Many people have asked “So, what do I actually do in therapy?”.  Most of us are familiar with the idea of a therapist in an office with a couch but many of us have never actually sat down for the therapeutic process and have questions about how it all works.  That is completely understandable.  I can say specifically what happens in my office but much of it is common practice and you would likely find it in some form with any therapist.  With that said, here is some info on how to get started and why therapy tends to be helpful for many folks.


The very first step is reaching out to a therapist for services. After doing a google search in your area or finding someone on a listing of therapy providers, most therapists have websites where you can gather some basic information about them and their practice.  If they seem like someone you would like to work with, you can reach out by phone or email letting them know you found them online and would like to talk more about receiving services.  Be sure to leave your best contact information and let them know if there are any stipulations around reaching out to you (i.e. can they leave a voicemail for you to return your call?).  Most therapists return your message within 24 – 48 hours.  Don’t be discouraged if the first therapist you reach out to does not respond, is booked, or just doesn’t work out for some reason.  For various reasons, it can take a couple tries to connect with someone and get things started.

Once you have actually made contact with a therapist and found a time to meet there will likely be some paperwork that you will have to complete.  Some therapists use online sites with confidential links to manage paperwork that can be completed prior to the first session.  I try to keep them simple and straightforward because who likes paperwork?  But it is very helpful in allowing me to understand a bit of who you are and your background prior to our first session. 


The first session is where I really start getting to know you.  I leave plenty of space for you to tell me about yourself and what has been happening that you decided to seek therapy.  I may ask some clarifying questions to be sure I understand everything but this time is really about hearing from you and understanding how I may help.  Often we can identify some practical action steps in this first session.  There may be one or two obvious things you can start trying after you leave the session.  Developing some structure for your change is an important part of the therapeutic process. Expressing and processing emotions during your session is important, but identifying what you can do to improve things outside of the office is also a part of the process.

Goals can be as focused or freeform as you would like.  Some people like to use the time to focus more on processing emotions and experiences with incremental goals.  Others equally process emotions and focus on identified goals.  We can work together to decide what feels best for you.  The process is meant to work for you and does not have to look the same for everyone.


Many people wonder how therapy actually helps.  It’s a good question.  The difference between having a friend and a therapist can seem subtle but they are actually really different.  First, a therapist is actually trained to work with you.  Friends know you and love you and can definitely give you good insight. Good friends are important to have. They are not, however, usually trained to listen between the lines or ask some of the more pointed questions that can help us grow.  Unless, of course, your friend is a therapist which brings up the next difference between therapists and friends. 

If you are doing it right, the therapeutic process is hard emotional work.  I am working hard and you should be too.  It is not the kind of consistent emotional labor you should expect from a friend.  You should certainly be able to vent to your friends and turn to them for emotional support but you should not necessarily expect them to regularly sit with you and process deep emotions and the tactics for your change.  That is where therapy comes in.

Another note about friendships is that they are biased by nature.  You often have mutual friends and history.  Although, therapists are human and may carry some bias, our job is to minimize it as much as possible and work objectively only with what you present.

Lastly, your friendships should be a two-way street.  While your friends provide support for you, you should also be there for them.  If you need to talk but they do too, you may have to hold emotional space for them at times when you would rather be able to talk about your needs.  Therapy provides a space that is solely about you.  Your emotional needs are front and center for you to process, heal, and grow.


Yes! A lot of people can feel afraid of really facing some of their emotions and experiences in therapy.  There is a quote by Shannon Adler that says “Courage doesn’t happen when you have all the answers.  It happens when you are ready to face the questions”.  I love that quote because it doesn’t make growth and change about right and wrong answers to our problems but simply about saying “this isn’t working” and starting to think more about why and what will.  The quote encourages us to ask questions about ourselves and our lives, our emotions and experiences and see what comes up for us. 

A lot of people are surprised by what actually shows up for them in therapy.  What they thought was the problem turned out to not be at all.  Their process for change was easier than they thought.  Or, sometimes, it’s harder than they thought but they find they had more courage and strength to face it than they once believed.  Therapy is not for when you have all the answers but for when you know you are ready for something different but are not quite sure how to get there.  It is a process and a journey that involves taking some risk and taking one step at a time.  But it can and certainly does work for lots of people. 

Another quote I love is “trust the process”.  I’ll add to that “trust yourself”.  If you are feeling like it is time to make a change, look around for a therapist that can work with you along the way.