A woman dealing with mental health issues

“What happens in your first therapy session?” We asked a therapist all your burning questions

Want to seek therapy, but not sure where to start? Stylist sat down with therapist and writer Sharnade George to find out everything you need to know about therapy, from finding the right therapist to what happens in your first session.

Seeking therapy for the first time can be intimidating. While it’s well-known that therapy is one of the most effective ways to treat mental health conditions like anxiety and depression, the idea of sitting opposite a professional and telling them how you’re feeling can seem scary if you’ve never done it before.

With this in mind, it’s likely you’ll have a lot of questions before your first therapy session. And that’s where this Q and A with therapist, writer and founder of Culture Minds Therapy directory Sharnade George comes in.

Whether you want to seek help via the NHS, find a private therapist, work out what kind of therapy is right for you or just find out more about what to expect from your first session, keep reading to find out more.  

What different types of therapy are there?

“So there’s many different types of therapy. The most popular type of therapy is called Cognitive Behavioural Therapy (CBT). CBT is a talking therapy and it helps you to manage your problems by changing the way you think, feel and behave – because ultimately how we think, feel and behave is all connected to how we feel mentally.

“Often we find that a lot of clients who are struggling think unhelpful thoughts, which we call negative automatic thoughts or NATs for short. These NATs are very spontaneous, and so with CBT we help people to recognise what their mind is telling them based on their negative automatic thoughts, and then help them with managing those thoughts in relation to the difficulty that is currently presenting in their life. So CBT is very solution focused – it focuses on the here and now. If you have a problem in the moment, let’s say you’re struggling with anxiety, CBT will be very good for helping you in the here and now.

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“Another popular type of therapy is counselling. Counsellors work in lots of different ways, but predominantly what a counsellor does which is different from a CBT therapist is explore more of your past and your childhood. Counsellors can use many different types of interventions and therapy, but they mainly focus on the past, and may consider how your childhood could have contributed to the difficulties you’re facing right now.”

Do you need a mental health diagnosis to start therapy?

“No not at all. You don’t need a diagnosis to seek therapy.

“If you do have a diagnosis – so let’s say you go to your GP and speak to them about what you’ve been struggling with – they can refer you to a talking therapy service, which will be part of the NHS. And then based on that the NHS will do an assessment and then they can provide you with a diagnosis from which you can seek therapy.

“But you don’t have to have a diagnosis to seek therapy because therapy can help you with your lifestyle problems as well as mental health problems. For example, therapy can help you if you’re having low self-esteem, struggling with anger management, or having relationship difficulties. You could be experiencing just some general difficulties that everyone encounters, and you may want support from a therapist or a coach, and you can get that support.”

How do you know when you need therapy?

Two women during a therapy session
If you're feeling overwhelmed, stressed or just not feeling like yourself, seeking therapy could help you to understand why.

“Seeking therapy is very dependent on the individual. I like to use physical health as an example – so for me, if I’m feeling quite weak or I’m not as strong as I could be, I will go and see a personal trainer to help. So I say with therapy you don’t need to wait for an end result where things are very bad and you don’t know what to do – you can seek therapy even in the early intervention stages.

“We know ourselves, so we know when we’re feeling quite stressed or overwhelmed. If you’re feeling like you’re not your normal self, you’re withdrawing, you’re isolated, maybe your behaving differently from how you would normally behave or your thoughts are a bit all over the place, you can seek support.

“Although therapy is for people who are struggling mentally and for people who have a mental health diagnosis, it’s also there to help people at the early intervention stages, to help you understand what you’re going through so that it doesn’t continue and get more severe.”

Do you need to prepare anything for your first therapy session?

“The first time you have therapy is generally an introductory session. So it’s about getting to know your therapist, speaking about your difficulties and identifying your goals – what you want to do or achieve from therapy – and just building your relationship.

“As the sessions go on, you can work with towards your goals and the therapist will help you with your therapeutic journey, but the first session is generally used for information gathering and for the therapist to work out how best they can work with the client.”

What is a therapy session like? What if you don’t know what to say?

“The best thing to do if you don’t know what to say is just to go to the session because sometimes a session may be quiet, or sometimes you may just want to cry. Therapy is not always all about taking – it’s also about letting go of certain emotions that you may have suppressed. I’ve had clients who have just come and cried, and then that can start a conversation: ‘How are you feeling?’ ‘What’s made you feel like crying today?’ ‘What’s going on right now?’

“Generally, a therapist will prompt clients. So a therapist might ask how they’ve been since the last session and then perhaps ask how they can help within the sessions.

“If a client does feel that they’re not benefiting from sessions, and they just really don’t want to talk, then maybe it’s about reconsidering whether therapy is right for them right now and whether they need to wait for a bit, because sometimes people need time to heal before they can feel comfortable speaking about how they’re feeling.

“Therapy isn’t about pressuring a person to speak, it’s about giving them time and letting them make the decisions that are best for them.”

Who is meant to talk more? The therapist or the client?

“Definitely the client. If the therapist is talking too much, that’s a bit of a ‘hmmm’ situation. In my sessions, I generally want my client to talk more than me as the therapist, because my aim is to guide you through therapy.

“The whole aim of therapy is for the client to understand what they’re experiencing, how it impacts their lives and what changes they want to make. As a therapist I can’t advice a client what changes they should make – they need to come up with their own changes, because otherwise that’s me telling them how they should live their life and what they should do.

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“So the client should definitely be speaking more, and the therapist should simply be guiding the client as they’re talking and helping them feel encouraged and empowered to speak about what they’re going through.”

Is it OK to change therapists once you’ve started therapy?

“It’s OK to switch change because sometimes you may not build that therapeutic alliance with your therapist and that’s totally OK. As therapists, we know that we may not be the best fit for each client.

“What I would say is think about the reasons why you’re changing therapist before you do so. Maybe you have a therapist that provokes your emotions, and so you feel quite emotional during the sessions – you might want to change your therapist because you feel like they’re bringing out emotions that you don’t want, but that might be good for you because during therapy we want to unpick those emotions and help you.

“So I would say if you feel like you want to change therapists, take some time to think about the reasons why you want to change your therapist, and if changing is going to be the best solution for you.”

What if you decide that therapy isn’t right for you?

A woman looking out her window
If you feel like you're not benefitting from your therapy sessions, it's important to let your therapist know so they can help.

“If you decide that therapy isn’t right for you, that’s OK. It takes a lot of courage to even seek therapy, so to know that therapy isn’t for you, that takes even more courage.

“It’s important to communicate how you’re feeling about therapy with your therapist, because what you don’t want to happen is to continue in therapy and it be detrimental to your mental wellbeing because you’re not gaining anything from the therapist.

“So try and communicate how you’re feeling in the best way you can, whether that be face-to-face, in an email or over the telephone. But I would definitely say communicate with your therapist if you feel like you’re not benefitting from the sessions.”

What should you do if you’re afraid your therapist will judge you?

“Feeling like you’re going to be judged is very common because we live in a society where everyone gets judged, especially with mental health, because mental health is still stigmatised. But one thing a therapist will never do – or should never do, because we’re taught not to in training – is judge you.

“We’ve not only got an understanding of what our clients have gone through, but we’ve spoken to many clients and we understand mental health, we understand how mental health can manifest and we understand that life can be quite challenging. We always come from a place of being able to empathise with the client and understand how the client is feeling, and we want to work out how best to support the client.

“A therapist judging you for your mental health is like a doctor judging you because you’ve injured your knee. We’re not there to judge – we’re there to empower and encourage.”

How often should you go to therapy? And how long for?

“In relation to the frequency of therapy, you can have sessions once a week or you can have sessions fortnightly – it’s dependent on the individual and what they can tolerate and manage, because what you don’t want is to overwhelm yourself with too many sessions, because some people find them quite overwhelming and emotionally provoking.

“When it comes to the duration of therapy, with CBT sessions, they can be structured in different ways. You could have six, eight or twelve sessions, for example. But I think it’s not about the number of sessions you complete, it’s about what you’re learning from each session, because you can learn so much in three sessions, for example.

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“Therapy is a journey, so you’re going to continue to grow and you’re going to continue to learn so it’s dependent on the individual and how long they want to be in therapy for and how long they see themselves in therapy.

“Therapy is generally not long term, so it’s not something you will have for the rest of your life. While it can be more long term, generally it is short term. But I wouldn’t put a number on how many sessions you should complete – it really is dependent on the individual and what they’re struggling with.”

Are any problems too ‘small’ for therapy?

“No problem is too small. Everyone’s lifestyle is different and everyone’s journey is different – many people go through different difficulties in their life. And it’s all about understanding that everyone has different temperaments, so what could trigger me may not trigger somebody else. Therapy is all about understanding your mind, how it works, how you think, how you feel and how you behave.

“Essentially the client can come in with any type of problem or difficulty, and we help you in overcoming and managing that. So if you’ve noticed that your main problem is affecting your daily functioning – so your work life, your social life, your family life – or you’ve noticed you’ve withdrawn from others and are not living a life based on fruition, then no problem is too small. We can unpick that problem and help you manage that.”

How should you go about finding a private therapist?

A woman searching the internet for a therapist
Online therapy directories like Sharnade's are a great place to start when you're looking for a therapist.

“I have a directory of therapists called Culture Minds Therapy, and how it works is that all the therapists have audio and video content, because for me I feel that being able to hear your therapist speak and being able to see the work that your therapist does can really help you to recognise whether that therapist will work for you.

“Therapists will also have a profile where you can see their speciality, so you can work out whether that therapist can help you with what you’re struggling with.”

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“My directory also has a personalised matching service which some people find very helpful. Sometimes it can be quite overwhelming when you search for a therapist and there are so many people available, so how our matching service works is you send us an email about your main problem, we have a telephone consultation with you an then we will find a suitable therapist for you based on your preferences.”

Therapy can be expensive and NHS waiting lists can be long – what private therapy options are there for people on a budget?

“Obviously you do have the free options with both the NHS and local mental health charities. But when it comes to private therapy, therapists can also provide something called a sliding scale. A sliding scale is there to help people if they’re having financial difficulties, so the therapist can work with you and your budget and set a price based on an understanding of how much you can afford.

“It is dependent on the therapist – some therapists may have it, others won’t – but I do have a sliding scale.”

For more information on finding a therapist and seeking both free and private therapy, you can check out Mind’s website or access the NHS guide. 

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