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Therapist and patient in therapy session

What you need to know about preparing for your appointment and working through common roadblocks.

Jessica Migala

By Jessica Migala

If you’re just starting therapy or returning to it after a long hiatus, you should be applauded for taking care of your mental health. Our mental well-being can be essential for our overall health. And it impacts how we think, feel, act and function in our day-to-day lives.

Many people seek therapy to care for their mental health. In fact, about 1 in 3 adult Americans reported having depressive symptoms, according to a 2022 study in The Lancet Regional Health-Americas (thanks, pandemic). These may include feelings of sadness, emptiness or hopelessness. They could also include feelings of fatigue or irritability, or a loss of interest in activities you enjoyed.

During therapy, a mental health professional helps you name and work through your triggers. And they can help you gain healthy coping skills. (Here’s what therapy is and how to afford it.)

Let’s be real, though: Therapy isn’t a cakewalk. It requires time, work and commitment. Being all in on your sessions allows the healing to begin. So we spoke with licensed clinical social worker Karmen Smith of Henderson, Nevada, about preparing for your initial appointment, between-session homework and how to really connect with your therapist.

(Don’t forget to grab your free discount prescription card. It could help you save up to 80% on your medications.)

Question: What can I expect during my first therapy session?

Smith: Your therapist will spend time getting to know and understand you. They may ask about what brought you to therapy. And they’ll want to know what you’d like to get out of your time together.

If you feel nervous, that’s normal. Your provider’s job is to help you feel comfortable sharing and being honest. After all, what’s said between you both won’t leave the room unless you threaten harm to yourself or others.

(Related: Have questions about therapy from home? Here are some reasons virtual therapy is a popular choice.)

Q: I don’t have anything big to talk about. What if I don’t know what to say?

Smith: Don’t worry if you feel like you don’t know what to say. It’s the therapist’s job to support you by guiding the conversations and helping you get closer to your life goals. The only thing we ask is that you have an open mind.

Q: How do I build trust with my therapist?

Smith: Spilling your thoughts, hopes and fears to a stranger? Yes, that can be challenging. But it doesn’t have to be.

Therapists are trained in nonjudgmental, compassionate and caring communication. Plus, they’re really good listeners. Don’t worry if you’ve never talked about your well-being in this way. Many people may not be used to someone whose main goal is to support them through tough times.

One way to build your relationship is to collaborate. Feel free to take an active role in your sessions. Write down things during the week that you want to talk to your therapist about. You can say: “I’d like to talk about this” or “I’d like to get some clarity about this” or “I’m confused about some of the thoughts I’m having on this, am I seeing this right?”

Q: How do I know if I’ve found the right therapist for me?

Smith: Finding the right therapist is key to your growth and healing. If you start to feel comfortable sharing anything with your therapist, that’s a really good sign. And that can lead to deeper relationships with other people in your life, too.

If vulnerability makes you feel uncertain, it may be a sign that you’re pushing through your comfort zone. But if you feel like they don’t understand you or they aren’t really listening, then they may not be the right fit for you.

Be honest with the therapist about your concerns. But know that you’re not stuck.

(Recommended reading: How to find a therapist you love.)

Q: Is there work I should be doing between sessions?

Smith: Absolutely. Ask your therapist for things to practice between your therapy sessions. You can practice skills you learned during the week, too. (This is why taking notes can be helpful.) For example, if you’re working on self-esteem, then verbal affirmations can be practiced every day.

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A large chunk of your work takes place when you’re not in a session. Moving toward the best version of yourself requires practice. And that’s exactly what therapy is for.

Q: What else can I do to get the most out of my time with the therapist?

Smith: Therapy is a 2-way street. The more engaged you are, the more you’ll likely get out of your time together. Here’s my advice:

  • Take notes during the session. And be sure to review them before your next meeting. When you build on your last conversation, it’ll help fuel your own healing. If mid-session note-taking is tough, spend a few minutes post-session jotting down the highlights while they’re fresh.
  • Ask questions. Again, this is a 2-way street. If you have a concern or are curious about the process, speak up.
  • Journal between sessions. Even just a few minutes of reflection each day can provide insight to share during a session.
  • Do outside research. Therapy is only 1 part of the journey. Take charge of your healing by reading books or learning about those who have overcome trauma (or the issue you’re seeking help with). You can ask your therapist for recommendations and resources.

Opening up to someone new can be tough. But therapists aren’t just regular folks on the street. They’re trained professionals who want to help you thrive.

If your treatment also involves medication, download our free prescription medication discount app to start saving. And if you’re ready to start therapy and prioritize your mental health, check out Care on the Optum Store. It’s virtual, affordable and you can switch therapists at any time with no fee.


Additional source
Study on Americans and depression:
The Lancet Regional Health (2022). “Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults”