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A GUIDE TO STARTING THERAPY


You have decided that you want to see a therapist…

Choosing a therapist

Some people like to get referrals for therapists. They feel confident that if someone they know recommends that person that they are likely to like them. Others, research online either with keywords pertaining to their personal issue or by using online directories such as Psychology Today, Counseling California or review sites such as Yelp. A lot of therapists have websites or directory profiles which will give you information on them and give you a first idea of whether they might be a good fit. You may look for a therapist that lives close to you or your place of work or someone who specializes in a specific issue or who uses a technique that you like. You may also need someone who is reimbursed by your insurance.

Contacting therapists

Once you have narrowed down some therapists, you have to contact them. You can usually call, email or use websites’ contact forms. I have been told multiple times that prospective clients were not getting return calls. Make sure to leave your phone number clearly, repeat it at least once. Let the therapist know whether they can leave a voicemail and what are good times to call you.

It shouldn’t be too difficult to get in touch, yet…


I have had multiple clients and acquaintances complain that they were not getting called back. If the therapist doesn’t return your call, it might be that they are away or that there was a technological breakdown. When I set up my Google voice number, I had the hardest time getting calls transferred to my regular cell and then voicemails didn’t show on my phone, only in my email. There might be some therapists who have a full practice and do not have the time to return calls which is unpleasant and below standard of care. Regardless of what it may be, try at least twice and maybe even use an alternate means of communication. If you started with the phone, try email or a text message if the voicemail goes unanswered. Don’t give up. If you really do not get any response then you need to move on and try someone else.

If you were to reach a therapist you are interested in working with but you don’t have a schedule match then ask for referrals from them.

“Etiquette”

If you were to communicate with a therapist and express your interest in working with them and then not respond to their messages don’t hesitate to call back or email when you are ready even if it’s many months later. Therapists usually understand that entering therapy is sometimes anxiety-provoking for some people. It’s a process. It takes time for people to realize they are ready for therapy.

If you can’t make it to an appointment please let your therapist know. Sometimes, they may have a client who would benefit from coming in at an unusual time but if the therapist reserved the spot for you and you don’t come, it’s a lose-lose. If you miss an appointment or fail to cancel early enough, you may have to pay for the session or part of the fee. There are multiple reasons for this:

1. therapists in private practice need an income and if people never show to their reserved spot, they just don’t get paid;

2. keeping you accountable to the commitment you are making to yourself in therapy;

3. it will probably serve the purpose of you not forgetting again because it’s unpleasant to pay for a service you don’t get. Some therapist will not charge you if you manage to reschedule within the same week.

Usually you will meet with your therapist weekly or every other week, on a set day and time. Some therapists have flexibility. One day, you may need your appointment day and time to change. Communicate with your therapist. Sometimes they can accommodate sometimes they may not be able to.

Getting to know your therapist

After, you have done some research. Talking to people, going on-line and set up the 1st contact here is what that may look like:

Some therapists will offer a free 20-30 min in person or phone consultation. Others will expect you to pay for their time from the beginning.

It is expected that you know the fee before your first meeting or at the very beginning of the 1st contact.

The fee

Most therapists have a fee bracket that they work with. They also often will take sliding scale clients. Usually, at times of the day, which are less busy but in some cases, they have flexibility. Therapists try to set their fees in order to have a successful business that covers their expenses and provide what they consider healthy finances. They also want to serve their community. Private practice experienced therapist will be more costly than associates who are in training or community resources which provide free or low cost therapy. Look for therapists that set fees that match your budget. But don’t hesitate to ask for a sliding scale should you really be interested in working with a specific person. Keep in mind that they may decline.

First impressions

Once you meet the therapist you will get your first impression. Try to figure out if you are usually on point with your first impressions or if you often find you are wrong either in a positive or negative way. In some cases, you may find that the person is not a good fit from the first phone contact. Other times it’s at that first in-person session. Sometimes you may not be sure but it’s worth it to give this a try. Give yourself, 2-3 or more sessions to see how you feel. Know that establishing the therapeutic relationship takes a while and the therapist needs to learn about you and what works for you. You also have to see how the therapist functions and if you feel that it works for you. Don’t stay with a therapist you do not have a good feeling with for too long but don’t give up too quickly either.

Honest Communication

In order for your therapist to help you best, it is important that you be honest with him/her. This means communicating how you feel and not hesitate to ask for your needs to be met. Should you not feel heard, repeat, should you feel that the therapist misunderstood, clarify. Share with them what works for you and what doesn’t. If you feel that the therapist is not a good fit for you ask for a referral. Most therapists are supposed to be able to manage these communications. They actually welcome feedback. Unfortunately and fortunately they are human and they might have reactions, which are not the best. It’s okay, everyone can repair. Ultimately, if the therapist is not able to manage honesty from you then it’s not a good fit. But if they can, and are able to adjust to your needs then it’s win-win. You may have learned to express your needs and to recognize the reactions you need.

Therapy usually has 4 phases

1. Getting to know each other but mostly the therapist getting to know you.

2. Assessment: As the therapist gets to know you, he/she will make an assessment to determine how you are doing. The therapist will work with you to define your goals and needs.

3. Treatment: These are the sessions during which your therapist and you will be working on your issues and needs. The assessment is ongoing in that your therapist will look for signs that you are making progress such as that you are less depressed or that your anxiety is decreasing or that you are sharing feeling more comfortable in your relationships. Should you or your therapist notice that progress is not happening or too slow, it would be necessary to assess whether changes need to occur such as switching to another therapist or using another method.

4. Termination: Once your goals are met then it is time to start the termination process of therapy. Your therapist will share noticing that your goals have been met or you will let him/her know that you do not need to come anymore. In some cases, the termination process is brief. Ideally, it would at least include one session during which you and your therapist can review the work accomplished and say goodbye in a healthy way. In other cases, termination is spread out on multiple sessions and will require decreasing frequency, such as moving to every other week and then once a month.

Treatment

Therapy looks many different ways. Often, it is talk therapy where the client and therapists have conversations. The flow of ideas, helps the client increase awareness. Some therapists use art, others play or sand trays. Usually sessions last 50 minutes, the client and therapist are engaged. Sometimes the therapy involves multiple family members. Some sessions will be light and fun, others may be very intense and involve hard emotions. You may notice that the work done in session carries through in your life. In between sessions, you may think about your therapy process or not at all. Some therapies involve homework, others do not.

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