What to Expect When You Start Therapy (And How to Know If You're Ready)
Taking the first step toward therapy is one of the most courageous things you can do for yourself, but it can also be one of the most confusing. Here's what the process actually looks like, from that first moment of "maybe I should talk to someone" all the way through to doing real work in sessions.
You Don't Have to Have It All Figured Out
One of the biggest myths about starting therapy is that you need to arrive with a clear problem and a clear goal. Most people don't. They show up because something feels off: relationships that keeps going sideways, a low hum of anxiety that won't quit, a grief they can't shake, or simply the sense that they're not quite living the life they want.
That's enough. You don't need to know what kind of therapy you want, whether your problems are "serious enough," or exactly what you hope to get out of it. A good therapist will help you figure all of that out.
Step 1: Finding a Therapist
Before any therapy can begin, you need to find someone to work with. This process can feel overwhelming (Psychology Today alone lists thousands of therapists - though I recommend using more specialized directories if you can first) but it doesn't have to be.
A few things to look for:
Specialties that match your needs. Therapists often specialize in areas like anxiety, depression, trauma, relationships, life transitions, or specific populations. If you have something specific in mind, look for someone with relevant experience.
Logistics that work for you. Location or telehealth availability, fee or insurance access, and schedule all matter. Therapy only works if you can actually show up.
A sense that this person gets it. Even from a bio or website, you can often get a feel for someone's approach and personality. Trust that instinct.
Step 2: The Initial Consultation
Many therapists (myself included) offer a brief phone consultation before scheduling a full appointment. This is a low-stakes, no-commitment conversation, and it serves both of you.
What to expect: The consultation usually lasts 15–20 minutes at most. You'll have a chance to share a little about what's bringing you to therapy and what you're hoping to work on. The therapist will ask a few questions and tell you a bit about how they work.
What it's really for: Chemistry matters enormously in therapy. Research consistently shows that the relationship between client and therapist is one of the strongest predictors of good outcomes — more than any particular technique or approach. A consultation gives you both a chance to sense whether you'll work well together. If you’re hoping to use insurance for your sessions, this will also allow the therapist to get an idea of whether you will qualify. Insurance does require a billable diagnosis, so discussing this during your consultation can be really helpful in determining what your options are.
During my consultations, we talk about what's leading you to therapy, what kind of support you're looking for, and whether my schedule and approach are a good match for what you need. If I don't feel like the right fit — whether because of specialty, approach, or scheduling — I'll tell you honestly and do my best to point you toward someone who might work better. Finding the right therapist matters more to me than filling a spot on my calendar.
Step 3: The Initial Assessment
If the consultation goes well and you decide to move forward, the next step is an initial assessment. This is your first real appointment.
Before you arrive, your therapist will likely send you some intake paperwork - things like a consent form, a privacy notice (HIPAA), and likely a questionnaire about your history and current concerns. It can feel like a lot, but it's worth taking seriously. The more honest and thorough you are, the more useful the assessment will be.
During the assessment, you and your therapist will talk in depth about:
What's brought you to therapy right now
Your goals: what you're hoping to change, understand, or work through
Relevant history: family background, significant life events, past experiences with therapy, and anything else that helps your therapist understand the full picture
This isn't an interrogation, and there are no wrong answers. You're helping your therapist get to know you well enough to actually help you. This is also where your therapist will evaluate you for an official diagnosis if you’re planning to use insurance.
At the end of the assessment, you'll begin to get a sense of direction: what to focus on, where to start, and what the work ahead might look like.
Step 4: Ongoing Sessions
Either during your consultation or after the initial assessment (depending on the therapist’s process), you and your therapist will decide together how often to meet. Weekly sessions are common when things are acute or you're early in the process. Biweekly can work well once you've built some momentum or for people who feel like they need space between sessions to process and practice skills. The right cadence depends on what you're working on and what fits your life.
What sessions actually look like varies a lot depending on the therapist's approach and what you're working on. Some sessions are structured around specific skills or exercises. Some sessions might focus on a specific modality, like Brainspotting or EMDR. Others are more open-ended conversations. Most are somewhere in between.
What stays consistent: you're working toward something. Good therapy isn't just venting (though venting has its place). It's moving, sometimes slowly and not always in a straight line, toward the life you want to be living.
I work collaboratively with clients to set small, realistic goals that build toward bigger ones over time. We'll check in regularly on what's working and what isn't, and adjust the approach and schedule as needed.
How Long Does Therapy Take?
This is one of the most common questions, and the honest answer is: it depends.
Some people come in with a specific issue and feel significantly better in 8–12 sessions. Others are working through things that took decades to develop and are in it for the long haul. Most people fall somewhere in between.
What I've found is that the clients who get the most out of therapy are the ones who stay curious about their own process and honest with their therapist when something isn't working. The duration isn't something I can prescribe in advance. It emerges from the work itself.
Common Questions About Starting Therapy
What if I'm not sure I need therapy? If you're wondering whether you need therapy, that's often reason enough to try it. You don't need to be in crisis. Therapy is useful for anyone who wants to understand themselves better, relate to others more effectively, or just feel more like themselves.
What if I've tried therapy before and it didn't help? Therapy not working in the past often comes down to fit: the wrong therapist, the wrong approach, or the wrong timing. It doesn't mean therapy won't work for you. It might just mean you haven't found the right match yet.
What if I don't know what to talk about? Your therapist will help guide the conversation, especially at first. You don't need to come in with an agenda. Saying "I don't really know where to start" is a perfectly good place to begin.
Is everything I say confidential? Yes, with a few legal exceptions (like if you're at immediate risk of harming yourself or someone else). Your therapist should explain confidentiality clearly at the start of your work together and this will be included in your intake paperwork, as well.
Ready to Take the First Step?
If you've been thinking about starting therapy, whether for the first time or after a break, I'd encourage you to reach out to a therapist whose work resonates with you. Most of us, myself included, are genuinely glad when people find us.
If you'd like to start the conversation with me, I'd welcome you to schedule a phone consultation by clicking the Schedule Now button above. We'll talk about what's bringing you to therapy and see if we're a good fit. If we are, we'll schedule your initial assessment from there. And if I'm not the right therapist for you, I'll do my best to help you find someone who is.
Taking that first step is the hardest part. The rest, we figure out together.