With everything going on in the world, it's no surprise that many people have become more open to receiving mental health care than they otherwise would have been. This is great news, as it's always a good time to prioritize your mental health. But it can also be hard to know where to start and how to get the most of this work—especially if you're brand new to therapy.
To make this journey a little more straightforward, SELF spoke with therapists and therapy-goers for their advice on maximizing your therapy journey—before, during, and after sessions.
Things to consider before you start therapy…
While you may be limited in your options based on your location or your health insurance coverage (or lack thereof), there are several online databases that can help you narrow down what you’re looking for, such as experience working with certain marginalized groups, says psychologist James Rodriguez, Ph.D., L.C.S.W., director of trauma-informed services at the NYU McSilver Institute.
“Psychology Today, for example, has its Find a Therapist platform where providers can list information about themselves and the type of therapy they specialize in, and many providers also have social media profiles describing their approach and how they view therapy,” Dr. Rodriguez tells SELF. “So even if you’re limited by your insurance plan, you can still get names from there and do some research on them.” Other helpful databases include GoodTherapy, Therapy for Black Girls, and Inclusive Therapists.
One good suggestion is to think about finding a therapist a little bit like you think about dating, says Deanna C., 41, of Beacon, New York. While you might find someone online, you could also go the old-fashioned route and ask for recommendations from friends, family, and coworkers if you're comfortable doing that. “If you have sources you trust, ask for recommendations—I asked a bunch of friends, but ultimately found my current therapist via recommendations in a local mom group on Facebook,” Deanna says.
Feeling safe and comfortable in therapy can be particularly challenging and crucial for people from marginalized groups such as people of color and members of LGBTQ+ communities, Dr. Rodriguez says.
Because of this, it's worth considering if you would feel more comfortable with a therapist who is sensitive to these aspects of your identity—whether through lived experience or through specialized training and experience treating a specific population. For instance, if you're looking for a therapist who is part of an LGBTQ+ community or who has robust experience treating LGBTQ+ patients, it's perfectly acceptable to ask about that from the start.
“I think having those kinds of questions in mind and being prepared to ask them is absolutely appropriate and fair game in terms of being a good consumer and getting the most out of therapy,” Dr. Rodriguez says.
It may also be good to find a therapist who shares or understands your cultural or religious background, Jennifer Henry, L.P.C., CCATP, director of the Counseling Center at Maryville University in St. Louis, Mo., tells SELF. “It may really help to speak with someone who is really familiar with [your specific] culture and the challenges that maybe they deal with related to gender roles or religious beliefs and different things like that."
Of course, finding a therapist who checks off all of the same boxes as you can be difficult, but this is another reason online databases may help. “A few years ago I learned about mentalhealthmatch.com, which includes a pretty extensive screener to match with providers who meet your needs, which you can filter based on health insurance [status],” Victoria H., 29, of Houston, tells SELF. “Having a woman of color as my therapist has really made a difference, especially after [everything that has] happened in the world over the last year and a half. It’s way easier to talk about race, microaggressions, and internalized racism with someone who isn’t white.”
Deanna also noted that it can be helpful to disclose if you have a disability or chronic illness, and possibly even search for a therapist who is well versed in treating patients with certain health conditions.
“It’s important to confirm if they’ll be able to provide certain accommodations due to your disability, or if they’re familiar with or have any experience helping people with this type of disability, living with chronic pain, etc.,” she says. “[Keep in mind that] you might have to spend some time describing your diagnosis at length.”
You'll likely have an initial consultation with your therapist before your first session, and that's often when they'll ask what brings you to therapy.
“It can be helpful to prepare to take notes about what you want to talk about and what you hope to accomplish in therapy, whether that's changing behavior that you're working on, thinking about future goals, dealing with depression or anxiety symptoms, or other difficulties you’re facing,” Dr. Rodriguez says. “Sometimes knowing what you want to share and what you feel comfortable sharing early on with respect to any traumas you may have experienced in your life is important, as that’s some critical information that therapists are going to want to know about.”
It's also smart to jot down any hesitations or questions you have about therapy ahead of time so you can bring those up before you begin. “I've been to therapy and know it's nerve-wracking because in the beginning, you don't know this person,” says Henry. “It can be helpful to write down your concerns so that it’s easier to share with a therapist in that first session if you’ve thought through it.”
It’s never fun to be caught by surprise by a high medical bill, which is why Henry recommends solidifying those details before your first session. Before scheduling your appointment, ask the office if they can confirm what the cost of each session will be—whether or not you're going through health insurance. If you are going through insurance, you might even want to double-check your coverage and copays with your insurance company, too.
“Figuring out the financial piece first will keep you from worrying about that during the session or later being caught off guard by a certain cost,” she says. “Having that all figured out first will allow you to go in and really use that time to focus on your therapy.”
How to maximize your time during therapy...
According to Dr. Rodriguez, most therapy sessions will be about an hour long, but don't stress about spending that entire time talking about yourself. Instead, Dr. Rodriguez suggests thinking about your session as a two-way interview where you're both contributing questions and observations.
“You are being interviewed by a therapist or being asked questions by a therapist about what you need, but you might also have some questions you want to ask a therapist,” he says. “These can include things like ‘What's your approach?,’ ‘How do you view therapy?,’ ‘What can I expect from week to week in our work together?’ and ‘What are some of the other expectations that you have?’”
It can also be helpful to come to your sessions prepared with a few things you want to discuss and let your therapist know that at the top of the session. “The value of that is that this is a relationship that you're developing, and it can be helpful and signal to the therapist that you have an interest and commitment to doing the work of therapy,” Dr. Rodriguez says.
Henry adds that it's important to seek clarification if you don't understand something your therapist says. You should also do your best to speak up if you disagree with something that was said or if something they said offended you.
“That can be hard to do, but it can make the relationship a lot better between you and the therapist and make counseling more productive,” Henry says. “It can also give the counselor a chance to respond and potentially clarify something so that it doesn't harm that relationship and they can explain where they're coming from.” Here’s how to make the process of giving your therapist feedback less intimidating.
You and your therapist may not hit it off right from the start, but both Henry and Dr. Rodriguez suggest giving it some time.
“I usually recommend people give a therapist at least three sessions to see how they feel because that first session will inevitably feel uncomfortable,” Henry says. But ultimately, “If you feel like they're just not understanding you, their style doesn't really fit for you, or if you're leaving the session feeling like you're not connecting, then I think it's perfectly fine to look and try and find somebody else,” Henry continues. “Therapists understand that they're not going to be the perfect fit for everyone, so they don't take it personally. They're going to want you to get connected with someone who is the best fit for you.”
Dr. Rodriguez adds that while some discomfort comes with the territory, you should take note if you're feeling at all unsafe physically or emotionally. That would be a sign to seek out a different provider.
With the uptick in teletherapy services and people working from home, the COVID-19 pandemic created a worthwhile opportunity for many people who may otherwise not have been able to fit mental health care in with their busy schedules. But it’s not without its caveats, as you may feel less of a personal connection with your therapist, especially if you have technical difficulties that cut into your session time.
“Make sure you’re in a peaceful and private location where you don’t risk having a friend, parent, or a spouse walk in the room, which could make you feel hesitant to bring up what you want to talk about,” Henry adds. “Make sure you’re also comfortable with the technology and have a good Wi-Fi connection, as it can be really frustrating to the client and the therapist when Wi-Fi is going in and out, and it will likely impact the whole conversation.”
Many people have internalized certain stereotypes and misconceptions around therapy, and those attitudes can influence your progress in your own therapy journey. So if you have certain hang-ups or hesitations around therapy, consider airing that out with your therapist.
“A lot of our training relates to being able to address the stigma of mental health, and oftentimes, therapists are encouraged to ask [clients] questions about how their families or people in their community view therapy to be able to gauge to what degree that might be a challenge for them,” Dr. Rodriguez says. “I’ve had many clients come in saying ‘My family thinks [therapy] is just for people who are crazy,’ or some people sort of outwardly question why [they’d] want to be in therapy, and I think those are things that are absolutely worthy of discussing and processing.”
“It’s also important to recognize that if there are people in your life who don't support you getting therapy, you don't have to tell them you're going,” Henry adds. “As long as you’re over 18, everything is confidential, so you can have boundaries surrounding who you let in and who you don't.”
Physically showing up (on time) is a given, but being mentally present and focused throughout the session is also crucial, Henry says.
“Sometimes people are just really busy and fly into their session and [I ask], ‘Well, tell me what's on your mind today,’ and they haven't really thought about it,” she says. “Because you're paying for that time, you want to really get the most out of it, so it can also be helpful when scheduling to make sure that you're not going to be rushed trying to get there, or be late and then fly in there feeling totally stressed out.”
A common misconception is that therapists will give you advice and tell you exactly how to better your life in the span of a session or two. That's not how it works.
“It’s key to understand that you're not going to come in for one counseling session and everything's going to be different, that everything's going to be fixed,” Henry says. “It can have so much impact if you go into it expecting it to be helpful and expecting it to be productive, and that your counselor will help you reach your own conclusions and act for yourself, not make decisions for you.”
Henry urges clients to approach therapy with curiosity and be prepared to take a deeper look at the way they currently behave, think, and feel, as well as what life experience may have contributed to that.
Some therapists may give homework assignments or reflective activities for the person to engage in between sessions, which might include things like journaling about or reflecting on certain areas of your life, noting when something you discussed in therapy comes up for you, or practicing certain skills, Dr. Rodriguez says.
“But even if the therapist doesn't do that, journaling your experiences and keeping notes on what aspects of your time with the therapist are playing out in your life can be helpful,” he says. “It can serve as a good practice for you to be able to do that so you have materials to bring into the therapist to share with them and process these things that may be working or not working to help you get the most that you can out of therapy.”
Counseling can be really difficult and can bring up a lot of upsetting feelings, which is why it’s all the more important to be patient, show yourself grace and compassion, and give yourself some time to recover if things are getting difficult, Henry says. For that reason, Henry doesn’t recommend scheduling a session immediately before or after a big work meeting, presentation, or other event that may leave you feeling stressed and not in the best emotional state.
“I try to never schedule anything after a session because sometimes they can be emotionally draining,” Victoria adds. "After particularly rough sessions (i.e. lots of crying), I’ll go get ice cream or something that makes me feel better.”
“Schedule a come-down time after your session," Celeste R., 36, of Arlington, Virginia, tells SELF. "You may have cried or feel tired after the session, so protect the 30-60 minutes after the session to give your body and mind time to recuperate."
“If I have the time immediately after a session ends, I usually allow myself at least half an hour to just sit and reflect on the session," adds Deanna. When this isn't possible, she tries to at least make time to take notes. “When I am able to find another quiet moment to myself, I can look at my notes and see, [for example], that I do need to work on forgiving myself.”
Some people stay in therapy over the course of their lives, either continually or on and off. But many people don't stay in therapy forever. So it can be natural to get to a point where you feel confident ending your regular sessions. Of course, this doesn't mean you can't resume therapy again in the future or try out a different therapist or mode of therapy for another area of your life, says Dr. Rodriguez.
When you do decide to end therapy, Henry recommends maintaining a list of insights and skills that you've learned and going back to this list every now and then just to make sure that you're keeping that mindset.
“It’s easy to just get back into the swing of day-to-day life and forget some of the ways that you were approaching things, which is where revisiting your notes and your accomplishments can help,” Henry says. “Having checkups with your therapist periodically—perhaps two and, later, six months later—can also be really helpful in keeping you on track and keeping you on top of using those skills and insights, and also figuring out if you may want to restart sessions down the line.”
See more from our Guide to Caring for Your Mental Health here.
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