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What to Expect When You Start Therapy

I was never a big believer in therapy until I started myself. It’s been a literally life-changing experience in the best possible way — mostly due to luck.

I was adamant that I didn’t need therapy until my life was a wreck and I couldn’t stand myself anymore. I happened to luck out and get assigned to a therapist who works with OCD patients, who immediately recognized my symptoms. I know a lot of people aren’t that lucky.

And if your experiences are different or you want to add your own advice, please comment!

Preparing for Your First Appointment

First, don’t think of starting therapy as admitting failure. This was my problem, and dragging my feet on some of my therapist’s suggestions (like starting medication) slowed my progress down a lot at first. And that’s OK — it was something I needed to deal with.

It’s OK to need help and advice now and then, but seeking therapy doesn’t mean you’re weak. It means you’re strong; you have a problem with your mental health, and instead of avoiding or ignoring it or just trying to survive it, you are facing it and learning tools to help you cope. That takes guts. I wish I’d made that connection a long time ago!

One thing several websites suggest when starting therapy is to make a list of goals and expectations. You can go over these goals during your first session, decide which ones are best to tackle first, and make sure your expectations are realistic.

A few other preparation tips:

  • Research your therapy options (if you’re not limited by your HMO). Therapists often specialize in certain disorders. If you have no idea what’s going on, this may not help, but if you’re fairly sure you have something in the depression or anxiety families, finding a therapist who specializes in mood disorders or anxiety disorders will help you get the help you need. Psychology Today has a tool for finding a therapist; the International OCD Foundation has one as well, right on their homepage.
  • Write down any questions you have. If you think you have OCD (or have been diagnosed in the past but not found effective treatment before), one of those questions should be, “Do you guide patients through exposure and response prevention treatment?” ERP is a type of cognitive behavioral therapy, and is often very successful in treating OCD. If the therapist doesn’t do ERP or CBT, and especially if they become defensive or dismissive of your questions, the IOCDF suggests scratching them off the list and moving on to someone else. They also have a list of other potential questions.
  • Keep track of your symptoms for at least a few days. You can do this with an app, a paper journal, or however else you’re comfortable with. If you’re not comfortable writing your specific symptoms down (I wasn’t, when it came to intrusive thoughts), you can use shorthand or clues for yourself, but keep in mind your therapist may encourage you to write out or say your symptoms aloud. But a list of your symptoms will keep you from forgetting anything important, and can help your therapist figure out what’s going on more quickly.

That said, don’t go overboard! A lot of us OCDers are big on lists and become very anxious about forgetting things. If all goes well, though, this will not be your only therapy appointment, so if you forget something important, you can bring it up at your second session.

What to Expect When You Get There

My therapist is through Kaiser, so when I called to make an appointment, they encouraged me to go to a group intake meeting first. I didn’t want to (and they said I could skip it if needed), but I went.

It was nerve-wracking, but it ended up being a very short meeting where one of the staff members just gave us a booklet of phone numbers and went over what we could expect in our sessions. They also gave us information about the therapists we’d see that day, and a shopping bag with items like stress balls, bottled water, pens, and so on it in.

When I actually met with my therapist, I cried and didn’t say much, answering some questions about my background and trying to explain the problem without actually sharing any details (not helpful). The little information I shared was enough for her to immediately tell me I have OCD. She went over what I could expect, gave me a booklet about anxiety disorders that had breathing exercises in it, and scheduled a couple more appointments.

I also got my first “homework:” I’d been limited my diet for fear of food-borne illnesses, so she wanted me to try to eat something like beef or pork fried rice (no going straight to a steak full of mad cow). That was it.

Aside from the group intake, my first appointment wasn’t really out of the ordinary. I can’t speak for how other therapists work, but Dr. John Grohol wrote a couple of articles right here on Psych Central.

According to Dr. Grohol, the first session is mainly for the therapist to gather information that will help develop some initial steps toward treatment. They may ask questions about your current problem, as well as ask about your history and childhood.

You may get a referral to a psychiatrist for medication. You do not have to go. If you don’t want medication, you can talk to your therapist about it, and see if they’re willing to work with you for a few months.

That said, if your therapist is recommending medication, it’s often because they feel it will help you in your course of treatment. I refused any and all medication for three months of therapy, and made next to no progress. When I finally tried medication, it helped immensely, and every time I’ve tried to go off my OCD has spiraled back to unmanageable (for me) levels.

There’s nothing wrong with needing medication, and there’s also nothing wrong with trying other things first. This decision is one you should discuss with your therapist and psychiatrist if you have any qualms about medication at all.

Dr. Grohol also offers three tips for your first session, including to trust your gut. Your first session may be anxiety-inducing (though it may also be a relief to get it over with), so keep that in mind. But if, after a couple of sessions, you don’t feel like you are building a relationship with your therapist or you feel they cannot be trusted with your care, it’s okay to seek out someone else.

Final Thoughts

I won’t lie — taking the plunge and going to that first therapy session can be really, really scary. But for most of us, in the long run, it is so very worth it.

We fear therapy because of the stigma that surrounds mental illness, and because we feel like we should be able to handle mental health issues on our own, without help. But you wouldn’t treat diabetes or a broken leg by yourself, and no one would think you were weak for getting a doctor’s help.

The idea of therapy can be scary, but your therapist is not there to judge you. They’ve heard it all before. I danced around my intrusive thoughts for a long time in appointments, until my therapist basically told me what they were, and that she’d had several patients with similar thoughts.

Your therapist’s job is to be compassionate and guide you through whatever mental suffering you’re dealing with, so that you can learn to cope with mental illness and be content. They’re there to help you.

That first step is a doozy, but I’m so glad I took it.

What to Expect When You Start Therapy

Kyla Cathey

Kyla Cathey is a freelance writer from Galt, California who has been overcoming OCD for the past year, after struggling with it for much of her life.

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APA Reference
Cathey, K. (2016). What to Expect When You Start Therapy. Psych Central. Retrieved on January 21, 2019, from


Last updated: 5 Mar 2016
Last reviewed: By John M. Grohol, Psy.D. on 5 Mar 2016
Published on All rights reserved.