What to expect from therapy

It's common to feel worried or unsure about what to expect from therapy.

We're here to let you know whet to expect, so you can feel more confident. 

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

Who might my therapist be?

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

• Counsellor
• Psychological wellbeing practitioner
• Therapist (or psychotherapist)
• Psychologist (or clinical psychologist or counselling psychologist)
• Psychoanalyst
• Psychiatrist

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

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

What should happen the first time I see a therapist?

Some therapists might call your first session a taster session, a consultation, an intake session or an assessment. But these generally involve the same thing.

Your first session is for:

• Setting expectations
• starting to build trust between you both

It's also a chance to see if you and your therapist are a good fit to work together. You don’t have to continue with your therapist if you struggle to relate to them.

Your therapist should clearly explain to you:

• Their background and qualifications
• Which professional body they're registered with
• Their confidentiality policy
• Their policy on contact between sessions
• The type of therapy they do, and how it could help you
• Their experience working with people who have similar problems to yours
• How long the therapy will last, and how many sessions they can offer
• What to do if either of you need to miss or cancel a session
• Their fees, if they’re a private therapist
• How they store notes

They may also invite you to sign an agreement to show that you understand and agree to the therapy they can offer.

They should also give you space to explain and discuss:

• What you want to get out of therapy – your therapy goals
• Any accessibility needs you have, including any adjustments you need
• Any worries or concerns you have about therapy

The first session can feel overwhelming. If you're unsure about any of these things, it's OK to ask your therapist questions at any time. They should answer you openly and honestly.

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

Checking your therapist's credentials

It's good practice for any therapist to be a registered member of a professional body. This means they've:

• Trained to a certain level
• Formally agreed to meet specific standards of practice

You can usually double check this through the membership body's website.

These bodies are a good starting point:

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

babcp.com
Information about cognitive behavioural therapy and related treatments, including details of accredited therapists.

British Association for Counselling and Psychotherapy (BACP)

bacp.co.uk
Professional body for talking therapy and counselling. Provides information and a list of accredited therapists.

National Counselling and Psychotherapy Society (NCPS)

ncps.com
Professional body for talking therapy and counselling. Provides information and a directory of accredited therapists.

What might the therapy sessions be like?

How sessions are structured can vary 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.
• Structured, meaning you work with your therapist on a specific issue within a set number of sessions. The therapist tends to offer more direction than a therapist working in an unstructured way. For example, you might work together using a workbook. Cognitive behavioural therapy (CBT) often takes this approach.
• Unstructured, meaning your therapy will give you space to explore what’s troubling you. The therapist tends to ask more general questions about what’s going on in your life and how you’re feeling. This type of therapy tends to be open-ended.

Sessions can be delivered:

• One-to-one with just you and your therapist
• In a group with others who are having the same therapy
• With a partner or family members
• In a combination of individual and group sessions

One-to-one sessions typically last 50 minutes to 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 room owned or rented by your therapist, or by the organisation providing the therapy
• Over the phone or online, sometimes referred to as remote therapy
• At your therapist's home, if you're having private therapy
• Outside in nature such as in a park, sometimes referred to as walk and talk therapy or outdoor therapy

What will I talk about in therapy?

What you might cover in your therapy sessions 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.

But there are some exceptions, which help your therapist to work responsibly. These should be clearly explained by the therapist in your first session.

Your therapist's supervisor

Therapists always discuss clients regularly with a supervisor, who also has to keep your confidence. This person should be another experienced therapist. It's seen as unethical for a therapist to work without supervision. This is 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

Other professionals where they work

If your therapy takes place within an organisation, such as a GP practice, university and some therapeutic agencies, confidentiality may apply to the organisation as a whole. This is called organisational confidentiality.

This may mean that information about you is available to other professionals within the organisation. Your therapist should tell you if this is the case.

Your safety

If your therapist believes 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.

Legal requirements

Sometimes your therapist is required by the law to break confidentiality, for example in the case of terrorist activities.

How will I feel after a therapy session?

It's common to feel a range of emotions after a therapy 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

Sometimes therapy sessions can bring up feelings that are difficult to cope with. You might feel nervous about going back, or like you want to quit.

If you feel like this it can help to:

• Tell your therapist how you felt after your last session at your next session. They're there to listen 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, like friends or family. Our page on how to open up about your mental health might help.
• Write down how you’re feeling between sessions. You might find journalling helps you make sense of your therapy sessions.
• Plan something you enjoy for straight after each session as a little treat. Or to help you relax and feel grounded. Perhaps a relaxation exercise.