I see a therapist or a psychiatrist?

That depends on what you’re looking for. Therapists cannot prescribe medicine and psychiatrists can. But, the two often work together. “If I feel like somebody might benefit from medication, I will refer them to a psychiatrist,” says Gottlieb. “From there, the psychiatrist and I team up together with that patient. It’s doesn’t matter which you start with. Either way, you’ll get to the right place.”

4. Should I come prepared with questions or a conversation starter for my first session?

No, don’t sweat it. Just relax. “Most people are a little anxious about coming in and meeting a new person. A first session feels very different from other sessions,” says Gottlieb, who uses her initial interactive meeting as a forum to suss out why a patient came to her.

“I guide them in a way that will give me that information,” she explains. “I’ll say, ‘Tell me about what brought you here today.’ I’ll have a lot of questions about that, and we’ll have a conversation.” Of course, this might go differently depending on the specific person you see. So, again, if it doesn't feel like a fit, voice your concern, try to find common ground, and if it doesn't work out, be prepared to walk.

5. Why does it always seem like therapists are ferociously jotting down notes?

Actually, that’s more so a just-in-the-movies thing. Therapists don’t often take notes IRL because it’s distracting. “What’s happening in the room is so relational, and it's hard to be relational when you're recording what's happening,” Gottlieb says. “Sometimes, people will take notes in a first meeting, so they remember all the information. But after that, we don't generally write.”

Copious note-taking is more so a just-in-the-movies thing. Therapists don’t often take notes IRL because it’s distracting. —Lori Gottlieb, therapist and author

She will, however, scribble a note if she doesn’t want to interrupt a client with her own thoughts. “I’m writing something down because I don’t want to forget it and I want to come back to it.”

6. Is my therapist judging me?

If they’re doing their job right, they most definitely are not. “Often, I don’t agree with what you’re saying, but I’m not judging,” says Gottlieb. “If everything you're saying is working for you, there's no reason for you to be sitting in my office. But I do have a point of view.” That said, the feeling of shame patients sometimes feel from a therapist is a projection of their own insecurities. “They’re imagining I’m doing that because it feels similar to an experience where they've opened up to somebody else and have been judged,” she says. “Another possibility is that they judge themselves.”

7. Will my therapist tell me how to fix my life?

Sorry, but they don’t dole out advice; it's more about helping you find your own conclusions. “It’s not that we’re withholding the answer from you, but that we don’t know what the right answer is for you,” says Gottlieb, offering an example of marital strife. “Somebody might say, ‘Should I stay in my marriage?’ Well, if it were me, I would leave. But maybe I wouldn’t have gotten into that marriage in the first place.”

Instead, a therapist's role is to help a client through a given issue. “In life, there's no quote-unquote ‘right or wrong’ answer,” she says. “It's, ‘What is the choice that is going to make their lives run more smoothly?’”

8. Can’t I just talk to my friends about what I’m going through?

You can—and should—but keep in mind they may have a certain bias. Friends may say whatever it takes to make you feel better, or hold back their honest opinions so you don't get irritated. “We all want to be a good friend and we don't want our friends to feel unsupported,” says Gottlieb. “It's not that we won't call our friends out on things, but in the therapy room, a therapist can do it in a very skilled way. A way that, if you were friends with this person, it would not come across the same way.”

9. When will I see results?

That changes from person to person, and largely depends on what you actually want those results to be. “Is the goal, ‘I want to make a decision about whether I'm going to stay with this person?’ That’s very specific. Or is it, ‘I want to stop feeling worthless?’” asks Gottlieb. “That’s something else. It's not like one day, you're going to not feel worthless, that you're going to wake up that way. Maybe you'll be 50 percent better after a certain amount of time. But people don't always stay until 100 percent.”

10. How do I know when I can take a step back from therapy?

Put simply, when you're able to talk about it with your therapist. “If they haven't talked about it, it means maybe they're afraid if they do, they’ll discover they're not ready,” says Gottlieb.

“Our goal is to get you to leave [therapy]. It's a terrible business model. We want to help you, and part of that is to help manage what you're struggling with, and then to be able to manage it on your own.” —Gottlieb

But therapists aren’t here to trick you into seeing them weekly. “Our goal is to get you to leave.” she adds. “It's a terrible business model. We want to help you, and part of that is to help manage what you're struggling with, and then to be able to manage it on your own.”

11. Do online-therapy platforms, like TalkSpace, work just as well as in-person sessions?

Again, think of therapy like dating. “There’s a difference between if you went on a virtual date or you sat in a room with somebody,” says Gottlieb, who meets with clients in-person and via Skype. “It's not so much what you see, but how it feels. When someone is crying or telling you a really intense story and you're sitting there in the protected space of this room, where there are no distractions, it feels so different than sitting wherever you happen to be with your laptop. Something happens with the energy in the room that just can't happen over Skype.”

12. Is therapy for everyone?

Surprisingly, no. “I don’t think everyone should try it,” says Gottlieb. “But I do think what therapy can do is help you understand yourself and your place in the world. We all have blind spots and most of us have ways of shooting ourselves in the foot without realizing it. Sometimes, these ways are small and don't seem to impair functioning day to day. But sometimes they do. Therapy helps us understand how we relate to the world and therefore how we relate to ourselves.”

Check out the mental-health promoting strategies so effective, therapists themselves depend on them. Plus, here's how to find an LGTB+-positive therapist.

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