Talking therapy and counselling

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What to expect from therapy

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

This page covers:

• Who might my therapist be?
• What should happen the first time I see a therapist?
• What might the therapy sessions be like?
• What will I talk about in therapy?
• 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:

• Counsellor
• Wellbeing practitioner
• Therapist (or psychotherapist)
• Psychologist (or clinical psychologist)
• 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 - it matters 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' or an 'intake session'. But these generally involve the same thing. Your first session is for setting expectations and starting to build trust between you both.

Your therapist should clearly explain to you:  

• Their background and qualifications
• Which professional body they're registered with
• Their confidentiality policy
• The type of therapy they provide, and how it could help you specifically 
• 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 charge fees - but therapy is free on the NHS

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
• Any accessibility needs you have
• Any worries or concerns you have about therapy

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.

Checking your therapist's credentials

It's good practice for any therapist to be a registered member of one of the professional bodies listed in our useful contacts page. This means they've signed up to meet certain standards of practice. You can usually double check this through the membership body's website.

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 the therapy sessions be like?

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
• Over the phone or online using an internet calling software
• At your therapist's office or home, if you're having private 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 work responsibly.

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 therapist is part of a GP practice, confidentiality may apply to the practice as a whole. This is called organisational confidentiality.  This may mean that information about you is available to your GP.  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.

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

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 straight after each session as a little treat, or to help you relax.

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

This information was published in June 2018.

This page is currently under review. All content was accurate when published. 

References and bibliography available on request.

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