What is therapy really like?

A list of what to expect in your therapy sessions.

Therapy can be daunting for many people. And that may partially be because it’s hard to know what to expect when you first step into a therapy room or when you meet a therapist for the first time over Zoom. Thanks to pop culture (movies, tv, et al.), we see therapy in a certain way: a therapist wearing a sweater vest and thick glasses, sits in a leather club chair, note pad on their lap, pen or pencil in their mouth, asking deep questions of their client who is lying back on a couch in a visible state of distress.

And while there may be elements of that scene that play out in a modern therapy setting (cardigans and glasses really have become a therapist’s wardrobe cliché!), that is not always the case. So, what can you actually expect during a therapy session? Here is a rundown of what may occur in the therapy space. Of note: this is not an exhaustive list and each therapist will have their own style during a session.

*A consultation call or meeting will likely happen first. This is to help the client and therapist get to know each other, to ensure there are no conflicts, and to make sure that there is a natural fit or rapport to build upon. In this consultation, the therapist will likely ask what is going on for the client and ask what the client’s goals are in the therapy process. The therapist will also start to set the stage for what therapy with them will look like. They will discuss their schedule, their approach and start to set boundaries around the therapy.

*Confidentiality is of the utmost importance. And psychotherapists, in Ontario and wherever else they are regulated, are required to explain what the limits to confidentiality are and what you can expect in terms of privacy. Essentially, a psychotherapist is bound to do everything within their power to not divulge any personal health information to anyone. The exemptions come when they are in supervision (a mentorship role where therapists discuss their cases for clarity and advice, and where the supervisor is also bound by the same confidentiality ethics), or if the therapist is concerned that the client is a danger to themselves or another person.

*Therapy session generally last 50 minutes, especially if you are seeking individual therapy. If working with families and individuals, sessions may last longer. Therapists will likely want to meet weekly or biweekly with clients, in order to help establish a working relationship.

*If there is an initial session booked post consultation, this will be an assessment session. Assessments can take longer than the first session, but this is where the therapist starts to understand the client’s history and helps the client formulate goals for themselves. These may change as the therapeutic relationship deepens and the client becomes more comfortable with the therapist.

*If you are meeting in person, the therapist will greet you in their waiting room as you enter. Therapists may shake hands, or may not. Touching is generally not allowed between clients and therapist, for many reasons.

*If you are meeting online or in person, the therapist will expect that you show up on time to the meeting. This is an important part of the therapy. Some therapists will decide not to continue with the session if the client is later than 10 to 15 minutes. This is because it can be difficult to do therapy in such a short amount of time, and the therapist may have another client booked afterwards.

*You actually don’t have to divulge any information that makes you feel uncomfortable. Therapists know that people are complex and are dealing with many emotions at once. And they should also understand that becoming comfortable with a therapist takes time.

*If you do divulge too much information during a first or second session, you may experience what some call a vulnerability hangover. Feeling like you’ve shared too much is pretty common when seeing a new therapist for the first time. Most therapists are used to this and will also recommend that you be gentle on yourself afterward (self-care can be so important here!).

*Depending on the type of therapy, there may be a set time-frame (say 10 to 12 weeks) or it may be opened ended. Your therapist should be up front about the type the therapy that you’re doing and what you can expect. Psychodynamic psychotherapy is long-term therapy, that is open ended.

*The therapist is responsible for watching the clock and keeping the session at 50 minutes. They should help bring the client back from any emotional dysregulation, helping to ground the client before they leave the therapist’s office or virtual meeting. Be prepared to take another 30 to 60 minutes to process your session, especially if it’s been a particularly vulnerable one. Going for a walk, taking a bath, doing some sort of self-care post therapy can be really beneficial for clients.