MSU Extension Healthy Relationships

Admitting you need help dealing with mental health symptoms can be hard. It’s often scary to try something new, like therapy. It takes a lot of strength and self-awareness to schedule that first therapy session. It may also be challenging to continue therapy, when the process feels uncomfortable or is not what you expected. Approximately 19.7% of clients drop out of talk therapy, and most do so very early in treatment. Although there may be a lot of reasons for this, it often occurs because of unrealistic client expectations. To make therapy less scary and more effective, let’s discuss what to expect.

In the beginning

There will be paperwork. You may receive a link to fill out the information online, you may receive a packet of forms in the mail or you may be handed a clipboard as you wait for your first appointment. This paperwork tells the therapist your reason for meeting with them and provides them with relevant information such as your health history and any medications you are taking.  It may feel like a lot of work, but it is okay to fill it out in bits and pieces as you feel up to it.

During the first appointment, you may review much of the information from these forms with the therapist. This can feel repetitive, or even like the therapist did not read what you wrote. The purpose of the repetition is to hear you speak about things in a more in-depth way than what you shared on the forms. They may have more questions about what you filled in, or they may ask about things that have not been covered yet. The goal of this first session is to get to know each other. Your therapist wants to know more about you, the reason you are visiting and what has been helpful or unhelpful for you in the past. They might also provide background information about themselves, including their education or how long they have been a therapist. They will likely explain confidentiality and their approach to therapy. Therapy should not feel like an interview, but this first session might not feel as much like a conversation as future sessions.  There is a lot to cover in the first session to help them create a treatment plan. Sessions are usually 45-50 minutes, but the first may be longer to provide enough time to gain all the necessary information.

What you might not expect

• A “vulnerability hangover.” Early in the relationship, especially after the first few sessions, it is common to feel embarrassed or even ashamed after you have shared very personal information. This is often a reason clients leave therapy before they reach their goals. Therapy requires building trust between the client and the therapist, which can take time. Feeling embarrassed is normal in the beginning and does not reflect how your therapist sees you or your sessions. The relationship between you and your therapist grows stronger by continuing despite these feelings, as the therapist will provide a safe space to share your emotions.
• Therapy may look different than you expect. There are different types of therapy and different approaches to treatment. Treatment looks different based on problems, needs and therapist training. Therapy in one office or clinic may look different than therapy in another. It is okay to ask questions about the modality, or the type of treatment you will be receiving. The approach may be different as well, based on your needs. Although many participate in individual therapy, with just the client and therapist in sessions, therapy can also take place through group sessions, couple and family sessions. Some therapists also offer the option of virtual sessions, usually through an app like Teams or Zoom. These sessions are called teletherapy.
• You may have homework. There will often be between-session homework. The work of therapy does not exist in one hour blocks every other week. Instead, practicing the tools your therapist suggests between sessions allows you to become more independent and take ownership of your progress.
• Chemistry matters. Your first therapist might not be the best fit for you. That does not mean that therapy will not work. The relationship between client and clinician can be complicated, but developing a working relationship is important. Early in the treatment process, you will decide if you can trust your therapist, if they appear to have the skills to treat you and if you feel they will take the time to understand your needs. Personalities also factor into your comfort level. Keeping in mind that it is common to experience some embarrassment around sharing deeply personal information early in the relationship, at some point you may realize that this therapist isn’t a good fit for you. It is okay to seek therapy from another provider when that happens. Therapists want what is best for you and will not take it personally if you choose to try someone else.
• It won’t always feel good. You will not always feel better after a therapy session. Sometimes sharing can feel like a positive release, but often sessions uncover hidden issues and pain. Cooperating with your therapist to work through the pain will bring relief.
• Therapy may take longer than you think. The number of sessions can vary depending on the problems presented and the type of treatment used. About 50% of people feel better in 15-20 sessions. Some clients report noticing improvements after 8 sessions, and some short-term therapy types can meet goals in 12-16 sessions. Psychological conditions may require 12-18 months of treatment.

Opportunities to connect

You are not alone. If you find that you are struggling with suicidal thoughts, there is help available. Consider reaching out to the 988 Suicide and Crisis Lifeline. This service is available 24 hours a day, 7 days a week. You can call or text 988, or you can visit their website to chat with a Lifeline counselor through their online chat option. This resource is very accessible as they offer translation services for many languages and support for the hard of hearing. 988 is also beneficial for those who are concerned about a friend or family member and want to find support and guidance in helping them.

Michigan State University Extension offers a variety of programming and resources to support yourself or loved ones undergoing mental health distress. If you are a farmer coping with stress, the Managing Farm Stress website at Michigan State University Extension offers resources like teletherapy and education about recognizing signs of stress. MSU Extension offers programs such as Mental Health First Aid, which can teach you how to support someone who is experiencing a mental health challenge or crisis. The MSU Extension Virtual Health Programs calendar offers a variety of programming to support your emotional and physical health needs.