What to know before starting therapy | The Oscar Blog | Oscar | hioscar Blog | Oscar
What to know before starting therapy
We asked Charlotte Elkin, a mental health provider and Licensed Clinical Social Worker, to speak on what to expect.
General HealthClinically Speaking
5 min read
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Judgment, fear and embarrassment are some common reasons people are hesitant about starting therapy. It’s understandable, talking to a stranger about yourself can feel unnatural for some. So to help demystify therapy, we asked Charlotte Elkin (opens in new tab), a mental health provider and Licensed Clinical Social Worker, to shed some light on what to expect. Here’s what she said about what to know before starting therapy:
1. How can I benefit from therapy?
There are many benefits of therapy. In general, people look to therapy when they feel overwhelmed, stuck, or in pain, and realize that the strategies they have used to cope with life’s challenges are no longer working. Or, the strategies they’ve been using to cope are actually causing more problems, and/or are not enough.
2. How do I find a therapist that’s right for me? What are signs of a good therapist?
Today there are more ways than ever to find a therapist. Some options include using an insurance-based search tool, a website like Psychology Today (opens in new tab), a digital therapy app, or the recommendation of a trusted friend or medical provider. Usually there is an option for an initial consultation, where you can meet the therapist and get a sense of whether or not you feel comfortable talking with them (trust your gut here). You will also get a taste of how they work, and the types of questions they may ask. Feel free to ask them how they would approach treatment with you.
When researching a therapist online, look for keywords. You usually can filter on the basis of a therapist’s specialization (anxiety, depression, PTSD, etc), the type of therapies they use (cognitive behavioral, psychodynamic, EMDR, etc), populations they work with (LGBTQ, incest survivors, children, etc), language spoken, and/or a therapist’s identity (BIPOC, LGBTQ, Christian, etc). Pay attention to any additional information offered on a webpage, beyond just filtered categories. A good rule of thumb: if a therapist has mentioned a particular area of interest or training in their description, they are more likely to have truly trained in it than if it’s merely a category they “checked off.”
3. What should I expect in my first therapy session?
Whether you are embarking on therapy in-person or virtually, you can expect that your first therapy appointment will start and finish on time, and expect that the time has been allotted solely for you, without interruption.
A therapist should ask what you are hoping to get from therapy, why you are seeking help now, and for some general information about who you are, how you usually cope with life’s challenges, and how you believe your current situation came to be. Some therapists, depending on their treatment orientation, may ask you to fill out paperwork in advance, including details about your symptoms, any medications or substances you are using, other health issues, and any past experiences with mental health treatment. Others may do a more thorough intake, with more detailed questions about your family history and life experiences, in order to determine the best treatment approaches, and as a way to get to know you better. Before leaving the first visit, you should have a general sense of what to expect from the first few months of therapy; however there is often not enough time in a first visit to experience actual therapy interventions.
4. How should I prepare for my first therapy session?
First, it’s important to be clear on cost, how the therapist accepts payment, and if there is an option to use insurance. You may also be asked to complete a HIPAA agreement and provide other administrative information in advance of your appointment.
Otherwise, there is really no need to “prepare” for therapy as the therapist is trained to ask questions that shape the process, in real time. Knowing details about your history, like medications you have tried, as well as any family history (particularly about mental health and addictions, as there can be genetic components to each of these), is helpful.
Once therapy is underway, some therapists will suggest exercises or tasks to do in between sessions, to maximize the treatment and allow for its sustainability. Consciously paying attention to symptoms and behaviors between sessions is also a way to notice any patterns that need addressing. Akin to workouts, new perspectives and tools gained in therapy are only effective if they are used. These days much evidence points to the growth of new “neural pathways” that form as a result of therapy, even in those of us affected by ongoing trauma. Actively incorporating new approaches between therapy sessions is an important part of rewiring the brain, enhancing the time spent in actual therapy sessions.
5. How will I know if therapy is helping me or “working”?
Depending on the nature of your needs, your expectations, and your past experiences with therapy, you may find therapy to be immediately helpful or you may discover that it takes some time until you feel its positive effects. In general, because therapy requires you to look at your life (rather than ignore it or blame your problems on others), one sign that therapy is “working” is greater self-awareness, including emotional awareness (around a range of feelings, not just the “good” ones). Another is deeper insight into what, within yourself, is blocking you from living your best life. This clarity is needed in order to reframe past beliefs and experiences, heal, and then, move forward.
Concrete signs of “moving forward” can include a decrease in initial symptoms, or positive changes in behavior. For example, experiencing less outbursts and hopelessness, or coping with stress in ways other than by drinking and taking drugs. Other signs that therapy is working can include trying to accomplish things you weren’t able to in the past, gaining a sense of closure on unresolved issues, or feeling more at peace in relationships.
In general, it’s reasonable to expect progress in therapy however it’s not always possible to measure it in yourself. Asking trusted friends or family members for feedback and directly checking in with your therapist are important steps in understanding whether the therapy you are in is working for you.
Charlotte Elkin is a Licensed Clinical Social Worker located in NYC. She has been in private practice since 2003 and currently provides behavioral health consultation to Oscar Medical Group’s primary care providers.
