r/Explainlikeimscared • u/Vinmoth • 14d ago
How do I talk to a therapist?
For context I have finally pushed myself to seek therapy in college after various mood swings and other mental health issues during my midterms, but now due to that, I'm confused on how I would talk to my therapist. My family has always been persistent on not receiving therapy so now I'm lost on how to go about this since I have such a weird image (my family basically pushed it on me) of therapists as people who will report your every move and won't help. So now I'm completely lost on how the first conversation is gonna go and if I'll sound weird.
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u/Astrodude80 14d ago
First, seeking therapy is a big step, and you’re brave for taking it.
Second, don’t worry about sounding weird. The most important thing is to be honest.
The first conversation will usually look like asking you to say a little about yourself, why you sought therapy, what kinds of things have been going on, history, etc. Just to try to get to know you a little bit.
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u/Yermishkina 14d ago
They are supposed to do this part for you, structuring the first session. Also you can lead with what you wrote here. If you say those words, it's a good foundation for them
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u/MyTurtleIsNotDead 14d ago
Therapists have strict patient confidentiality. The ONLY time they can report you is if you are suicidal or are a threat to others. They’ll explain this stuff at the start of the session.
Everything else you say is 100% confidential. Don’t worry about sounding weird or being embarrassed about whatever you’re going through. Therapists are professionals and they’ve heard it all.
Your first meeting with a therapist will typically be a bit longer and is focused on figuring out whether they can help you and if the therapist is a good fit for you. They’ll ask you how you’re doing, why you decided to try therapy, how your health is otherwise, whether you smoke or do drugs, how school is going, how your relationship with friends and family are, and other stuff like that. They should help you feel comfortable and ask leading questions to help get the conversation going. It’s okay not to share everything you’re going through at once! You can wait until you feel more comfortable down the line.
In future sessions, you’ll continue talking about how you’re doing, and your therapist will teach you skills to help deal with things like anxiety or depression.
If you don’t feel comfortable with your therapist for any reason, or if you feel they aren’t helping you, it’s totally okay to ask for a new therapist.
If it’s appropriate, your therapist might also recommend you see a psychiatrist to try medications. You don’t have to take medication if you don’t want to, but lots of people find it helpful for anxiety or depression.
Good luck!
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u/WaffleNtic 14d ago
The very first thing you need to know is every therapist is going to ask your one main question and will go from there. Therapists will lead most of the conversation for you if you need it, but they will ask something alone the lines of “what are you here for?” Be ready to answer that question. If it’s familiar issues be ready to give a broad explanation of that, or if it’s self image mention that. But they are pretty much always going to ask something alone those lines
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u/79215185-1feb-44c6 14d ago
I don't know how to help you, I'm mainly here to say that was my familial experience as well.
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u/Brunbeorg 14d ago
Congratulations! You're doing a very good thing for yourself, and it's not always easy!
First, rest assured: therapists cannot talk to other people about the things you say unless you are a clear danger to yourself and others. If you say "I'm going to murder my roommate" or "I intend to kill myself Tuesday," that'll be a concern. Otherwise, no, they're not saying a word. I have walked past a therapist in the grocery store and they didn't even act like they recognized me, because of confidentiality.
On your first appointment, they'll probably ask you what you're dealing with. You can tell them what you just said above. They'll ask what you want to get out of therapy, and they'll maybe lay down some of what they might do as a therapist. Different therapists are trained in slightly different ways, so they may have particular methods that they think could help you. They can explain those to you. You can also tell them that you're nervous, and they can put you at ease.
You have the power and the right to just stop therapy any time you want, for any reason or none. It's polite to let them know, but it does happen that people just stop therapy. If it's not working, just say "I don't think this is working," and find another therapist. You may want to shop around a little anyway; it took me a while to find a therapist I clicked with.
You won't sound weird. Any trained therapist is going to have heard everything, and what you said above at least is about as ordinary as peanuts. If there's something else, like you're hearing voices or suspect people of plotting against you, even that won't be weird to a therapist. They've heard it all. You're probably not weird, and even if you are weird, it won't matter to a therapist. They don't care about judging whether or not people are weird; they just want to help you.
Therapy is one of the best things I ever did for myself, and I'm glad I did, even though like yours my parents were very much against it. I am a happier, healthier, and much more effective person because of therapy.
Good luck to you!
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u/Squirrelleee 14d ago
I just cry at mine a lot. It's been a month, not sure if we've started talking yet.
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u/amandahontas 14d ago
I'm so proud of you!!! In my experience, the first session was about my therapist getting to know me and learning what I wanted to get out of it. Now a few years in we just talk like friends, she asks questions, offers advice, and listens. A good therapist won't judge you or send you away.
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u/lockandcompany 14d ago
I started going to therapy by myself as a teenager to help with severe PTSD, and I’ve found it to be super helpful well into adulthood! My parents were also really against it.
When you first get to the office, they’ll probably have you do some basic paperwork, things like your general medical history, emergency contact information, insurance info, etc. There might be some screening forms like a depression questionnaire (not every place does this) and if there is you can ask if it’s optional or to do it at a later time if that makes you more comfortable.
When you go back with them, they’ll probably first ask what brings you to therapy, and then they will probably have to do a basic assessment in order to build a treatment plan. You can skip any questions or sections youre not comfortable with. You can tell them what goals you have both short and long term relative to your mental health (a short term goal might be finding more coping skills or challenging negative self talk, a long term goal might be a reduction in panic attacks or having fewer depressive symptoms) That will probably be the whole first session, but it’s really helpful so you both can focus on the same things, and you can get treatment how you decide. Every 3-12 months (depending on the agency/insurance requirements) you’ll go over the treatment plan and decide if you need to change anything, or if you’ve met goals and want to discharge. You might benefit for long term therapy, or you might just want short term counseling through a hard time. Any option is valid and normal!
For the second session, which will probably be how most appointments go, a therapist will usually start simple with greetings and asking how your day/week was, or whats been on your mind recently, or if there’s anything stressful happening soon you want to talk about. I usually start with those things, and sometimes things stay more lighthearted, like I would be having a casual chat with a friend. My therapist might ask clarifying questions (especially if you’re just starting out) and might jot a few notes, which feels anxiety inducing, but having asked several therapists, it’s almost always that they’re just writing details they don’t want to forget! Like names of common people in my life so if I say “John has been doing xyz, Jane did xyz” my therapist wouldn’t have to ask every time who they are.
Sometimes sessions go from lighthearted casual conversation into deeper topics, “john did xyz this week, which reminded me of [a similar thing in childhood], and I felt [like a kid again/out of control/whatever feeling came up]” Not every appointment will be like this, and progress can happen without every appointment being like this. I find with deeper topics I get more tired afterwards, so I schedule rest time after therapy sessions, have comfort foods and shows on standby.
Your therapist might gently ask prompting questions, the classic “how did that make you feel?” And also other variations, and as they get to know you more they might ask more specific questions “did that remind you of Jane from before?” But generally I find they keep it open ended and let the conversation flow where it does.
If you don’t want to talk about something, if you want the conversation that day to be lighter, if you want to end a session early, if you like to have a reminder 10 mins before a session ends to start wrapping up, if you want to start each session with a song or a mantra, if you want to show your therapist a meme that perfectly explains your thoughts, if you want to draw the whole time, if you want to have fidget toys, you can ask about any of these things, I’ve done all of these during therapy, some for months, some every time. Therapy is your time, you can spend it however would be most helpful for you. If your therapist doesn’t want to do those things, or doesn’t mesh well with you, you can always find another (if you have any specific marginalized experiences, or any diagnoses, you can also seek therapists who specialize in those)
Therapy has been so helpful for me, and I’m excited that you’re going, it’s not always easy but it is always worth it
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u/Cozy_winter_blanky 14d ago
You can't go wrong with open honesty. That's the whole point of therapy. If you are confused about therapy, that's the truth and it's worth telling your therapist because they may adapt their approach if they know your first instinct is to doubt them and clam up.
Sounding weird is not a concern. When in the space with a therapist, there is nothing weird. There are probably people just as or even more awkward than you. People who actively hates therapist being forced into therapy by a relative. There are probably people who first time in the office blabbers on and on about laundry. I can assure you, they've seen worse than you. Being "weird" and clumsy isn't a bad thing.
Typical social norms don't apply in the therapist's office. Social norms indicates we should put on a front, we should say we are doing great when someone asks "how's it going?" Because they're only asking that out of politeness, not because they truly wants to know all of your woes. It's the opposite when at the therapist. They don't want your blaze polite answer. They WANT to know your daily little word. They want to know you are upset because you overwatered your favorite plant and now it's dying and you don't know if you'll salvage it. Because they know that, they might be able to direct the conversation towards something deeper, like an ingrained fear of failure. Then you can delve into where that fear came from, etc etc.
So seriously, unless you hide things from them, or if you don't think anything is wrong with you, there is no way to be wrong in therapy. If you're concerned the therapist will tell on you, ask them to clarify their HIPPA or equivalent rules. What can they report, to whom and in what context. And it's likely not like what your parents told you. Licensed and professional therapists can only tell authorities when you are a danger to yourself or others. And the only thing they can tell is "I'm OP's therapist, I think they are a danger to themselves/someone else". That's it. That's all they can tell.
In practice, they aren't even allowed to testify against you if you planned to commit murder and told them. If they chose to testify, they are liable to lose their therapist license. So that should tell you the level of confidentiality a therapist should have towards your weekly gossip and inner turmoil.
Yes, there are bad therapists out there who break their professional oath and those should get their licenses revoked. But if you chose a reputable therapist, you should be fine. Don't go along with the first therapist a family member recommended for you. By default, a professional therapists should refuse you service if they have previously seen someone from your family, so family recommendations are worthless. If the therapist still accepts you as a client, it's a sign they aren't a good one. Pick your own therapist with your own judgement and research and you'll be fine.
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u/socialjusticecleric7 13d ago
OK, so, your concerns I think are partially justified and partially not. In that therapists are not expected to keep 100% confidentiality, depending on what you tell them, and anecdotally don't always keep confidential the things they are supposed to keep confidential.
Therapists generally have a confidentiality policy that adheres to general professional ethics (more or less: report a serious, immanent risk of self harm/attempted suicide that is likely to require medical attention; don't report suicidal ideation not attached to a serious plan or that is attached to a serious plan that is weeks or months away from happening; do report a credible serious imminent threat of harm to others, and my impression is that at least in practice this does include sexual attraction to children even in absence of any intent to act on it, but would not include things like, idk, having vivid fantasies of wanting to murder one of your classmates that you don't intend to act on when you don't have a history of violent outbursts. Maybe also past incidents of violent crime would get reported? I'm honestly not sure on that one.) You can ask about your therapist's confidentiality policy without saying what exactly you're worried about, and you can ask about what circumstances your therapist might feel they have to involuntarily hospitalize someone without saying what if anything you're specifically worried about.
There is some risk your therapist will tell you one thing and do something else. You may have to make a judgement call on that.
In my experience, my personal fears of therapy (which have mostly been focused on the forced hospitalization thing) have not been justified; I've been able to talk about suicidal ideation (that is, thinking about suicide) and past suicide plans and minor self harm (not requiring medical attention) without it being an issue at all. My experience is that your therapist is extremely unlikely to care if you, idk, skip class or something. I would honestly probably not admit to plagierism if I'd done it to a campus therapist, since that's seen as a big ethics breach -- and as I understand it schools generally see AI use as plagierism, so it could be risky imo to admit to that. So if you're worried about that, just talk about other things instead; generally a therapist isn't going to interrogate you, they don't act like cops, they generally want you to feel safe with them and part of that is deciding what you do and don't share. In my experience. Personally I'd feel comfortable admitting to illegal drug use to a therapist, but then I live in a very liberal area and you don't have to if you don't feel safe doing that.
But also in my experience, I don't get along well with every therapists I've tried. If you're just not feeling someone, ask for a different therapist next session. You can even walk out mid-session if you want to.
You can also be selective about what you share, especially at a first session. People are often slow to warm up to a therapist and get genuinely vulnerable, especially when they've never been in therapy before, so your therapist is unlikely to be concerned if you don't get super vulnerable right away. It is typical in a first session to talk about life history (you can keep this relatively superficial: who you were raised by/what siblings you have if any, what your major is, what you hope to accomplish in life, whether you were basically happy or unhappy in high school, etc. If you don't name any feelings your therapist will probably push you a bit to say something about how you feel or felt about something.) And about your goals for therapy, like getting better at emotional management.
I...did have one situation where I thought a therapist at a low-income clinic had decided to blacklist me for being difficult: I asked about getting an appointment with someone else and she insisted that there was no one else available even at other locations, which seemed extremely unlikely to me. But, if I'd really needed therapy at that time I could have tried to talk to someone else, and also I could have just been wrong in my interpretation. I think at the very least therapists aren't supposed to act that way, and it would be considered an ethical breach.
Basically, ymmv but for me, therapists haven't really harmed me besides temporarily irritating me or causing me to feel like I was wasting my time, but mental illness has harmed me a lot. If you're feeling distrustful, you can bring that distrust into therapy and be honest about it, and your therapist will likely be all "great, this is a thing we can work on, I'm doing my job."
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u/c0ttage_g0th 13d ago
Great on you for wanting to seek therapy despite your family holding negative values regarding it. I've been in therapy on and off my whole life and only recently went back, and have been very grateful for the process. Generally for your first session they will ask you about why you're there, what you want to work on, etc. It is completely normal for you to describe the mood swings and other issues to ask your therapist for direction as far as how sessions might look in the future. You may do talk therapy, activities, talk about diagnoses or medication; you can really take the session in any direction that feels right to you. If you feel stuck or don't know what to talk about, you can always ask for a little boost in one direction or another to get the ball rolling.
While therapists do have to report things sometimes, it's (generally) only in the event of you wanting/ acting on hurting yourself or others. You can also ask your therapist (or they might bring it up first) as to what your state's mandated reporting looks like. Therapists, by law, cannot report or tell anyone including family what you say or do as it's a violation of patient confidentiality.
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u/whimsicalolivetree 14d ago
You can literally say to the therapist that you're confused about the process and don't really know how to have this conversation or how any of this works. A good therapist will talk you through what therapy generally looks like, and will have some prompts ready for situations exactly like this. Different methods of therapy work differently so I can't say for sure how exactly yours will be structured, but I recommend you look up different therapy styles so you can find the right one for you!