It's common to feel worried or unsure about what to expect from therapy. This page covers: 

• Who might my therapist be?
• What will happen the first time I see a therapist?
• What might sessions be like after that?
• Will everything I tell my therapist be confidential?
  
• How will I feel after a therapy session?

Who might my therapist be?

Your therapist might describe themselves in various ways, such as:

• a counsellor
• a wellbeing practitioner
• a therapist (or psychotherapist)
• a psychologist (or clinical psychologist)
• a psychiatrist.

All of these titles should mean that the person you see is trained in delivering therapy, although they will differ in their educational backgrounds and levels of training.

But whatever their title and level of training, it matters that the person delivering your therapy is someone you feel comfortable talking to.

See the British Association for Counselling and Psychotherapy (BACP) factsheet on choosing a counsellor or psychotherapist for more information on the differences between different types of therapist.

What will happen the first time I see a therapist?

Some therapists might call your first session an 'assessment', a 'taster session', a 'consultation' or an 'intake session', but these generally involve the same thing. In this session, you and your therapist might discuss:

• the type of therapy they practice
• how long the therapy will last and what the sessions will be like
• what you want to get out of the therapy
• their confidentiality policy
• what to do if you they have to cancel a session or you miss a session
• if there is any cost involved (this usually applies to private therapy)
• any concerns or worries you have about the therapy.

If you're unsure about any of these it's ok to ask your therapist questions at any time before, during or after your sessions. For more information on what to expect in your first session see the BACP factsheet on what happens in your first session with your therapist​.

My first session was bit of a blur – I had no clue what to say. I think I mainly just cried and apologised! But it got easier over time when I realised that my counsellor wasn't going to laugh at me or tell me to go away.

What might sessions be like after that?

How sessions are structured can vary depending on depending on the type of therapy you're getting and the type of problem you want help with.

Therapy can be:

• time-limited, meaning your therapy will come to an end after a set number of sessions. Most therapists through the NHS offer time-limited sessions.
• open-ended, meaning it can continue for as long as you need it. This is something that is more commonly offered by private therapists.

Sessions can be delivered:

• individually, with just you and your therapist
• in a group with others who are having the same therapy
• with your partner or family members
• in a combination of individual and group sessions.

One-to-one sessions typically last between 50 minutes and an hour, but group sessions can sometimes be longer. It's common for sessions to be held once a week, but you might also agree to see your therapist more or less often than this.

Sessions may take place:

• in an appropriate meeting room owned or rented by your therapist (or by the organisation providing the therapy, such as the NHS, a charity or place of education)
• over the phone or online using an internet calling software
• at your therapist's office or home, if you're having private therapy.

What you might cover in therapy sessions also varies. For example, your therapist may go through specific exercises with you, or you might have a more general discussion about how you're feeling. They may ask you questions about:

• your current and past relationships
• your childhood and past experiences
• situations or events you find difficult
• how you feel
• how you behave
• what you think about things
• issues that have come up in previous sessions.

But it's important to remember that you don't have to talk about anything you're not ready to talk about, or do anything you don't want to do.  (See our page on getting the most from therapy for more tips.)

Will everything I tell my therapist be confidential?

In most cases, yes. Confidentiality is an important part of building trust with your therapist. However, there are some exceptions to this, which allow the therapist to work responsibly.

These are:

• Supervision – therapists always discuss clients regularly with a supervisor (another experienced therapist) who also has to maintain confidentiality. It's seen as unethical for a therapist to work without supervision because:
  • it helps your therapist look after their own mental health, so they're better able to support you
  • it means someone else is aware of how your therapist is treating you, to make sure it's appropriate.

• Safety – if your therapist is concerned that you're at serious risk of harming yourself or someone else, they may need to inform your GP, a healthcare professional or someone else. They should tell you first if they're going to do this.

• Organisational confidentiality – if your therapist is part of a GP practice, confidentiality may apply to the practice as a whole rather than to the individual therapist. This may mean that information is available to your GP. Your therapist should tell you if this is the case.

How will I feel after a therapy session?

It's common to feel a range of emotions after a session. For example, you might come out of your session feeling:

• relieved, if you've shared something important and felt heard and understood.
• energised, if you've started to understand something new about yourself or set yourself a new goal to work on
• exhausted, if you've found the session challenging or hard work
• frustrated, if you didn't get what you wanted out of your session or haven't felt heard or understood
• upset or overwhelmed, if the session has brought up very painful or difficult memories or feelings.

Some days I left therapy feeling tired and drained. Other days I felt relieved, as if a weight had been lifted.

Sometimes therapy sessions can bring up feelings that are difficult to cope with, and you might feel nervous about going back, or like you want to quit. If you feel like this it can help to:

• Start your next session by telling your therapist how you felt after your last session, and give them a chance to reflect with you and offer support. You might find it helpful to write down some notes.
• Talk about how you feel with a listening service or someone you trust, such as friends or family.
• Plan something you enjoy for after immediately each session as a little treat, or to help you relax.

This information was published in June 2018 – to be revised in 2021. References are available on request. If you would like to reproduce any of this information see our page on permissions and licensing.