What Exactly Happens in a Therapy Session? Demystifying the Process

The decision to start therapy is often accompanied by a very common question: "What will I actually do in there?" The idea of sitting in a room with a stranger and talking about your life can feel strange, largely because it's an unknown.

This guide aims to walk you through a typical structure and flow of a therapy session to give you an idea of what it could look like. While every therapist's style is unique, most sessions follow a recognisable pattern.

The First Meeting: The Initial Assessment

The first session is often different from those that follow. Its primary goal is assessment and foundation-building.

1. The Practicalities: You'll likely start by reviewing and signing a working agreement or contract. This document outlines important details like confidentiality, session fees, cancellation policies, and the therapist's professional boundaries. This isn't just paperwork; it's the first step in creating a safe framework for your work together.

2. Your Story: The therapist will invite you to share what has brought you to therapy. You might be asked questions like:

   • "What would you like to get out of our work together?"

   • "Can you tell me a little about what's been troubling you lately?"

   • "What is your personal history and current life situation like?"

     The aim here is not for you to recount your entire life story, but to give the therapist a broad understanding of your context and what’s going on for you.

3. Collaborative Goal-Setting: By the end of the first session, you and the therapist should have a preliminary sense of what you'd like to focus on. This could be as specific as "learning to manage panic attacks" or as broad as "understanding my relationship patterns."

The Structure of Ongoing Sessions

Once the therapeutic work begins, sessions often settle into a more familiar rhythm. A standard session is typically 50 minutes long.

• The Opening (The "Check-In"): The session will usually begin with an open-ended question like, "How have you been since we last met?" or "Where would you like to start today?" This is your opportunity to bring up what feels most pressing—it could be something that happened during the week, a recurring thought, a dream, or a feeling you can't shake.

• The Middle (The Exploratory Work): This is the core of the session. There is no single script. The process is a collaborative conversation. Your therapist's role is to listen deeply, help you explore your thoughts and feelings, and perhaps offer observations, reflections, or questions.

  • They might notice a pattern you haven't seen.

  • They might gently challenge a long-held belief that is causing you pain.

  • They might help you connect a current reaction to a past experience.

  • They will create a supportive space for you to sit with difficult emotions that you might usually avoid.

• The Closing (Summarising and Transitioning): In the final few minutes, the therapist will often help you bring the session to a close. They might summarise what was discussed, highlight a key insight, or suggest something to reflect on before your next meeting. This process helps to contain the often-intense work of the session and prepares you to transition back into your day.

What You Actually "Do" in Therapy

The stereotype of lying on a couch while a silent therapist takes notes is specific to psychoanalysis – think Freud here. In most modern therapy, you are an active participant. Here’s what you might find yourself "doing":

• Talking: This is the primary medium. You talk about your experiences, and your therapist helps you make sense of them.

• Feeling: Therapy is one of the few places where you are encouraged to feel and express a full range of emotions—sadness, anger, fear, joy—whatever happens to come up

• Thinking in New Ways: Your therapist will ask questions that prompt you to consider different perspectives or understand the "why" behind your feelings and behaviours.

• Noticing: You might be encouraged to notice bodily sensations, thought patterns, or emotional triggers that occur both inside and outside the session.

What is the Therapist's Role?

A therapist is not a friend who gives advice. Think of them as a skilled facilitator. Their job is to:

• Provide a confidential and empathetic space.

• Listen not just to your words, but for the patterns, emotions, and meanings beneath them.

• Facilitate your growing self-awareness.

• Support you in finding your own answers and developing your own inner resources.

Ultimately, a therapy session is a dedicated space for you to focus on yourself, with the guidance of a trained professional. It's a place to be heard, to be understood, and to do the work of becoming the person you want to be.

Remember, every therapeutic relationship is unique, so consider this a guide rather than a strict blueprint. The most important gauge is your own experience. Checking in with yourself about how you feel in your sessions is a vital part of the process. If something isn't working for you, bringing this to your therapist can become one of the most valuable conversations you have. I wish you all the best on your journey.