How Does Therapy Work?

How Does Therapy Work?

You’ve done it. You’ve decided mental health support could be helpful for you right now—an important step toward positive changes in your life. For many people, this first step is riddled with questions. How does therapy work? How do you get the help you need? Here are answers to some common questions people have about mental health services. 

Q: I want to seek professional mental health services, but I feel ashamed or weak for doing so. Why is this?

A: Feeling shame or weakness for seeking mental health care is often the result of mental health stigma or negative ideas associated with mental illness or mental distress. It can be a tough barrier to overcome. While feelings of weakness or shame are common, messages from the media, popular culture, and our communities can further affirm this myth, making it even harder to have the courage to seek care. Some cultures experience this at even higher rates, such as Asian and Black American communities. 

Even as a psychologist, I found myself feeling hesitant to begin counseling or admit it to friends and family. Mental health stigma is everywhere, and can be internalized even when we know that seeking support isn’t a bad thing to do. I would encourage anyone feeling this way to explore where their feelings of shame or weakness come from, and if they’re based in reality or  inaccurate cultural messaging. Chances are it will be the latter. 

Q: How do I know if I need therapy? I’m not on the verge of a breakdown or anything like that. 

A: Therapy isn’t only for those experiencing a mental health crisis or having a “breakdown.” Anyone can benefit from professional mental health services at any point in their lives.

So, ​​why do people go to therapy? Most people seek care because they’re experiencing some sort of distress. For example, some people notice that their thoughts, feelings, or behaviors are becoming more overwhelming, intense, or “out of character” in a way that interferes with their everyday lives. They may find themselves unmotivated, unusually sad, or disengaged in daily activities. Or they may notice that a life circumstance (positive or negative) is causing stress, worry, or confusion, and their best efforts at managing the situation aren’t working.

Professional support can also be helpful when you’re aware of the “right thing to do” and some ways to cope, but you’re having a tough time making those changes. Or sometimes, people seek help because they’re in the process of getting to know themselves better. Therapy is beneficial for anyone who wants to explore and better understand different aspects of who they are, such as gender identity, sexual orientation, or experience as an immigrant.

Finally, one of the best reasons for therapy is simply wanting additional support. It sounds simple, but many of us—especially us high achievers who are used to taking care of other people while juggling and balancing “all the things”—don’t do what we want to do, but what we need to do. And if you just want a safe, consistent space for yourself, remember that you’re worth having that. 

Q:What is the difference between counseling and therapy? 

A: The terms “counseling” and “therapy” are often used interchangeably to describe meeting with a mental health professional. However, many professionals define therapy as an intervention with a licensed mental health professional (typically with a master’s degree or higher) that involves a clinical assessment, which can inform a diagnosis and treatment plan. 

In contrast, counseling is often viewed as a less formal process of speaking with someone who may not be licensed or specifically trained to provide psychotherapy (such as pastoral counseling or career counseling).

Q: Coaching vs. therapy: What’s the difference?

A: Mental health coaching is an intervention that helps people make desired changes in their lives to enhance their well-being. Coaching is driven by clients’ goals. It can help with issues like stress management, anxiety, relationship difficulties, adjusting to changes, clarifying goals and values in life, making decisions, getting unstuck from a particular situation, and prolonged sadness.

However, coaches are not trained as therapists. Coaching is not a substitute for any form of medically prescribed or therapeutic services (including psychiatric services, psychotherapy, or counseling). And it doesn’t involve the diagnosis or treatment of psychological disorders.

Q: What’s the difference between a psychologist and a psychiatrist? 

A: While both professionals work in mental health-related fields and have doctorate degrees, a psychologist holds either a PhD, PsyD, or EdD, and is trained in therapy techniques and psychological assessment. Psychologists spend most of their time working with evidence-based therapy techniques to help clients regulate their mood, behaviors, and thoughts. 

Psychiatrists are also trained in therapy techniques, but spend most of their time assisting people through medical interventions. As a physician with a medical degree, only psychiatrists can prescribe medication as treatment. 

Q: Why should I talk to a stranger about my problems? Shouldn’t I keep my personal and family business to myself? 

A: This type of thinking can also be a common barrier to mental health care, especially when cultural messaging suggests that it’s disloyal to air “family business” with strangers. While it can feel unnatural to talk about personal (and possibly upsetting) information with someone you don’t personally know, it can also be a valuable opportunity to get a new and objective perspective from someone without any personal investment in the outcome of a situation. 

Mental health professionals have education and training in understanding the human experience and can offer insights and research-supported strategies that friends and family cannot. This means they can offer techniques to help regulate mood, thoughts, and behaviors in a way that has been shown to be effective in other people. 

Finally, mental health professionals aren’t involved in your personal life and are obligated to keep the information you share confidential. Because of this, you can feel comfortable speaking in an uncensored way, without worrying about what you say being shared with people you know.

Q: What do I need to do to prepare for my first visit? 

A: Short answer—nothing! Just bring your authentic self and prepare to be as open and honest as you feel comfortable being. It’s perfectly normal to feel a bit worried, tense, or anxious about meeting someone new and possibly sharing intimate information with them. Remember, you’re not being graded on how you act, and you can’t do it wrong. Whatever is true and honest for you during that first visit is exactly what you should be feeling. 

It’s likely that the mental health professional you meet with will ask what led you to schedule your session or what you’d like to get out of your time with them. It may be helpful to reflect on this for yourself, but if you’re not sure, don’t pressure yourself to come up with an answer. It could be as simple as, “I don’t know, but I think this will help me.” 

Q: How long do therapy sessions last? 

A: Typically, sessions with a mental health care professional are scheduled for one hour, but often end at 50 minutes to reserve time for them to prepare for another session. 

Q:What will happen during my first visit with a mental health professional?

A: There are some things you can expect when seeing any mental health professional. For example, you’ll receive documentation with an overview of things like how much it costs, how many sessions are covered by insurance, the treatment approach the professional takes, and confidentiality policies. Your attendance in counseling is confidential, even from your employer. The limits to confidentiality center around keeping people safe, especially those who are unable to keep themselves safe. This includes folks like children, elderly, and people with disabilities. And even if a breach to confidentiality is required, it will only involve necessary professionals—mental health providers are bound not to share information with anyone in your personal or professional life, and are subject to losing their license or being sued if they do so. The mental health professional will also review these things with you. 

If you consent to treatment, the first meeting (or two) will involve you signing some documents to that effect, much like you do at a physician’s office. It’ll also involve taking time for the professional to get to know you and why you decided to seek services. Be prepared to answer questions about your history—the more information you’re able to share, the more likely the professional is to get an accurate understanding of who you are. This is also an opportunity to ask your mental health professional questions to understand if they’re a good fit for you. You can ask questions like, “How will I know if therapy is working?” or “What is your theoretical approach to therapy?”

Q: How often should I go to therapy?

A: As with all things mental health-related, the answer depends on each person’s concerns and needs. It’s common for people to go to therapy once a week. Over time, they may adjust to every other week or even once a month. Those with more complex needs or who prefer certain therapeutic approaches may go to therapy several times a week. Some providers, like Lyra Health’s blended care therapists, typically see clients weekly with several touchpoints (texts, therapeutic assignments, etc.) between sessions. You can talk with your coach or therapist to figure out a plan that works best for you.

Q: Do you have any guidance on what to talk about in therapy?

A: The great thing about mental health coaching and therapy is that you can discuss anything that’s important to you. This could include hopes, fears, thoughts, patterns, behaviors, recent life events, past experiences, relationships—the list goes on and on. There’s no “correct” topic to talk about, no “right” answers to provide, and no issue too big or small. If you aren’t sure what you want to talk about, that’s OK too. Mental health professionals have lots of experience asking questions and giving you space to figure out where you want to go.

Q: Will a mental health professional understand someone of my background or identity? 

A: A common concern of many people who belong to minoritized communities is whether or not a therapist can understand someone like them, especially when they have different presenting identities. It’s important to remember that you have the power to advocate for your wants and needs with your provider. 

During the first visit, you can ask a provider about their work with identities like race or gender and then decide if they’re a good fit for you. Asking questions during your first visit like, “What’s your approach to working with my racial group?” or “How do you incorporate culture, race, and identity in your work?” or “Can you tell me about your experience or training in working with this identity?” can be great ways to get information you need to feel comfortable continuing this relationship.

Remember, one of the most important aspects of your experience with a mental health provider is the relationship the two of you build. Certain demographic requests may help you trust or relate to your coach or therapist. However, it’s possible to establish a trusting relationship with a provider who doesn’t share your racial identity, sexual orientation, gender, or other identities. An open mind and willingness to invest in yourself and your wellness are key. A trusting relationship with your provider should be prioritized above all, because it’s the biggest predictor of the effectiveness of mental health support. 

Q: How long does therapy last? How will I know when it’s time to stop?

A: Mental health is a journey, not a destination. Research shows 15 to 20 sessions are needed, on average, for 50 percent of clients to recover from a mental health condition. However, everyone’s path looks different—some people may benefit from just a few sessions while others may need care for 18 months or more. 

If you have mental health coverage through your employer, check with your employee benefits team to confirm how many sessions are available to you and your dependents. Additionally, life stages and transitions can influence if and when we need counseling. Your therapist should be able to discuss this with you and offer options for decreasing, temporarily suspending, or stopping sessions. This article offers some helpful signs it may be time to take a break. 

Q: Therapy sounds fine, but I also have practices that aren’t traditional or mainstream, such as alternative healing practices or spiritual routines. Will I have to stop doing this to go to therapy?

A: Other practices can absolutely be used alongside traditional therapy, coaching, or mental health-related medication. In fact, I would encourage it, since professional mental health support is just one tool to have in your mental health “toolbox.” While these services can offer great benefits, they aren’t a one-size-fits-all approach and can’t completely solve all problems for all people. So adding other things to your toolbox that promote healing, such as prayer, meditation, nutrition regimens or supplements, exercise, social support, and more, can help you become the best version of yourself. You don’t have to choose between them. What’s healthy and helpful for one person may not be for another, so it’s important to add tools that work for you. You can also talk with your therapist or coach about these practices and their importance in your life.

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About the author
Andrea Holman, PhD

Dr. Holman is a DEI&B program manager on the workforce transformation team at Lyra Health. Previously, she served as a tenured associate professor of psychology at Huston-Tillotson University. She served as co-chair of the health and wellness working group for the city of Austin's task force on Institutional Racism & Systemic Inequities and now works as a leader in the nonprofit Central Texas Collective for Race Equity that resulted from the task force. She has conducted research on understanding the psychological experience of African Americans and racial advocacy from the perspective of Black and Latinx Americans. She has contributed to articles (including publications in The Counseling Psychologist and Harvard Business Review), book chapters, national conference presentations, virtual seminars, workshops, and a number of podcasts on these subjects.

By Andrea Holman, PhD
Program Manager, Workforce Transformation
24 of January 2023 - 11 min read
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