What Happens in Therapy?

Curious about what it’s like to see a mental health professional? Here are answers to some common questions.

As you read, ask yourself: How is talking to a therapist different than talking to a friend or parent?

We all have big emotions from time to time. It’s part of what makes us human. Chatting about these feelings with friends, family members, and teachers can be super helpful. But sometimes you need someone who’s specifically trained to help people work through their problems­—in other words, you need a therapist.

You might think that therapy is just for adults. Or you might think you need to be dealing with a major trauma or serious mental illness to benefit from therapy. But in fact, therapy can help anyone who wants to understand themselves and their feelings better. That includes teens: According to the National Alliance on Mental Illness, 28 percent of teens in the U.S. have received some kind of mental health treatment, like therapy.

Dr. Gauri Khurana is a psychiatrist who specializes in teens. She explains, “You’re not crazy if you go to therapy. There’s nothing wrong with you. I actually think that some of the most put-together people are the ones who go to therapy and examine how their actions affect themselves and others.”

We asked some experts for the answers to common questions about therapy, including how to get started if you’d like to give it a try.

1. How does therapy work?

Therapy is a conversation between you and a trained mental health professional. This conversation can happen in-person at a therapist’s office or on a video call.

Usually in your first session, your therapist will ask you questions about your life, how you’ve been feeling, and what you want to get out of therapy. This is so they can start to understand you and think about ways to help you. This is also a time for you to ask them any questions you may have about how you will work together.

After that first session, conversations will probably be less structured. You can talk about anything you want! You’ll get the most out of therapy if you are as honest as possible. This might feel scary at first, but it’s important for your therapist to know the real you. “Therapy is a collaboration,” explains Emily Reading Bianco. She’s a high school counselor in New York. “Your therapist is an expert in mental health, and you are an expert in you! You and your therapist work together over time to find what will help you.”

2. How do I find a therapist?

A great first step is telling your parent, school counselor, or pediatrician that you’d like to try therapy. Your counselor or pediatrician might have lists of therapists who specialize in teens.

If you want to do research on your own, use the search function on the websites of the American Psychological Association (locator.apa.org) or Psychology Today (psychologytoday.com). You can filter your search to find therapists who work with teens. Most therapists will chat with you briefly on the phone to make sure they’re a good fit before scheduling your first session. It’s totally fine to talk to several therapists before choosing one you think is right.

3. Will I feel better right away?

Therapy isn’t going to change things overnight. It’s not supposed to! Dr. Khurana says, “In movies and TV shows, we might see characters go to one therapy session and everything gets solved. But in real life, good changes happen really slowly. Try to be patient.”

Some people go to therapy for a while, then stop when they feel they have tools to work on their problems on their own. Other people go for many years. And sometimes people go, stop for a while, then start again with the same therapist or a different one.

4. How much does therapy cost?

It depends. Different types of therapists charge different amounts. Some have sliding scales, which means you pay what you can afford. Your family may be able to pay for some or all of your therapy with health insurance. If your family has insurance, ask an adult to help you find a therapist who accepts your insurance plan.

There are also options that are free or low-cost. For example, you may be able to set up regular appointments with your school counselor, school psychologist, or school social worker. Many regions also have free support groups or therapy groups for teens. Ask your doctor or school counselor for help finding a group.

5. Will my therapist tell my parents and teachers what I say?

The short answer is no. What you say in therapy is confidential. Your therapist will only tell other people what you say if they are worried you might hurt yourself or someone else, or if someone is hurting you. That is to keep you and the people around you safe.

But if you need to talk about other feelings, even feelings that you might think are shameful, mean, or weird, your therapist will listen and will not tell other people what you say. They might give you advice if you ask for it, but they’ll never judge you for anything you say or tell you you’re wrong for feeling the way you do.

Your sessions with your therapist, regardless of whether they take place in person or online, should feel like a safe space where you can say anything.

6. Are all therapists the same?

No. Therapist is a general term for many different types of mental health professionals. Here are a few of the main types:

  • A psychiatrist has a medical degree (M.D. or D.O.). They can diagnose and treat mental health conditions such as depression and anxiety. If you have a condition that requires medication, you will likely need to see a psychiatrist in order to get a prescription.
  • A psychologist has a doctoral degree (Ph.D.). They can diagnose and treat mental health conditions, but they cannot prescribe medication.
  • A counselor or social worker has a master’s degree. They can help you with mental health conditions, but they cannot prescribe medication.

Reflection prompt: Dr. Khurana says that in real life, good changes happen slowly. Do you agree? Write a paragraph explaining your opinion, including examples from your own life experiences.

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