What to Expect in Therapy
With Bradford Wolf, LCSW
Almost everything written about starting therapy describes the first session and stops there. This page covers the rest of it: the first hour, the months after it, what gets asked of you, how you would know whether it was working, and how it ends.
I am Bradford Wolf, a licensed clinical social worker. I have been doing this with people for fifteen years, and nearly every question below is one somebody has asked me in a first session.
Before anything starts
Two things happen before a first session: a free 15-minute phone call, and paperwork.
The free consultation covers what the call involves. Fees, insurance, and FAQs covers the forms, the money, and how scheduling works. Neither is the subject of this page, which picks up where those leave off, at the first time you sit down for an actual session.
The first session
The first session is mostly questions. What brought you here, what has been going on, how long it has been going on, and what you want to be different. Some history, because context explains things that make no sense on their own. Not all of your history, and not in order.
Here is what does not happen. There is no couch. I do not sit in silence waiting for you to produce something. You will not be told what is wrong with you inside the first hour, and you will not leave with a diagnosis unless you came specifically for one and we have talked about why.
One honest thing about it: the first session is the least representative session you will have. It is the one that feels most like an interview and least like therapy, because I am collecting information I do not have yet. A lot of people judge the whole thing on that hour, which is a bit like judging a conversation by the introductions.
What gets asked of you
The most common worry people bring to a first session is not about me and not about money. It is that they will be bad at this.
You cannot be bad at this. That is not encouragement, it is how the thing is built. There is no performance to get right, and the parts you find difficult are information rather than failure. The specific versions of the worry are still worth answering.
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Then you say that, and we start there. Not knowing what to say is a session, not a wasted one. What you find hard to put into words is usually the most useful material in the room, and the difficulty itself points at where to look.
In practice I ask questions. You are not responsible for filling an hour.
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Sometimes, and not as an opening move. Patterns tend to have a history, and when something you do now keeps producing a result you do not want, where you learned it is often relevant. It comes up when it earns its place, not because a script requires it.
If you do not want to go there, say so. That is allowed, and it is also useful information.
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Then you cry and I wait. There are tissues. It is a therapy office, and it would be strange if nobody ever did.
Most people worrying about this are worrying about being embarrassed in front of a stranger. That wears off faster than people expect.
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Plenty of sessions open with some version of “I do not really have anything.” Those are often the good ones. When there is no crisis taking up the room, there is space for the slower material: the pattern you have been running for twenty years, the thing you have never said out loud to anybody.
Therapy is not a weekly incident report.
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Sometimes, and only when it is useful to you. It is usually small. Notice when a particular thing happens. Try saying the thing you did not say. Pay attention to what your body does in a specific situation.
Nobody checks it. If you did not do it, that is worth five minutes of conversation rather than an apology.
Most people start weekly. The reason is momentum rather than urgency: a week is short enough that you arrive still holding the thread of the last conversation, and long enough that something has happened in between.
Here is the part almost nobody tells you in advance. Therapy often feels worse before it feels better. Talking about something properly, sometimes for the first time in your life, tends to make it louder for a few weeks. People who do not know that is normal read it as the therapy failing, and it is the most common point at which people stop. If it happens to you, say so in the room. It is not a sign you picked the wrong thing.
How long the whole course takes depends on things I cannot see from a website. How long the pattern has been running. Whether it is one problem or several wearing the same coat. Whether something is actively on fire, which usually has to be put out before the slower work can start.
What I can tell you is that anyone who gives you a number in the first session is guessing. I will give you a straight assessment once I have seen how you work, including if I think you need less than you came expecting.
Once things are steadier, some people move to every other week, and some stop. That is a conversation rather than a policy.
What the next few months look like
How therapy ends
Therapy ends. It usually tapers rather than stops: weekly becomes every other week, every other week becomes monthly, and at some point you notice you are mostly turning up to report that things are fine.
The ending is normally planned a few sessions ahead rather than announced. Partly so there is time to talk about what you are taking with you, and partly because how something ends is worth paying attention to in its own right.
You can also stop whenever you want. You do not need a reason, you do not need my permission, and you do not have to justify it. I would rather you told me, so we can finish properly instead of trailing off, but that is a preference and not a condition.
Coming back later for a stretch is common. It is not a relapse and it is not starting over.
How to tell whether it is working
Not by feeling better every week. That is the measure most people reach for, and it is the one most likely to make you quit in week five, because progress here is not linear and the weeks are not a graph.
The useful markers are smaller and more specific:
Something that would have set you off a month ago does not, or does but less.
You catch a pattern while it is happening rather than three days later.
A bad day is still a bad day, but it is finished by Tuesday instead of running to Friday.
You say something out loud that you would not have said before, inside the room or outside it.
Somebody close to you remarks on a change before you have mentioned anything.
None of those feel like breakthroughs. They are what change looks like from the inside, which is to say barely noticeable until you compare against six months ago.
If you are not sure, ask me. It is a reasonable question and you will get an honest answer, including if the honest answer is that I do not think this is working either.
If it is not the right fit
Fit matters more than credentials, and you will usually know inside a few sessions. Not whether you like me, exactly. Whether you can be honest in the room.
If it is not right, say so. Out loud, to me. People find that difficult because it feels rude, and it is not. It is one of the more useful conversations available in therapy, and for some people it is the first time they have told somebody directly that something is not working for them. Sometimes that conversation fixes it. Sometimes it confirms what you already suspected.
If I am not the right person for you, I will tell you, and I will help you find someone who is. I would rather do that in session three than have you spend a year being politely unhelped. Changing therapists is ordinary. It is not a failure and it is not something you owe anybody an explanation for.
Starting, if you want to
If you want to ask about any of this before committing to a session, book a free 15-minute consultation. It is a phone call rather than a session, and there is no waiting list.
I am Bradford Wolf, LCSW-C in Maryland and LCSW in Virginia. I see adults in person in Rockville and by video across both states. More about how I work.
If you are still working out whether therapy fits what you are dealing with, individual therapy covers the areas I work in. Couples work runs on a different process, which couples therapy describes.