No couch required: What to expect at your therapy appointment

Fever, sore throat, and chills: Typically, these are signs that it’s time to visit your doctor, and you usually know what to expect. The nurse might weigh you, check your blood pressure, and take your temperature. The doc will arrive, ask what’s bothering you, take a look, maybe prescribe some medicine, and send you on your way. However, when it comes to your mental health, it can be hard to decide when it’s time to make an appointment and even harder to know what to expect when you get there. That fear of the unfamiliar and unknown can give you pause in going to see a therapist, but the good news is a little knowledge can feel like a lot of power.

You don’t have to wait until you’re in crisis to see a mental health professional. Therapists are ready and trained to assist with problems such as grief over a loss, strain in your relationships, depression, anxiety, insomnia, and other issues. Or you might need help with improving health behaviors such as quitting smoking or losing weight.

Similar to your physical health, it’s also important to catch and address psychological struggles early before things get worse or your symptoms start to impact your day-to-day functioning. And just like your annual physical, you might want to schedule regular checkups with your care provider to make sure you’re engaged in preventive maintenance—even if things seem just fine.

You made an appointment to see a therapist. Now what?

For starters, there likely will be some paperwork and questionnaires about how you’ve been feeling lately and any symptoms or problems you’re experiencing. During the first meeting, she or he will ask a lot of questions and get to know you. You also can ask questions to learn more about his or her approach and decide if it’s a good fit.

The first meeting usually takes about 60–90 minutes and, despite common misconceptions, rarely involves lying on a couch or talking about your childhood. Your therapist will ask questions that focus more on your specific problem to help understand what’s contributing to it and what your goals are for improvement.

It can be hard to open up to a stranger at first. Still, be open and honest, so you get the most out of your visit. Rest assured, your therapist won’t think you’re crazy, and she or he isn’t there to judge you. Your therapist is on your side and serious about maintaining your privacy as well. Mental health professionals are held to strict confidentiality guidelines, and it’s extremely rare that speaking with one will impact your security clearance.

Once there is a shared understanding of what your goals are and what you want to achieve, you also might discuss what stood between you and those goals in the past. Finally, you and your therapist will talk through your treatment plan. You’re driving the car, and your therapist is there to help navigate. You’ll work together to build up your tool box, so you have the skills you need to excel when you reach your destination. Keep in mind many of the gains you make while working with a mental health professional happen outside of the therapy room, so you must be willing to put in the hard work. It’s also common for your therapist to assign “homework,” so it’s essential to practice what you’re learning between sessions.

Your therapist’s goal is to ensure you’re safe and help you reach your goals, improve your functioning and performance, and build resilience and strength to manage your current problem and any others you might face in the future. With this in mind, therapy isn’t intended to last forever. Once you’re equipped with the essential skills you need to thrive, sessions might become less frequent, and treatment will end while you still continue the work on your own.

Bottom line

Common barriers can make it hard to take action toward addressing your mental health. Working with a psychologist or other behavioral health provider can help you master the skills you need to manage many types of life challenges in a safe, confidential setting. Use the following resources to learn more and help locate a therapist:

Published on: May 21, 2018

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Kennedy, C. (2017). How often do people lose security clearances because of mental health reasons? Retrieved from