Because each person has different issues and goals for therapy, therapy will be different depending on the individual.  In general, you can expect to discuss the current events happening in your life, your personal history relevant to your issue, and report progress (or any new insights gained) from the previous therapy session.  

Don’t expect your therapist to tell you what to do. Therapy is less about advice and more about helping you make decisions that serve you. It can be tempting to ask a therapist to “just tell you” what to do - They will guide you to solutions they believe are best, or help you identify your options and thoroughly weigh them, but they will not tell you what to do. We cannot, and do not, want to force you to do anything you’re not ready for or willing to. It’s up to you to apply what you’re learning in therapy.

In the age of “do-it-yourself,” it can be easy to get caught up in the desire to handle everything on your own. Many people have tried different avenues (i.e. self-help books, talking to trusted friends, hoping emotional hardships will get better with time) and are still bombarded by barriers to achieving total mental wellness.

It is not a weakness to speak with a therapist; it is in an act of courage and strength to be in touch with your needs and seek support when necessary.

Therapy provides long-lasting benefits, like increased self-awareness, gaining new and healthier coping skills, and ways to engage in healthy patterns of thinking, feeling, and behaving so you can find the fulfillment you desire. Think of it as a long-term investment in yourself! 

If a psychiatrist believes you may benefit from medication, they will suggest it, including a recommendation of specific drugs. They’ll do so after they have evaluated you. The final decision is yours, however.

Studies show medication in conjunction with therapy is more effective than medication alone. Many medications also take some time to take full effect, while others are maximally beneficial only in combination with external guidance.

It is difficult to initially predict how many sessions will be needed.

Typically, sessions last 45-50 minutes. Sessions are usually scheduled once a week or every other week, depending on client goals. On average, clients can expect to be scheduled for 10-12 sessions total.

Everyone’s therapy journey is different. Some people only want to address a single issue and can make progress in a short timeframe. Other people want to do longer, more in-depth work and  like to incorporate therapy into their self-care or self-development

The frequency and length of treatment depend on multiple factors such as client goals, commitment, and the work put in outside of therapy. Usually, counseling starts with weekly sessions to build momentum towards achieving goals. Once progress has been made, adjusting the frequency of sessions is based on individual needs.

Some people experience great benefit after a limited number of sessions, while others participate in therapy over longer periods of time. The length of therapy will be an ongoing discussion throughout the course of treatment.

According to the American Psychological Association, about 75% of people who enter psychotherapy have found benefit and increased functioning in their day-to-day lives. Therapy can last as long as it takes for you to feel like it’s been a success, and you’re ready to move on.

Federal HIPAA laws and Missouri State laws protect the confidentiality of the communication between client and therapist. What you share in session is kept confidential except in very few instances. Those exceptions include

1. reasonable suspicion of child abuse;
2. reasonable suspicion of elder or dependent adult abuse;
3. if client is threatening serious bodily harm to self or others;
4. if client is gravely disabled and unable to care for themselves;
5. in case of medical emergencies;
6. if I am subpoenaed by a judge.

As mandated reporters, by law and CCCNMO's professional code of ethics, we are required to report the above to the proper authorities.

Some therapists have an agenda they like to follow to guide the session, while others let you take charge, based on what you wish to discuss. Also, specific types of therapy may need to lean more heavily on active guidance from a therapist. Your therapist will discuss this with you when necessary. Depending on what you’re more comfortable with, as well as the type of therapy you choose, the therapist may take the lead or you might.

You can talk about anything and everything. Depending on the type of therapy you’re in, you may stick to one specific issue, or you may talk about just everyday life. Good therapy is meant to translate to the real world. It should improve your mental health and well-being, and overall make you feel better.

Plus, there is nothing stupid to talk about in therapy. Your therapist will do their best work when you’re honest about what’s on your mind, whether it’s the state of the world and your place in it, or just a tweet that made you feel bad. Everything is fair game in therapy.

The act of “venting” can improve your outlook, and there is room in the therapy session to do this. But therapy goes beyond only talking about your problems. Your therapist will have specific areas they want you to reflect and report bock on, or exercises they’d like you to try between sessions.

It’s a common belief that progress only happens during the “therapy hour”, but for therapy to work, you’ll need to be putting in effort between sessions. It can take time to see positive changes – therapy can be really hard work!

 It is important to understand that you will get more results from therapy if you actively participate in the process.  The ultimate purpose of therapy is to help you bring what you learn in session back into your life. Therefore, beyond the work you do in therapy sessions, your therapist may suggest some things you can do outside of therapy to support your process - such as reading a pertinent book, journaling on specific topics, noting particular behaviors or taking action on your goals. People seeking psychotherapy are ready to make positive changes in their lives, are open to new perspectives and take responsibility for their lives.   

You do not need to share all of your inner secrets at your first session, nor should you. The beginning phase of therapy is about building a trusting therapeutic rapport and relationship. You can share things at a rate that feels comfortable for you. Numerous times, I have had clients indicate that they experienced a bigger trauma in the past (like childhood sexual abuse or rape, etc) that they are not ready to address. This is a healthy way of being open and honest with your therapist, and also setting boundaries and pacing the therapy at a rate that feels comfortable for you. 

As you establish a stronger relationship with your therapist and when your therapist knows you are ready, you can work together to address those experiences. Many clients report feeling tremendous relief and that sharing those experiences wasn’t as difficult or scary as they thought

Your therapist is not there to judge you and you can improve your prognosis in therapy by sharing as much as you can when you feel ready. The beauty of therapy is that it is a confidential relationship and you do not need to see your therapist outside of sessions. The therapy office can be your own safe place to share these experiences without judgment.

When clients come to therapy, they are all in different levels of readiness to change. You aren’t any different. And therapists are trained to meet you "where you are at," meaning they respect where you are at in the process of change. 

Furthermore, therapists know that people only change when they are ready and when they want to change. Therapy isn’t a straight line from problem to solution. Often, negative relationship patterns or self-sabotaging behaviors will likely continue during the first phase of treatment, or they may recur at various points in the therapeutic process. This is normal and clients are expected to be open and honest because it allows the therapist to help them the most when they share these setbacks.