What Does Therapy Actually Look Like?

If you’ve never been to therapy before, you may have wondered what actually happens once the session begins.

Maybe you picture something you’ve seen on television or in a movie: lying on a stiff sofa while a very serious, stoic therapist sits across from you, asking question after question, all the while scribbling notes.

The reality can be much simpler—and much more wonderfully human.

After more than three decades as a therapist, I’ve found that some of the most meaningful sessions don’t necessarily feel like therapy. Sometimes they simply feel like a comfortable conversation between two people.

So, what happens at the first appointment?

When I meet someone for the first time, one of my priorities is helping them know what to expect.

We’ll talk about how that initial appointment works, including confidentiality and its limits, and then I’ll ask some questions to help me learn more about you, your history, and what brought you to therapy. I’ll also ask whether you’ve been in therapy before. We’ll talk about whether that work was helpful or if you’re looking for something different.

There is no expectation that you walk into that first appointment and immediately tell me the most difficult things that have ever happened to you. You are in charge of what you choose to share, and we can always allow it to unfold as you feel ready.

That first meeting is also an opportunity for you to get to know a little bit about me. Feeling comfortable with your therapist matters, and it’s important that you feel that we’re a good “fit.” At the end, we can talk about whether you’d like to schedule another appointment. There is no pressure to do so. This time belongs to you and your voice matters.

“Owning our story and loving ourselves through it is the bravest thing we’ll ever do.”

- Brene Brown

What do we actually talk about?

Pretty much anything. And everything.

In later sessions, I’ll often begin by asking how you’ve been feeling and whether something has happened since we last met that you’d like to share.

Sometimes people tell me, “I really don’t have anything to talk about today.”

And that’s okay, too.

Therapy doesn’t have to be an hour devoted exclusively to problems. We might end up talking about a recent book you’ve read or a movie you’ve seen, a favorite sports team, time with friends, something funny that happened during the week, or any number of seemingly ordinary things.

Those conversations aren’t necessarily wasted time or distractions from the “real work.” They help me get to know you. And very often, ordinary conversations lead naturally into something much more meaningful.

There is room for humor in my sessions, too. Therapy can be serious when it needs to be, but I don’t believe it needs to feel serious all the time in order to be valuable. I welcome laughter.

My hope is that it feels calm, safe and, yes, sometimes even enjoyable.

Will my therapist tell me what to do?

Not necessarily—and that’s intentional.

I don’t see my role as sitting across from someone and handing them the answers to their life. Even if I did, I certainly don’t have all the answers.

Instead, I may ask questions that help you explore what you think, what you want, and what feels right to you. We can look at possibilities together, and I may offer another perspective or suggestion when I believe it could be helpful.

But one of the most valuable things that can happen in therapy is discovering that you already have more insight than you realized.

Over time, therapy can help you learn to trust that insight—to recognize your own strengths, build resilience, and feel more confident navigating challenges when they arise.

“That’s it?”

Years ago, I met with someone who was required to have what was essentially a mental health wellness visit as one part of a larger treatment process.

He wasn’t particularly interested in therapy (and he made that very clear to me!) and didn’t expect to get much from the appointment.

I explained that we could simply spend a few minutes checking in. That would be it and he’d be free to leave.

Instead, we started talking.

And talking.

And talking.

After some time, I let him know that the session was ending. He looked at me and said something along the lines of “That’s it?” and “It’s already over?”

“That’s it,” I told him.

He was surprised. This wasn’t at all what he had expected.

And then something wonderful happened: without any prompting or encouragement from me, he asked if he could schedule another appointment.

He had discovered that therapy wasn’t what he had imagined. It was simply a place where he felt comfortable enough to talk. And someone had listened.

Sometimes therapy really can be that simple.

But therapy isn’t always comfortable

There are also times when therapy is difficult.

Sometimes we may explore something that hasn’t been looked at for a very long time. I often compare these moments to removing a bandage from an old wound that never completely healed. Healing from an injury or surgery can be uncomfortable. Emotional healing can be uncomfortable, too.

The goal isn’t to create pain for the sake of pain.

The difference is that you don’t have to sit in that discomfort alone. And to remember that with healing comes relief.

If you share something painful, I’m not going to leave you there wondering what to do with it. We can sit with it together. We can try to understand it, navigate the feelings surrounding it, and work toward finding some peace on the other side.

When someone trusts me with something they’ve perhaps never told another person, I consider that a privilege.

There is no judgment.

There is simply another person sitting with you and saying: We can look at this together.

Do I really need therapy?

You don’t need to have experienced a major trauma or have a serious mental health diagnosis to benefit from therapy.

You don’t need to reach some imaginary threshold where your life has become “bad enough”.

I don’t believe there is a measuring stick for struggle.

We each have our own experiences. At different times in our lives, some challenges will be bigger and some will be smaller. They are still our challenges, and they still matter.

Sometimes people come to therapy because they’ve talked to friends and family and they’re still struggling. Sometimes they don’t want to burden the people they love. Sometimes they’ve told the story so many times that they feel as though they’ve “worn out the welcome mat.”

And sometimes they simply want an objective person who isn’t part of their everyday life to sit with them and help them sort through what they’re experiencing.

Therapy can be that place.

You don’t need to know what to say

Perhaps this is the most important thing I would tell someone who is considering therapy for the first time: You don’t have to show up with the answers.

You don’t even have to know exactly what the problem is. You can simply know that something in your life doesn’t feel the way you’d like it to feel. Or that “things” aren’t working. We can start there.

Together, we can explore what you’re experiencing, what you’d like to be different, and what might help you move toward that change.

And somewhere along the way, you may discover something surprising:

You had more of the answers within you than you thought.

………

Ready to talk? Stone Harbor Therapy provides online therapy for women throughout North Carolina and New York, with support for anxiety, relationships, grief, fertility, motherhood, and life transitions.
Contact Stone Harbor Therapy to schedule a free 15-minute consultation.

Mary Claire Kerwin, LCSW
Founder, Stone Harbor Therapy for Women

This article is for educational purposes and is not a substitute for individual mental health care. If you are experiencing an emergency, contact 911 or 988.