Walking into a therapist’s office or speaking to a mental health professional on the phone for the first time isn’t always easy. It can make you feel vulnerable, strange, awkward, or even like a broken toy in need of repair. Trust me — I’ve walked myself into a new therapist’s office more times than I can count over the last 24 years. I’m not sure it gets easier, but it does get more familiar.
It’s uncomfortable to admit that the challenges you’re facing, whether they are real and immediate or long-standing and creeping, might require expert advice. These days, however, it’s easier than ever to connect to a mental health professional. You don’t even have to physically go anywhere in some cases, and you can simply text a therapist who can help you figure out what next steps you might need to take, thanks to platforms like Talkspace, BetterHelp, Therapy for Black Girls, and Ginger. As a result of social distancing, many therapists are conducting their sessions virtually, too, choosing to do phone or video sessions via secure HIPAA-approved platforms to protect patient privacy.
That being said, finding a therapist and working with one for the first time are the two major hurdles you’ll have to clear before you can see the long-term benefits of working with someone who has your best mental health in mind, and sometimes that can be the toughest step to take.
Here’s what you can expect when you see a therapist for the first time (and how to get over those first-time jitters).
Finding the right therapist
I could tell you that it’s super easy to find the therapist who will work with you to improve whatever you are struggling with — but I’d be lying. I’ve cycled through at least a dozen (probably more) therapists since I was 16 years old. Each one had their high points and their low points, but today, it’s much easier to find a therapist than when I was 16. Rather than having to rely on the recommendation of hushed names whispered in bars, or the miswritten numbers of a friend’s therapist scribbled on a napkin, you can hit the web, where you’ll find thousands of options. Since mental health professionals are far more open to virtual sessions these days, it’s even easier to find someone you click with.
A good therapist will support your self-determination and leave you feeling more seen and understood
If you’re seeking a therapist, it’s a good idea to consider your needs and preferences. Do you want someone who works from a mindfulness-based perspective, perhaps offering meditations to ease anxiety? Maybe you want a female who works exclusively with the LGBTQ+ community? What about someone who specializes in very specific techniques like existential therapy (yes, that exists)? Suffice it to say there are hundreds of treatment types you can choose from and all kinds of specializations. Check out Psychology Today’s page on types of therapy that exist.
Not all licensed mental health professionals have the same credentials — there are a variety of certifications, education, and licensing that allow them to practice. It’s important to have a basic grasp of all those letters after their names, as each indicates the level of schooling the professional has had and the type of remedies they can prescribe.
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For example, clinical psychologists will have Ph.D. and/or Psy.D. after their names, indicating that they have completed doctoral degrees in psychology. A Ph.D. focuses more on research, and a Psy.D. focuses on the practice of psychology. In addition to clinical psychologists, you can find licensed therapists, most having a minimum of a Master’s Degree. These credentials can include letters like MSW (masters in social work), LCSW (licensed clinical social worker), LMFT (licensed marriage family therapist), and LPC (licensed professional counselor). There are many other designations, too, and a quick Google search can help you decode anything you don’t recognize when you’re doing research.
Keep in mind that in order to provide therapy in the U.S., practitioners must be licensed and have appropriate credentials, and these are typically listed on their websites. You can always search a therapist’s license number through your state. The Association of State and Provincial Psychology Boards (ASPPB) provides quick links to each state’s database.
If you think you may need a prescription to help with your symptoms, you can seek out a psychiatrist — a medical doctor — who will have M.D. listed after their name. These doctors have gone through extensive schooling to become specialized in psychiatry, which typically means spending two to three additional years in school after completing medical school. These doctors focus on treating the biological roots of mental health problems, and typically don’t provide hour-long talk therapy as a psychotherapist would.
Once you’ve narrowed down the type of therapy you’re looking for, you should check with your health insurer to see which in-network providers offer the kind of treatment you want. In-person therapy is generally pretty pricey, with per session costs running around $100 to $150 and up, and it’s common for clinical psychologists to charge more for services than licensed social workers or or licensed counselors. Psychiatrists almost always charge the most — anywhere from $300 and up. Ensuring that the therapist you’re looking to hire works with your insurance will help keep your costs down if you need to see them more frequently.
Almost all therapists and mental health professionals have some web presence, so the best next step is to look them up. Jenn Kennedy is a Santa Barabara-based therapist specializing in marriage and family. She suggests checking therapists out both by running a search on any search engine and looking them up on platforms like GoodTherapy and TherapyDen.
“If clients take the time to really go through the therapist profiles, they can narrow it down with some accuracy. Notice the specializations they claim, the tone of their description of how they approach therapy, and when they work to see if schedules mesh,” Kennedy says.
She also suggests hopping on the phone with your potential therapist to chat for 10-15 minutes and make sure that you mesh well. “This will help clients get a sense of pacing, personality, and how well they gel with the therapist. It’s also good to ask the therapist how they approach the type of issue the client wants to address. Therapists should be able to give clients a roadmap of how they conceptualize this issue and general ideas about what seems to help.”
In all my years of therapy-hopping, I’ve found it best to think of finding a therapist like hiring someone for a really important job that needs a lot of care and attention. Ask questions that you would ask a job candidate, and if you don’t like the answers, don’t hire that person. Kennedy seconds that idea. She suggests that you should pay attention to the way the therapist speaks, what their photos look like online, and whether or not you feel at home with their style because, she says, “that’s a good indication of fit.” She also suggests paying attention to how organized they are and how quickly they respond to you if you had to send an email or leave a voicemail.
At this point, you should also ask about how much the therapist charges, how long sessions are (some are 45 minutes, while others are an hour or longer), and ask any details about how they bill and work with your insurance. Some therapists ask you to pay in full and then submit the claim to your insurance. Some allow you to pay by credit card rather than check, and even others take HSA. You’re going to be entering a business relationship with this person, as well as a personal one. It’s important to nail all the details down so that you know what to expect.
Once you’ve done the preliminary legwork, it’s time to make that first appointment. I can honestly say that making that first appointment can be the toughest step to take, especially if you have to call to schedule. It’s a good thing that many insurers, providers, and mental health professionals offer online booking these days, making it as easy as clicking a few buttons and putting a few details in to set up your first meeting.
What to expect at your first appointment
Your first appointment will be a lot like a first date without the fear that the person sitting across from you might not like you. A therapist isn’t going to sit you down and instantly label you with some kind of mental health moniker at your first appointment. They need to get to know more about you first. Remember, you’re the one doing the hiring here, and you are in the driver’s seat. You can always fire or break up with your therapist if they don’t work for you, and you can and should set the guidelines for what you want.
Most therapists are small business owners, and if you go to their office, or place of work, you should expect a small, uncrowded waiting room. That is unless you’re going to a large healthcare provider for your appointment, in which case you’ll likely hang out in the general waiting area. Every therapist I have worked with has some kind of white noise machine, or music playing in the waiting room to give other patients in session privacy. When it’s your turn, your therapist will call you, and you’ll head into the office, which is typically set up with a chair for your therapist and a chair or couch for you, depending on the space and the type of practice. Your therapist will offer you a seat, and your session will begin.
A therapist isn’t going to sit you down and instantly label you with some kind of mental health moniker at your first appointment. They need to get to know more about you
What you discuss with your therapist is totally up to you. It usually helps to have a topic to in mind, so that you can maximize your time. It’s up to you how honest and open you want to be about the things you are struggling with, just remember that if you aren’t entirely truthful with the mental health professional you hired, you might not achieve the results you’re looking for. But the good news is you can work your way up to disclosing traumatic, repressed, or painful experiences and feelings. Over time, as you build trust with your therapist, you’ll feel more comfortable disclosing such things.
During your first session, your therapist will ask questions to understand what you’re struggling with and what brought you in to see them. You’ll likely talk about some of your past (family history, traumatic experiences) and how your symptoms or feelings are manifesting today, and how long they have been showing up. You’ll also likely set some ground rules about how to contact each other, how the sessions will go, and what you hope to achieve by going to therapy.
The role of a therapist is, as Kennedy says, “to help you unravel the ball of confusion, indecision, and difficulty that you walked in holding. They will assist you as you navigate new ideas and try on alternate ways of being. They might reflect patterns that have surfaced through your telling of the past and present challenges, however, ultimately your decisions have to be yours to make. A good therapist will support your self-determination and leave you feeling more seen and understood,” Kennedy says. “If that wasn’t your experience, then find someone else!”
If a therapist makes you physically uncomfortable or asks you questions that feel inappropriate or accuse you or openly judge you, you have every right to speak up and leave. You do not have to return to see that person ever again, and you have a right to end your professional relationship with them. Remember, you are in the driver’s seat, and you are hiring this person to help you manage your challenges. If they are actively tearing you down, it’s time to find a new therapist.
“We know so much about others in the first few minutes of talking to them. If we tune in and trust our gut sense, it will give us good guidance on if this therapist is a fit for you,” Kennedy says.
There are plenty of amazing professional mental health providers out there who can help you figure out what your next steps should be to help improve or change your life.
Abigail Bassett is an Emmy-winning journalist, writer and producer who covers wellness, tech, business, cars, travel, art and food. Abigail spent more than 10 years as a senior producer at CNN. She’s currently a freelance writer and yoga teacher in Los Angeles. You can find her on Twitter at @abigailbassett.
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