10 Things You Should Know Before Starting Therapy

Dear new client: Welcome to the wonderful world of therapy! I know it can be hard to come in for your first appointment—really hard. You are here to meet me, a stranger who will hear about parts of your life that no one else hears about, and entrust I will do everything I can to help you. To make things easier, here are 10 crucial things I want you to know.

1. Honesty is the best policy.

If you’re not honest in the therapy space, you’re missing out! This is a rare opportunity to be 100% honest without the prospect of being judged. You’re paying for therapy, so lying is counterproductive. Are you using drugs? Tell me. It helps me better understand and work with you on everything from coping skills to medication use and interactions, to social skills, to behaviors that may or may not be attributed to substance use, to relationships, to even finances. Cutting? Tell me.

2. Therapy is an investment in both the present and the future.

The skills you learn here, and the support and insight you receive, will not only help you with the situation you’re in, but will become part of the “toolbox” on your lifelong journey. You’ll gain knowledge that improves your ability to cope with stress and mood swings, helps your understanding of why and how you do things, and facilitates communication between you and others in your life including loved ones, friends, and business connections.

3. Keeping appointments and being on time is critical.

Part of therapy is consistency. If you’re late, we not only have less time together, we also have to think about the reasons you’re not arriving on time. Making therapy a priority is important. And yes, you may be charged a fee if you don’t show up or you cancel late. The time you’ve reserved is yours and yours alone. When you don’t show up, two things happen: other people needing help who would love to have your time slot are not able to, and I don’t get paid for my time. I rely on this in planning my family and work finances.

4. If you have any concerns, tell me.

I can’t fix or address what is wrong unless I know about it. I won’t get angry or offended or lose my cool. Therapy is all about the therapeutic relationship between the therapist and the person in therapy. If you’re offended about something I said or how you feel treated or mistreated, give me a chance to help you understand or change things. Some things that may seem trivial, such as the fear of being overheard by others in the waiting area, can be addressed and/or explored. If you’re worried because I seem angry, let’s talk about that. My thinking face can look like a grumpy face at times. Knowing your concerns and allowing me to address them is a way to work on empowerment.

5. Nothing is off limits.

Don’t be embarrassed to bring up things, even uncomfortable ones such as sexual experiences or feelings, anger or rage, dreams or fantasies. Believe me, I’ve heard and dealt with nearly everything. I’m not easily embarrassed or fazed. You can also say something such as, “There is something I really want to bring up, but I’m embarrassed.” I’ll help you work through your feelings, and even if you don’t talk about it right away, we can work toward creating a space where you feel okay sharing it.

6. Don’t worry about me.

I have support systems in place if I need help. I seek supervision from peers or others who have more expertise in a given area than I do. Therapists don’t operate in a vacuum, nor should they. I can handle your anger, sadness, and grief. I also know my limits. This is why some therapists refer people to other therapists for some issues. If, for example, I am uncomfortable working with someone who is struggling with a terminal illness because it’s outside my expertise, I will help you find someone who can better assist you.

In the case of therapy, if I were to have an outside relationship with you, I couldn’t be a productive or helpful (or ethical) therapist. Unlike a friendship where both people support each other, my only focus when we meet is you.

7. There’s a good reason I can’t have a friendship with you.

It’s the same reason I can’t be my friend’s therapist. It’s called a dual relationship, which basically means being two things at once to someone. In the case of therapy, if I were to have an outside relationship with you, I couldn’t be a productive or helpful (or ethical) therapist. Unlike a friendship where both people support each other, my only focus when we meet is you. My years of training, supervision, and experience are all focused on helping you.

8. I’m not perfect by any means.

I run late sometimes. I may miss an email or forget to return a phone call. This doesn’t happen often, but if it does, please let me know. In the case of running late, I will make up the time either at the current session or at a later time. If it bothers you, let’s talk about it. Again, nothing is off limits.

9. What you say to me stays with me, with two exceptions.

The exceptions are if I feel you are going to kill yourself or hurt someone else, or if I suspect there is child or elder abuse or neglect. This doesn’t mean if you say you wish you were dead I’ll call the police. But if you mention a plan or I feel like you are on the edge of suicide, I have to take action to ensure the safety of you and others.

10. When you’re ready to leave therapy, that’s great!

It’s something you might be thinking of or I may bring up. Please don’t just stop coming in. Let’s talk about it. If you abruptly leave without letting me know, I am likely to be both confused and concerned for your well-being. The preferred method of ending therapy is to have at least one session where we talk about what we’ve achieved and where to go from here. Closure is important for both of us. You are always welcome back—be it in a month, a year, or five years.

Again, welcome to therapy. I’m glad you’re here. Let’s start this journey together.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.