Starting Therapy: What to Expect, What It Is, and What It Is Not

People arrive at therapy from a variety of different starting points. Some are in acute distress or have reached a point where something has to change. Some have been considering therapy for a long time and have decided to act. Some are not in crisis at all but have a quiet sense that they would benefit from a space to think. And some are not quite sure what they are seeking but they know that something feels off and they are seeking some help in making a change that they have not been able to do alone.

All of these are valid reasons to begin. Therapy does not require a particular level of difficulty or a specific kind of presenting problem. It does require curiosity about oneself and a willingness to engage with what comes up.

When considering therapy it is helpful to have a realistic sense of what therapy actually involves and what it does not.

What therapy is

Therapy is a professional relationship with a trained practitioner. It is conducted within a clear ethical and contractual framework, in which you are offered a consistent, confidential space to explore your experiences, make sense of patterns, and work towards making desired changes. Therapy is collaborative in nature. The therapist brings training, skills, and a particular type of attention. As the client, you bring your experience, your honesty, and your willingness to engage. Neither of those things works without the other.

Therapists can come from many different schools of thought and have a variety of different approaches. Good therapy involves being genuinely heard, perhaps for the first time in a significant way. It involves being asked questions you may not have thought to ask yourself. It may involve sitting with things that are uncomfortable, understanding where they come from, and gradually developing a different relationship with them. The most useful sessions are often the ones that leave you with something to think about rather than something neatly resolved.

What therapy is not

A therapist does not necessarily have a map or a predetermined route to the destination. There is no magic wand, no set of simple answers waiting to be delivered. Therapy is different to advice, and it isn’t about being told what to do. That can be frustrating, but it reflects something important: the point is not to give you someone else’s answers but to help you find your own.

Therapy is an active experience. The therapist holds the space and guides the process, but the work is yours. Coming to sessions and waiting for something to happen tends not to produce very much. Coming to sessions engaged, even if that engagement is uncertain, tends to lead to something more beneficial.

How therapy is typically structured

Typically therapy takes place on a weekly basis. Regular sessions provide a framework and consistency that allows a meaningful therapeutic relationship to develop and work to build from one session to the next.

Some people prefer to meet fortnightly, and this can work well depending on the presenting difficulty and the stage of the work. More ad hoc arrangements are possible in some circumstances, though frequency can have an impact on progress and process.

Sessions are fifty minutes in length. They begin and end at the agreed time. Many therapists like myself offer a free 30 initial consultation to allow you and the therapist to get a sense of each other, discuss what brings you to therapy, and allows you both to consider whether working together feels like a good fit. That assessment goes both ways: you are also assessing whether this therapist and their ways of working feel right for you.

Therapy can be individual, with couples, with family members, or with a young person. Each of these formats has its own particular dynamic and particular considerations, and the right format depends on what you are bringing and the willingness of other parties.

The practicalities: what to expect before you begin

Before therapy begins, there is often some paperwork to be completed. Intake forms which involve having emergency contact and GP details in place so that there is a safety net in place if it is ever needed.

Other paperwork provides the contractual framework within which therapy takes place. Understanding the agreement you are entering into is part of beginning therapy well.

Confidentiality and its limits

Confidentiality is one of the foundations of the therapeutic relationship. What you share in sessions is not passed on to anyone else without your knowledge and consent, with some important exceptions that are essential to understand from the outset.

A therapist has a professional and ethical duty of care which means that under certain circumstances they may need to involve other people or services, including your GP, emergency contact(s), or emergency services, to keep you safe. This is not a breach of trust, it is part of the ethical framework that oversees therapeutic practice, and this should be clearly explained to you before you commence.

For young people under eighteen, confidentiality operates slightly differently. A therapist working with a young person will always discuss the limits of confidentiality clearly at the start, but where there is a risk to the young person’s safety, it may be necessary to involve a parent, carer, or other appropriate adult. My view is that no conversation about you should happen without you, so you will be fully informed of this.

Monitoring risk is part of the therapists ethical responsibility to keep you safe. This will involve asking questions about how you are managing, whether you are having thoughts of harming yourself, and what your support looks like outside of sessions. These questions are asked because your safety matters, and being honest in response to them allows your therapist to support you most effectively.

Online therapy and  Walk and Talk sessions

Therapy does not have to take place in a consulting room. I offer therapy online via video call and this provides consistent, flexible access regardless of where you are in the UK or internationally (depending on the registration requirements of the country that you are in). Online therapy has a strong evidence base and many people find it as effective as, or in some cases more comfortable than, in-person work. It removes the need to travel, allows sessions to fit more easily around work and family commitments, and provides access to a wider range of practitioners than geography alone would allow.

I also offer Walk and Talk therapy in the green spaces of North West London (Canons Park, Primrose Hill, Regent’s Park, and Hampstead Heath) for those who prefer a different kind of therapeutic environment. Walking side by side in nature offers a particular kind of conversation that some people find more accessible than sitting face to face.

Whether therapy is right for you right now

Therapy is most useful when there is some degree of feeling ready to begin. If you are considering therapy and are not sure whether it will help or if now is the right time, the most useful thing is usually to have a free, initial conversation. A consultation does not commit you to anything. It is simply an opportunity to ask questions, get a sense of whether the fit feels right, and to make an informed decision about whether to proceed.

Wherever you are in your thinking about starting therapy, you are welcome to get in touch.

Dr Erin Reid is a counselling psychologist offering online therapy to individuals, couples, adolescents, and families across the UK and internationally, and 'Walk and Talk' therapy in Northwest London green spaces. Visit drerinreid.com to find out more.