What Do You Do in Therapy? Let’s Walk Through It Together

If you are feeling hesitant about the idea of attending therapy or unsure of what to expect from therapy, you’re not alone. The idea of opening up to someone new, especially about things that feel personal or painful, can be intimidating. Whatever you’re feeling, it’s valid!

When you come to therapy, the goal is to create a space where you feel comfortable talking about what’s on your mind - whether that’s your past, what’s going on in your life right now, or the future you want to work toward.

At Ritenour Counseling, we want you to feel supported every step of the way. To help make the process feel a little more approachable, we asked our Associate Therapists, Ali, Mike, and Olivea, to answer some questions we often hear from clients.

What do you wish more people knew about going to therapy?

Ali: I wish people knew that you don’t have to come in with just one clearly defined problem and stick to talking about only that. Often, my clients are surprised to discover that we can talk about anything, their work stress, their relationship with their mother, a weird dream they had, and we’ll almost always find meaningful connections that help them understand themselves better. Talk therapy works best when you bring your whole self, not just the “problem” parts.

What happens in a therapy session? Do you take notes?

Olivea: I tend to take notes during the session, just on anything that stands out to me as important or information that I want to make sure I remember in the long run. I find writing things down helps me remember the smaller details (such as names or dates) that might be important to the client down the road. I also typically go over this in the first session and cover what I’m generally taking notes on so the client feels comfortable.

What if I don’t know what to talk about in therapy?

Mike: That’s totally okay. Silence doesn’t mean that you have nothing to say. Silence makes room for thoughts, ideas, and feelings that haven’t had the chance to come out before.

Can you give an example of how progress in therapy might look?

Olivea: Progress looks different for everyone. I generally feel like “progress is being made” with a client when they’re starting to gain awareness and insight that they might not have connected with before. For some clients, it can look like realizing they have five different ways to react to a situation rather than a single way they chose to react before. For some, it’s simply being able to tolerate a feeling for one minute longer than they were a year ago. For others, it’s conquering a fear, setting a boundary, telling someone how they feel, being able to compliment themselves, noticing a feeling, realizing something that’s hurting them; it’s so different for every single client that I see.

What inspired you to become a therapist?

Ali: My own therapy experience completely changed my life; it showed me what was possible when someone really sees you and creates space for all parts of who you are. I was so moved by that relationship and the healing it facilitated that I knew I wanted to offer that same kind of presence to others. There’s something profound about witnessing someone’s growth and being trusted with their story.

What to expect from your first therapy session?

First sessions can feel a bit different than ongoing therapy, as they often involve gathering background information, discussing logistics, and beginning steps of relationship building between therapist and client. But what stays the same throughout the process is the emphasis on creating a space where you feel safe, supported, and seen.

Ali: In our first session, I’ll get to know you beyond just what brought you in, your background, values, and goals. We’ll talk about what you’re hoping to get from therapy, and I’ll explain what happens during a therapy session so you know what to expect. Most importantly, it’s a chance to see if we’re a good fit, since our relationship is the foundation of the work we’ll do together.

Mike: I conduct a personal history interview that covers family, education, hobbies, skills, mental health, physical health, and goals for therapy. The big focus is on therapy goals and family or origin history. Most therapists gather this information as sessions go along, but I find that doing this interview covers those bases more quickly.

Olivea: First therapy sessions are a bit different from the next sessions; they’re more focused on getting to know you. We’ll go over logistics (like policies and scheduling), and I’ll ask questions about your background, family, and work to get a sense of your life. I’ll also explain how therapy works and what to expect from the therapeutic process. It might feel a little awkward at first (talking about yourself can sometimes be uncomfortable in general, especially if you’re sharing something painful that’s bringing you to therapy), but that doesn’t mean it’s bad! Plus, you'll always have confidentiality on your side.

Feeling nervous about what to tell your therapist?

Feeling apprehensive about any type of therapy is completely normal. Whether you’re unsure about being vulnerable or uncertain about what the process of psychotherapy involves, a good therapist is there to meet you where you are, with compassion and care.

How do you support clients who are nervous about seeing a therapist?

Ali: I normalize those feelings completely. It makes total sense to feel nervous about opening up to someone new! I let clients set the pace and never push them to share more than feels comfortable. Often, I’ll share a bit about how I work and what they can expect, and I always let them know that part of my job is to pay attention to our relationship and make sure it feels safe for them. The nervousness usually tells us something important about their experience with trust and vulnerability.

What’s one thing you’ve learned from your clients over the years?

Olivea: Boundaries are SO important, things sometimes get worse before they get better, sometimes you just need to be sad for a while, and that’s okay and not necessarily something you need to “fix.” I’ve also learned that everyone (regardless of age, background, or circumstances) has the capacity for change and growth, no matter where they’re at in life.

Starting therapy can feel like a big step, but you don’t need to have all the answers before you start. As our therapists have shared, there’s no “right” way to show up. Whether you’ve come in with a clear goal or are just trying to make sense of your feelings, there’s room for all of it.

At Ritenour Counseling, we’re here to support you through every part of that journey. If you’re considering therapy, we hope this eases some of your uncertainty and offers some clarity on what to expect from in-person or online therapy. When you’re ready, we’re here! Get in touch!

This article was contributed by our guest, Katie Beaver, a UCLA Psychology student.

Other Questions You Might Have about What Happens in Therapy

How long are therapy sessions?

Most therapy sessions last about 50 minutes, though your therapist may adjust the time depending on your needs or treatment plan. Some people set a number of sessions ahead of time, while others keep going until they feel ready to end therapy. 

How do I prepare for therapy sessions?

You don’t have to have everything figured out before you come. Just think about what’s on your mind, whether it’s something from your past, what’s going on in your life right now, or something you want to work toward. 

What are some things to discuss in therapy?

Anything that matters to you is worth bringing up. You can talk about your past, current challenges, relationships, work stress, mental health conditions, or personal growth goals.