What to Expect in Therapy

If you’ve never been to therapy before, the process of finding a therapist and learning about what happens in session can feel quite daunting. Where do I find a therapist? How do I know if they’ll be a good fit? What can I expect during our sessions?

My mission has always been to empower people, so I hope this page will give you the information you need to feel more educated and informed about the entire therapy process.

How do I find a therapist?

The most common ways that people find a therapist include:

• Online registries: Psychology Today is perhaps the most popular website that people use when finding a therapist: click here and go to “Find a Therapist” at the top to search by region. Theravive and Yelp are other options, or you may try typing keywords into Google (i.e. “Anxiety Psychotherapist Markham”).

• Word of mouth: if there are people in your life with whom you feel comfortable discussing this topic, ask if they’ve been to therapy themselves and if they’ve had a positive experience. You can then connect with their therapist and ask if they’re taking on new clients—or if there are other therapists they’d recommend based on your presenting concern.

• Other health professionals: some therapists, including myself, have relationships with other health professionals to ensure that we can refer patients to people we trust. Ask your doctor, naturopath, chiropractor, physiotherapist, etc. if they know of any qualified and experienced psychotherapists.

How do I know if a therapist is a good fit for me?

Here are some important questions and considerations:

1. Do you get a good vibe from them?

1. Research shows that the relationship one has with their therapist is one of the most important predictors of positive change. So, it’s beneficial to find someone with whom you have a good connection and feel comfortable. If you get “good vibes” from your therapist, that’s a good sign.

• Some people find it useful to work with someone who occupies a similar social location as them, while other people are open to speak with anyone so long as they are knowledgeable. For example, if you’re a Black 30-year-old woman who would feel more comfortable speaking with another Black woman in a similar age bracket, keep this in mind when you’re doing your research.

2. Do they have experience working with the issue you’d like to discuss?

• Whether you’re working through anxiety, depression, relational issues, or an eating disorder, ask the therapist if they have experience working with your presenting issue.

• If a therapist does not have experience in the area you’d like to explore, ask if they can refer you to another professional with the appropriate expertise. I know several therapists with different specializations to whom I will refer clients if I’m not the right fit.

3. Have they been in therapy themselves?

• I am stunned when I learn that other therapists have actually never been in therapy. Firstly, going through therapy myself has allowed me to empathize with people who are new to the process. I know from firsthand experience how scary it can be to sit in a waiting room, nervously wondering what it will be like to open up to someone you’ve never met. Secondly, I feel like it’s essential that we therapists work on ourselves in the same ways that we expect others to work on themselves. We have to walk the walk if we’re going to talk the talk.

• Ask your therapist if they’ve been through—and benefited from—therapy. After all, you want them to have faith in the process and know that it can be beneficial!

4. Do a free consultation first.

I offer free 10-minute phone consultations with people so that we can assess if we’d make a good team. Ask any therapists you’re considering if they have a similar policy so you can speak to them before booking a full session.

How many sessions do I need?

While some models of therapy say that it takes “10 - 12 sessions to see results,” I’ve found that this is an incredibly difficult question to answer in the beginning. How many sessions someone needs depends on a few factors, including:

• Readiness for change: while some people come to therapy feeling very enthusiastic and driven to make changes in their lives, other people are in the “contemplation stage,” which is when you know some of your behaviours are problematic but are ambivalent about doing anything about it. (Read more about stages of change here).

• Environmental support: some people come to therapy with a spirit of enthusiasm but live in an environment that hinders their success. For example, if someone is eager to learn about how to improve their self-esteem yet lives with someone who is emotionally abusive, this will, naturally, influence how quickly they see improvements in their life (through no fault of their own).

• Goal-setting: while some people come to therapy with clear goals in mind about what they’d like to work on, other people aren’t so sure. Rather, they might have an overwhelming feeling of doubt, for example, but have difficulty identifying what, specifically, they’d like to be different in their lives. In these cases, the therapist may spend one or more sessions helping them articulate this so that they have a better idea of what “treatment” would be most helpful.

• Comfort: for people who have a history of trauma or violence, trusting someone enough to share their most vulnerable stories is a tall order. In these cases, the first step is for the person and therapist to build trust and rapport. Sometimes this takes many, many sessions, but no progress will be made at all if the therapist rushes through this crucial step. Even if you haven’t had a history of violence, some of us simply feel more comfortable sharing things about ourselves than others, which may affect how many sessions you need.

What models of therapy are best?

As stated previously, research shows that one of the most important factors for catalyzing change in therapy is the relationship between the therapist and client. In fact, studies have revealed that the techniques a therapist uses only account for 15% of the success someone experiences. In other words, the model of therapy might be much less relevant than you think!

Furthermore, there are many different models of therapy that all have their pros and cons. From Cognitive Behavioural Therapy (CBT) and Solution-Focused Therapy (SFT) to Dialectical Behavioural Therapy (DBT) and Acceptance and Commitment Therapy (ACT), the models a therapist can use are endless. What matters most is how a therapist incorporates a model into their practice and what their approach to therapy is like rather than the model itself. A skilled therapist will also be able to pick up on what approaches and strategies fit best for your specific needs, preferences, and concerns.

Let’s use Cognitive Behavioural Therapy (CBT) as an example. While some therapists will use CBT in a very rigid and structured way, others might incorporate some of its techniques when applicable but divert from the model if it feels more useful to do so.

It may be more helpful to ask yourself the following questions:

• Do you want to work with someone who takes more of a prescriptive approach to therapy OR who works more collaboratively? (In other words, do you want the therapist to “be the expert” or do you want to take more of a “two heads are better than one” approach and feel involved in the process?)

• Do you want a therapist who values you being able to find the answers to your own questions OR do you want to work with someone who can tell you about some more concrete tools and strategies?

• What is the therapist’s overall approach in therapy? What would other patients say about their style and way of working?

• What adjectives would the therapist use to describe the way they work?

How do I book a session?

Of course this will depend on the clinic, but at Fresh Insight, your therapist will ask for your first and last name and email address so that they can create an online file for you. From there, you’ll be sent a short online intake/consent form to be completed before your session. You can also then access the online booking site and find session times that work best for your schedule. Alternatively, you can email your therapist some different dates and times that you’d prefer and they’ll book the session for you.

Are sessions covered by insurance?

Only services provided by a psychiatrist are covered by OHIP. Psychologists, social workers, and psychotherapists are covered by some benefits provider, but it depends on your specific insurance company and plan. Click here for detailed information about this.

What happens in the first session?

First sessions look different at every clinic, but here’s how they go at Fresh Insight:

1. Your therapist will go over the Terms of Service, which is a legal agreement between the service provider and the recipient that discusses topics like the therapist’s cancellation policy, limitations to confidentiality, record-keeping, and more.

2. Your therapist will spend the majority of the session getting caught up to speed about your life, asking you questions about where you live, who’s in your life, what you do during the day, and more. They also may ask questions about your family of origin and other significant events that might be relevant for them to know. However, it is entirely up to you to determine how much you’d like to share in the first session; if there are things you do not want to discuss, you are more than welcome to say “pass” to ensure that you feel comfortable.

3. Your therapist will inquire about what you brought you to therapy at this point in time (or what your "symptoms" are, for lack of a better word).

4. Time permitting, you’ll discuss what goals you have and what “successful therapy” would look like so that you and your therapist have some sort of metrics to track your progress.

Sometimes people like to receive “homework” between sessions so that they can be more intentional and involved in the process. Feel free to give this feedback to your therapist.

What happens in the sessions thereafter?

Based on what you deem to be the most important topic to discuss first, you and your therapist will focus on helping you gain awareness about why you might be engaging in certain behaviours and strategies and techniques that could help you out. That said, sessions look different for everyone depending on what approach they prefer. For example, someone who has no interest in answering the "why" about their presenting concern may want to jump straight into learning emotion regulation techniques, which is totally fine! Other people find it useful to revisit significant events that have occurred in their lives and unpack how they affected them. It varies!

For more information on how to get the most out of therapy, check out my other blog post here!