What to Expect: Therapy for High Functioning Adults

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I remember my first time going to therapy as an adult. While sitting in the waiting room for my appointment, I could feel my anxiety rise with the uncertainty I was experiencing around the whole process. My thoughts ranged from “how much should I share?”, “what will she think of me?”, and “is this going to be awkward?!”. 

I really didn’t know what to expect. All I did know was that what I had been doing was no longer working, and I could really use some professional guidance to help get me through the current challenges I was navigating.  

“So what brings you in today?” is how our session began. 

I can’t remember how much or how little I shared that day. I do remember feeling much lighter afterward, like the weight I had been carrying had been lifted in a way, or at least like someone else was going to help me carry it. I no longer felt alone in my thoughts and struggles.

Finding The Right Fit

Beginning the process of therapy can often feel quite overwhelming. For one, it can be hard enough to actually find a good therapist that you feel comfortable with. It’s challenging to know where to look, who to ask, or what to look for in a therapist. I usually recommend requesting a 15-minute consultation call to touch base with a few therapists and see who might be the best fit based on your conversation. Many therapists I know will be happy to offer a consultation call for free.

When it comes to successful outcomes in therapy, the relationship is the most important thing.

This is why it is so important to find a therapist who is a good fit for you. During the consultation call, I recommend asking any questions that come to mind about the process of therapy. Some questions, in particular, that might be helpful could be “what is your style like as a therapist?”, “what interventions or approaches do you primarily use?”, “what populations do you typically work with?”, “what are your specialties?”, and “have you worked with people in similar situations as me?”. This can help you gain a better understanding of the therapist’s approach and overall experience, and help you get a feel for what it’s like talking to this person (do you feel like you could potentially open up to them?). It’s kind of like dating. If you feel someone is not a good fit for you, that’s okay. We aren’t meant to be a fit for everyone, and you don’t have to settle until you find the right match.

There is also a lot of confusion about insurance (naturally). A question I get asked often is why so many therapists do not accept insurance (meaning they are private pay/out-of-network providers). There can be a lot of restrictions that come with accepting insurance. Typically, most insurance companies offer a very low rate of reimbursement for therapists, and payment can often be delayed. A diagnosis is also often required when working with insurance companies. As a humanistic psychotherapist, many clients that I work with (high functioning, young professionals) do not meet the full criteria for a mental health diagnosis. Many people seek out therapy because they are dealing with life and the struggles that come with navigating life, not because they are seeking a diagnosis or struggling with a particular disorder. This is why there are usually more options available for therapy when paying out of pocket/using an out-of-network provider. 

Something that I recommend is to check with your insurance about your out-of-network mental health benefits. Some insurance companies may offer reimbursement upon submitting a superbill (a receipt that shows proof of payment, as well as any diagnoses) for therapy. It is uncommon for insurance to offer full reimbursement for sessions, but they may offer anywhere from 40-60% of the cost. Basically, you will still be responsible for paying the full fee to your therapist upfront, but you could get some money back if you send a superbill to your insurance company. It is also important to ask what your deductible is before they will begin reimbursing you. (If your deductible is $1000, they will not start reimbursing some of the cost of therapy until you meet this amount). You can also use an HSA or FSA account to pay for therapy.

The Process of Therapy

So what happens once you’re actually in your first session? Where do you even begin? 

I think an important point to make is that you don’t have to know what to do when beginning therapy. You don’t even need to prepare! Therapy is a relationship, and although it is unlike any other relationship you will have, it takes time to get to know someone and build trust with them. This is why the first few sessions are mainly focused on building rapport, your therapist gaining a better understanding of who you are, your background/history, and what your goals are in therapy. 

It might be helpful to consider what you’re hoping to get out of the process of therapy, and what your expectations and goals are in therapy. 

As this process is unfolding, you can choose to share as much or as little as you feel comfortable with. While leaning into the discomfort and vulnerability can definitely be a positive, it is also important to go at a pace that feels comfortable for you.

Based on the information you share in the early stages of therapy, this will inform your therapist what approaches and theoretical frameworks will be useful for you moving forward (for example, if you are struggling with anxiety, your therapist might take a cognitive-behavioral approach and focus on challenging negative thought patterns). This can also change over time as new information emerges and as new experiences occur. There is no “one size fits all”, and your therapist should pull from a variety of different modalities to individualize your process.

Making the Most Out of Therapy: A few tips that might be helpful for making the most out of therapy (and knowing what to expect with sessions):

You choose the content

As the client, you are tasked with the responsibility of bringing the content into session. Basically, you are the driver, not the therapist. I have had experiences where a client might have a hard time deciding what to talk about that day, and I’ll typically start asking questions about how things are going, or anything I’ve picked up on that I think might be helpful to process, which will usually lead us somewhere. But ultimately, it’s up to you to decide how you use the space in therapy each time and what topics you would like to bring in. That’s not to say a therapist won’t gently challenge you at times around potential topics that are being avoided as a defense mechanism.

Topics to bring in can pretty much be anything and everything – whatever is on your mind. This can include something that is happening in the present day, relationship struggles (family dynamics, friendships, romantic relationships, etc), your past or childhood experiences, dreams, sex, etc. Nothing is off the table, and there’s no such thing as “TMI” in therapy. 

Ask for what you need

I definitely recommend sharing with your therapist if you have any specific preferences in their approach with you. For example, I’ve had several clients who tell me they are really looking for direct feedback and/or specific tools to practice that might be helpful in their circumstances. This is your space, and you have all the permission to ask for what you need. 

Try your best to be transparent 

I know this one can be hard sometimes. Especially when we might have a hard time being fully honest with ourselves at times. I have definitely been guilty of tweaking a story to my therapist in an attempt to paint myself in a better light. But in the end, it wasn’t as helpful for her to just have the version that I had created of the story. 

It can be uncomfortable and the fear of judgment is real (even though you’re talking to a person who is specifically there not to judge you). This is what shame does. It causes us to bottle things up inside and says that if we tell anyone about this, they will reject us and this will reinforce that belief that we are unworthy of love and belonging. Therapy is the space for your shame and fear of judgment to be held and met with compassion. Research on shame has shown us that if we open up about the things we are ashamed of, and are met with compassion and empathy, this will help us overcome that shame. It is incredibly vulnerable to expose our full selves, which is why therapy takes so much courage. There is nothing that is too big or too heavy to bring into therapy. So, try your best to be honest.

Use the relationship

Using your time in session is a great opportunity to practice things you want to get better at outside of session. Therapy is a microcosm of the outside world. This means that how you show up in therapy and in your relationship with your therapist, is parallel with how you show up outside of therapy. That is why this is a great space to practice interpersonal skills you want to strengthen, such as communication and boundaries. Your therapist will have the tools and insight to navigate any ruptures and conflict in a healthy, productive way. This means that if you feel misunderstood or upset with your therapist for any reason, this can be used as an opportunity. Therapy is a space to practice showing up for yourself in a way that feels different and assert what you might need within the relationship.

Do the work outside of session.

I don’t typically give structured homework assignments for my clients to complete outside of session, unless I think there is something that will be particularly useful for them. But that does not mean that “the work” is only reserved for the time spent in session. Therapy is a space for reflection and to receive insightful feedback that supports your emotional growth and goals.

Gained insight and awareness can lead to increased intentionality around certain behaviors, and this increased intentionality will result in the greatest outcomes.

You will likely move towards your goals more quickly by consciously practicing outside of session what you have learned in session.

There also might be tools your therapist believes would be helpful for you to practice, such as using a thought journal, meditation, deep breathing, utilizing your social support system, practicing communication skills, etc. By putting these things into practice outside of session, you will begin to recognize what is most helpful for you, as well as what does not work well for you. I always encourage openness and flexibility with leaning into the discomfort that comes from trying something new.

What works for someone else might not work for you. It is so important to find a therapist who you feel is a good fit, and the success of therapy is highly dependent on the relationship you have with your therapist, as well as the willingness to “show up” and do the work. It IS a process and one that unfolds over time.

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