All the Things You’ve Wondered About Therapy But Didn’t Want to Ask

Or maybe you did want to ask, but just didn’t have an open, reliable source to inquire.

Psychotherapy has historically had a lot of cloudiness around it. It’s been like this mythical, behind-closed-doors “thing” that we’re all curious about, but somehow still unsure of.

Heck, as a young graduate student starting to do psychotherapy, I felt the exact same way. How will I ever learn if it’s this private, murky thing that do one can quite explain to me?

Well, it’s my belief that therapy shouldn’t be mysterious and it shouldn’t be unexplainable. I believe that those seeking therapy deserve to know exactly the treatment that they are receiving, why that’s recommended for them, how long it will take, and what it will involve. They deserve to have choices about the way that therapy is done, rather than it being at the therapist’s whim. And they deserve to be in the driver’s seat of their own care.

It’s time to put an end to therapy as a mystery. Below I’m answering some commonly wondered but often unasked questions about therapy. If you have others, shoot me an email or connect with me on Instagram.

Does my therapist talk about me to their friends?

If you learn that they do or have, we’ve got a big problem on our hands. Therapists should never be sharing anything about your treatment – including ever having even met you – with anyone for whom you have not given explicit permission. Assuming you are an adult or a minor with privacy rights in your state, you have the right to decide how your confidential health information is handled. There are a few important exceptions to these rules, and the specifics depend on where you are located. They generally include things like you posing an immediate threat to someone, having a plan to harm yourself, or if you or someone you know are causing harm to a child or other vulnerable person. Other than these exceptions, your relationship with your therapist works in large because of the confidentiality involved.

Can the things I say in therapy come back to haunt me later?

The confidentiality of the therapy relationship extends forever, so there is no point that it expires and all can be revealed. Your therapist will likely keep records of your work together, but these are protected by law and to be kept private. Others cannot request your private information without your permission, except in extreme circumstances.

Is it really always about my childhood?

Behavioral, emotional, and life problems develop for all sorts of reasons. Experiences or circumstances of our childhood can be part of the picture, but so can genetics, our current environment, discrimination, access to resources, our relationships, our temperament, and so much more. A comprehensive treatment approach evaluates you as a whole person who exists in a larger context. From there, you can identify key factors and areas of focus for work in therapy.

How do I know if therapy is actually working?

Your progress in therapy should not be ambiguous or hidden. At the start of your work together, it’s important for the therapist to collaborate with you to develop a treatment plan that will guide the focus areas of your work. As therapy progresses, the treatment plan should be reviewed regularly to evaluate where progress has happened and what work is left to be done. There may be times that this guide needs to be rewritten or updated based on new or changing concerns. It’s a fluid document and it’s great to keep it relevant. You should have open and transparent conversations about how you feel progress is going, and your therapist should invite your feedback on how they are doing in meeting your needs.

What kind of assumptions will my therapist make about me?

I’d like to tell you that all therapists are open-hearted and open-minded and withhold all assumptions without learning from you directly… but that’s just not the case. The reality is that therapists are trained in different styles, come from different backgrounds, and have different levels of awareness of their own biases. To be fair, they are also human, and quick assessments are part of the way humans are wired. All of that said, I believe it’s crucial to find a therapist who will work to actively get to know you as an individual human being with all of your uniquenesses and idiosyncrasies. A therapist should not make you as a person into a diagnosis and should not make assumptions about what you want or need without communicating actively with you about their perceptions and recommendations. The way to find this kind of therapist is by talking with them and asking questions before you enter into a therapeutic relationship. And by keeping in mind that if things aren’t feeling right or you’re worried that they are making assumptions, you have the right to discuss this with them.

Do I have to take medication if I want to feel better?

Medication is not part of every person’s treatment plan, and is not necessary for many people to get effective results from therapy. Medication can be a helpful adjunct to treatment and can allow individuals to make better use of therapy in some cases. This is particularly true when mood or anxiety symptoms are so severe that it’s hard to even focus on implementing the strategies discussed in therapy. There are many reasons that people can hesitate to take medication. Some of these may be related to misconceptions or old beliefs about the medicine, such as believing this signals “weakness” or that they will become addicted. It can be helpful to talk about these concerns to determine if medication could be a helpful part of your plan. And if medication isn’t needed or desired, there are lots of interventions that therapy can offer that can help you feel better.

Am I going to freak my therapist out?

While there is a first for everything that a therapist hears, it’s fairly difficult to freak us out if we’ve been practicing for almost any time at all. Hopefully your therapist has been trained in recognizing that the scope of human experience is vast and that taking a non-judgmental and open-minded stance is crucial to good treatment. There are definitely going to be things that may be out of your therapist’s wheelhouse, and they should know their own wheelhouse. If you share a symptom or an issue that therapist isn’t competent in addressing, they should help navigate you to the right resources for that particular need. An example of this is in eating disorder care. Most therapists are not trained specifically in this area, and they should refer to a specialist if that arises. But they should not freak out.

How will just talking help me to make actual changes?

One of the biggest concerns of people seeking therapy is that they are going to waste a bunch of time talking and not really accomplish anything. Part of this fear may come from the stereotypes and media images of therapy that portray a serious-looking therapist taking notes while a patient lays down on a couch rambling on about every memory that comes to mind. The vast majority of therapy does not look like this. The therapy that Galia Collaborative does is active and results-oriented and based on frequent assessment of progress to treatment goals. In fact, talking is just one piece of the puzzle. Good therapy often includes homework, practice of new ways of doing things, writing, role playing, and other methods (music, art, movement, and more!). Change is a dynamic process, but connection is at the heart of it. This can start through relationship building with a therapist and evolve into whatever interventions might be right for you.

How do I know if my therapist is really any good?

I’m so glad that you asked. It’s one way to assess a therapist at the forefront of treatment — ask how they will assess whether therapy is helpful to you and how you’re progressing. The nuances of what makes a therapist “good” are varied and everyone is likely to have a slightly different opinion. My perspective is that a “good” therapist will hold space for you to connect with yourself, will honor you as an individual, will actively support you in working toward your goals for therapy, and will uphold ethics in all of your care. There are lots of different styles and approaches, and so “goodness” might be a matter of fit. But you should also consider what your fundamental requirements are in a therapist and interview therapists based on these.


Dr. Ashley Solomon is the founder of Galia Collaborative, an organization dedicated to helping women heal, thrive, and lead. She works with individuals, teams, and companies to empower women with modern mental healthcare and the tools they need to amplify their impact in a messy world.

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