What To Expect When You Go To Therapy Or Counseling (A Step-By-Step Guide)

Don't be nervous, be informed!

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There are lots of thoughts and fantasies about what happens when someone goes to therapy or to see a counselor.

Many people have considered it or had it brought up in a discussion, but there are hurdles that some people still struggle to get over. Questions will go through your mind such as:

study by the American Psychological Association found that in a year, almost 48% of people polled had at least one person in the household make a visit to a Mental Health Professional and 91% said they would go if needed. The poll suggested that the stigma associated with going for counseling has diminished significantly. Another study co-sponsored by Psychology Today magazine and PacifiCare Behavioral Health found that 59 million people had gone for counseling and over 80% reported finding it effective.


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So what can you expect if you decide to seek out a marriage and family therapist?

  1. Marriage and family therapists/counselors are licensed by your state.
  2. They are required to receive ongoing training every year.
  3. They are often credentialed by your insurance company as a preferred provider, helping to reduce your cost.
  4. In some practices, they will call your insurance carrier and find out your benefits before your first session.
  5. In some practices, they will bill your insurance directly and save you the burden of completing all of that paperwork. In the practices that do not do this, they should provide you with the billing documents you need to file with insurance yourself.
  6. Plan to arrive early so that you are sure to find the office if you have not been there before AND to complete any paperwork that needs to be done.
  7. When your first appointment is set, the office should let you know what forms are required and, in some cases, will email them to you or direct you to a website where you can complete them.
  8. In most practices, you will find the waiting room and offices to be quiet and comfortable — almost homey.
  9. Don't be surprised if you are somewhat anxious before it all gets started. After all, you are about to meet someone you don't know and invite them into some of the most intimate parts of your life! If you find that the anxiety does not go away right away, simply say something about it.
  10. You will find that the therapist is very concerned about protecting your confidentiality.
  11. You will almost always find the therapist to be personable, warm, and genuinely concerned about you and what you are going through. If you are disappointed because your first visit is not that way, do not schedule further appointments and find someone you are comfortable with. A good therapist will want you to be with someone you are comfortable with.
  12. Don't be surprised if the therapist takes notes while you are in a session. This helps the therapist to remember details about your life, and they are often writing down things that they want to ask or tell you later and don't want to forget. 
  13. If you are concerned about what happens to the notes or what is being written, simply ask and it will be explained and changed if you need it for your own comfort.
  14. Expect the time to go really fast and to be over before you know it.
  15. Don't be surprised if you experience a rush of emotion in a session. The therapist will not be surprised or shocked by it at all and will allow you the time you need to emote and to regain composure.
  16. Don't be afraid to ask for direction when you need it or for assignments if they are not given.
  17. Don't be surprised if one session is very intense emotionally and the next one is much lighter, this just seems to naturally happen from time to time.
  18. If you are in a smaller community and are afraid of running into the therapist in town, ask how they handle those situations so you are prepared.
  19. Don't be surprised if the therapist seems to already know how you feel or react or experience certain situations. The therapist is a trained professional who deals with people in situations and responses similar to yours all the time.
  20. Don't be surprised when you hear direction and ways of dealing with some of your situations that seem pretty simple and make common sense, but you had never thought of doing it that way before.
  21. Remember that while you may not always like everything you hear, no therapist can make you do anything you don't want to do. If someone tries to do so, you are in the wrong place and should find someone else.
  22. If the cost is more than you expected, do not be afraid to bring it up to your therapist. The answer might be setting up a payment plan or not coming as often so that the cost is spread out over more time.
  23. Don't be surprised to find that some of the things you learn and try make a significant difference in your life and also improve your relationships or situation.
  24. Don't be surprised to find that some of the things you learn and try seem to backfire and make things worse. Be sure to bring that up in your next session and let your therapist debrief you and revise the plan.
  25. Don't be surprised if there are weeks that you can't wait to get to your next session, to connect with your therapist and report what has happened and other weeks when you don't really want to go and face the emotions involved. While that may be tough for you, it is not necessarily a bad sign to your therapist.
  26. Don't be surprised if you start feeling a real connection with your therapist over time, sort of like having a really good friend.
  27. You might even be kind of glad that your therapist knows your whole story (perhaps the only person in the world who truly does) and you are somewhat happy that when you are done with therapy, you can leave it all behind you in the office.

Going for therapy can be an intimidating and anxiety-producing process. It can also be one of the most beneficial things you can do for your own mental health, for your marriage or for the stability and health of your family. 


Remember to follow these rules:

  • Be honest at all times. Your therapist will always want what is best for you and will be unable to give you the best possible guidance if part of the story is missing.
  • You know you better than anyone else does, so if something doesn't sound right for you and your life, take some time to think it over and discuss it further in therapy before you make any major changes.
  • If you are going as a couple or a family to sessions and you have the feeling that you would like to have (or need) one on one sessions with your therapist, ask if that is possible. If the therapist is uncomfortable with it, they can refer you to someone else for individual counseling.
  • If you don't understand something that is going on in therapy, stop the therapist and ask them to explain.
  • Let your therapist know if things seem to be bogging down and you do not feel like you are getting what you need.
  • If something changes in your life and you are either ready to end therapy or need to take a break, do not be afraid to bring it up.
  • Don't be afraid to refer family members or friends to a therapist who has helped you and you trust.

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There are many online tools that are available to help you find a good therapist in your area. Psychology Today has a good list. The Association of Christian Counselors has a good list, as well as, The American Association of Marriage and Family Therapists.

You can also call the 800 number for your insurance company and they will supply you with the names and numbers of therapists in your area who are preferred providers in your plan.


David McFadden is a couple's counselor and relationship coach at davidanddebbiemcfadden.com. His marriage advice has appeared on YourTango.com, Marriage.com, HuffingtonPost.com, and Better Life Magazine. To learn more about how to improve your marriage and fall back in love again, please visit David online today.