Steps In Therapy: What To Expect

Therapy can be a complex process, and deciding to seek treatment may seem intimidating. Therapy is a highly individualized endeavor, and there may be no correct answer to questions about how “normal” therapeutic treatment proceeds. However, there are a series of steps that most therapeutic processes tend to follow. 

Steps in therapy typically begin with the introduction phase and move into the identification, goal setting, and exploration phases before concluding with the maintenance phase. Still, not everyone moves through these steps in a linear fashion. Therapy timelines may look different depending on the individual. Even so, these steps may provide a rough outline of what therapy treatment might look like for you. Keep reading to learn more about the steps in therapy, including what to expect and how you could benefit from the process. 

Step 1: Introduction/relationship building

In the first few therapy sessions, your therapist may focus on getting to know you and developing the therapeutic alliance, which is the relationship you have with them during treatment. You may not immediately feel comfortable telling every detail of your life with your therapist during your initial meeting. However, as you progress on your therapeutic journey, you may become more vulnerable with your counselor. 

During this beginning phase of the therapeutic process, your therapist will likely listen to you describe your thoughts, feelings, behaviors, and relationships. They may validate your experiences, which can help to build trust and a sense of safety. It is not unusual to begin to see a slight improvement in mental health symptoms at this stage. Simply having regular conversations with a person who is a neutral, unbiased, and trustworthy resource can make a difference.

This initial stage can provide you with an opportunity to ask questions about the therapeutic process (with the caveat that your therapist may not be able to propose specific treatment plans until they get to know you better). You and your therapist can work together to create an appropriate treatment plan as you move through subsequent therapy steps. 

Step 2: Identification

Now that you and your therapist have developed a connection and your therapist has a good sense of who you are as a person, you may be able to work toward identifying a challenge you would like to address through therapy. Some people may begin therapy with an idea of what they would like to work on such as improving their friendships or learning to control their anger, for example. Other therapy clients may have a diagnosed mental health condition such as depression or anxiety that they want to manage effectively.

If you don’t know exactly what you want or need out of therapy, this is something your therapist can help you with. Perhaps you have a general feeling of discontent in your life or a sense that you are not the best version of yourself. Even if you do have a clear idea of what you’re hoping to gain out of therapy, the identification step could help you and your therapist uncover deeper concerns. There may be other issues underpinning the external challenges in your life that could be hindering progress. 

For some people, mental health challenges may be associated with certain patterns of behavior. These behaviors could include avoiding unpleasant feelings, failing to communicate with the important people in one’s life, or using negative coping mechanisms such as substances. In the identification step, the client may begin to open up more about different parts of their life, and the client and therapist can start to understand such patterns on a deeper level.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Step 3: Goal setting

The goal-setting stage may represent one of the most important steps in the therapeutic process. Once you and your therapist have identified a concern, you can work together to develop a plan to address it. Your therapist can use their knowledge of human psychology and therapy techniques to develop a personalized treatment plan for you. They can also help ensure that this approach aligns with your value system and therapy timeline (with the understanding that some therapeutic situations may take longer than anticipated to progress). 

Your treatment plan might also include a detailed description of the treatment techniques your therapist plans to employ as well as the rationale behind the treatment, including the goals you are hoping to accomplish. These goals could include shifted behavioral patterns, a resolution to an ongoing conflict or challenge in your life, or relief from specific mental health symptoms. The goals of the treatment plan may need to be clearly stated and include measurable metrics so that you and your therapist can understand the progress you are making as you continue treatment.

Step 4: Exploration/working

The exploration stage may be the most difficult step in therapy. In this phase, you may begin the treatment plan you and your therapist developed together, and it could be a complex process. In therapy, the adage “it gets worse before it gets better” often applies. For instance, the exploration stage may uncover memories you had forgotten, deep-seated trauma, emotional challenges, or repressed thoughts and feelings. 

During this stage of therapy, you may also begin the process of learning to reframe painful experiences and belief systems. You might start to reassess your understanding of other people’s motives or your relationships with your family members, for example. This step could cause you to experience emotional distress, but your therapist can support you and guide you through the process of understanding yourself better and making positive changes.

If at any point during the exploration step, you start to feel as though your treatment plan is no longer working for you, you may need to talk about these concerns with your therapist. Sometimes, engaging in treatment can prompt realizations and shifts that may require different treatment options. Changing your treatment plan is not a sign of failure and may in fact be an indication of positive progress.

Step 5: Maintenance

Perhaps the first thing to know about the maintenance stage of therapy is that not every client reaches this step. Therapy can be a lifelong journey for many people, and there is nothing wrong with continuing to work on yourself and your mental health. Even if you feel as though you have successfully addressed the initial concern that brought you to therapy, you may continue to find your therapist to be a solid support system as you navigate life.

Some people who have completed a course of therapeutic treatment may feel as though they have successfully resolved the situation that prompted them to seek therapeutic intervention. In some cases, the situation may remain, but the individual might feel more equipped to handle the situation independently. 

Life is not always smooth sailing, and future challenges may incite mental health symptoms or unhealthy behavior patterns. In these cases, it may be helpful to view your therapist in the same way you view your doctor. That is, you might see your doctor when you are experiencing an illness or an injury. Once you’ve recovered from the illness or injury, you typically do not end your relationship with your doctor. You can still go to them for regular check-ups or for support with future illnesses or injuries. Your relationship with your therapist may follow a similar pattern. During the maintenance phase, you may not attend sessions as often, but you can still use your therapist as a resource during challenging times. 

Starting the therapeutic process with online therapy

If you believe that engaging in the therapeutic stages could be beneficial for you and your mental health, you may consider reaching out to a therapist for an initial consultation. With today’s packed calendars and busy schedules, it may be difficult to find time to sit down with a therapist in person. Online therapy can provide a convenient way to get the support you need. Through a platform like BetterHelp, you can receive mental health care from the comfort of your home and enjoy sessions at a cost-effective rate. If therapy isn’t what you expected, you can switch providers or end sessions at any time. 

The effectiveness of online therapy

Research has found that engaging in therapy online is just as effective as attending traditional in-person therapy. One study found that completing a course of online therapeutic treatment resulted in a reduction in symptoms of a range of mental health conditions. Those living with psychiatric conditions such as depression, anxiety, bipolar disorder, PTSD, OCD, and phobias, for instance, experienced significant improvement after participating in online cognitive behavioral therapy and were able to get care despite barriers like cost and geographical location.