How to make the most of your first (or next) therapy appointment

Therapists often do not enter sessions with clients with an agenda, especially if the relationship is new.
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By Caroline Moss

We’ve already talked about how to find a therapist, so here comes the next big question: What should you be talking about with your therapist? How should you be spending your 45 or 60 minutes a week?

As a longtime therapy-goer, I can tell you there’s really no right or wrong answer. Of course, that’s probably not what you want to hear. Therapists often do not enter sessions with clients with an agenda, especially if the relationship is new. In my experience, my therapists (and I’ve had a few throughout my life) generally provide the silence and space for me to decide what I want to talk about and how I want to spend that time. Sometimes the answer is obvious — anxiety around the coronavirus, feeling unmotivated in my work, things not feeling right at home, stressed about finances or the future — but sometimes I show up to therapy in a pretty good mood and think to myself, "OK, now what?" I pay an exorbitant amount of money just to stare at you while you stare back at me?

Here are some tips to avoid feeling like your next appointment's been a waste of time or money.

1. Understand your therapist's approach

I asked Caitlin Lynch, a licensed clinical social worker in Chicago, to lay out the different approaches therapists offer and the kinds of issues they can help manage. Knowing what they are can be an important part of anticipating how you’re going to spend your time with your therapist. Lynch also explained that it’s not really about the type of issue you'd like to discuss, but more about how each type of therapist will approach it in their practice.

  • Psychodynamic therapy: This involves a longer-term, relationship-based approach. You'll likely dive into your origin story in an attempt to discover the root of the current challenges you're dealing with.
  • Skills-based therapy: Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) all fall into this category. This type of therapy can be shorter-term and teaches you tangible skills to help better manage emotions.
  • Eclectic: This approach is a combination of different treatment styles, mostly from the methods mentioned above.
  • Psychoanalysis: Going very deep a few times a week and you are laying down. This is how therapy is often depicted in Hollywood.
  • Trauma-informed/trained: This approach relies on a therapist who has treated patients with trauma and can use different methods to help you process yours.

If your therapist does not fit your needs, they should be able to recommend someone who does.

2. Speak up about how you'd like the conversation to go

The first time my current therapist let a silence go on too long for my liking, I told her I respond best when someone else is asking me questions and setting an agenda. I was more direct with her than I would be with a friend or a colleague, mostly because I am paying her for a service and it’s expensive. Therapy is your time. Whether you sit in silence or talk for an hour doesn’t actually matter too much to your therapist, so it’s best to tell them what you want.

My therapist told me she wasn’t much of a question asker and I basically said “too bad, so sad” (but you know, with other words). She wasn’t saying no, she was just telling me how she worked. If I had been new to the therapy game I probably would have been like, "OMG, no problem. Please let me know how I can be the best therapy patient." But that’s really not how it works.

You literally have to tell them what you want out of that relationship. And at first, part of the therapy process is actually figuring out what exactly that is. If you don’t know yet, you can tell them you want help setting goals or working through a friendship or relationship problem. Maybe there’s something bothering you at work, or you’re not getting along with a family member, or you’ve been feeling sad and uninterested in things you usually love and you don’t know why. Even just starting somewhere broad will help a therapist direct you and start peeling away at layers that you may not be seeing on the surface.

3. Use "good" days to reinforce the progress you've already made

One of the biggest things I have taken away from therapy is the idea that consistency in attending sessions is the most helpful thing you can do to promote your own emotional and mental growth. If you only go to therapy when you’re at the brink — using it as a buoy while you’re moments from drowning out at sea — you may find that you aren’t making a ton of progress.

In fact, it’s often the problem-free sessions, the ones where everything that week is going fine and I have no immediate issues to deal with, where I learn the most about myself. That’s what my therapist calls building my toolbox, a phrase I hate but a phrase that has no better replacement. On those good days, I ask about things that I know I consistently struggle with: my temper, my anxiety level when there’s a change of plans and I have to redirect course, stuff like that.

Your therapist is not there to tell you what’s right or wrong, good or bad. They are there to help you advocate for yourself and gain perspective on your place in the world. That education can be gained through an entire host of exercises, but only you can shape what you want those to look like.