Therapy can profoundly benefit mental health, but it’s one of the least accessible and affordable forms of health care in America (and that’s really saying something, considering the state of our health care system). Some parts of the country are what’s known as mental health deserts, because there aren’t enough practitioners (if any) in the area to care for the population’s needs. Generally, there are far fewer psychologists and psychiatrists in this country than are needed to cover the ever-growing demand for care.
Adding to those challenges is the fact that therapy is extremely cost-prohibitive for most people. The average therapy session can cost $200 or more. That makes for an easy excuse to avoid diving into therapy, which can be an emotionally uncomfortable prospect, too.
But as stated, therapy can be an effective treatment for mental health issues such as anxiety and depression. It can help you better navigate relationship and career challenges, too. As such, it shouldn’t be avoided if it’s something you’re feeling called to do! If you’re contemplating seeing a mental health professional for the first time, below are a few things that can be helpful to know in advance.
How to start therapy for the first time: 7 tips
Of those surveyed by Hims & Hers who have tried therapy, 87 percent said they preferred online sessions to in-person sessions, so your computer may be a good place to start if you’ve never tried therapy before. Since the pandemic began, many providers have expanded their services to include online therapy sessions, but there are also providers such as Talkspace, BetterHelp, Frame, Real, and more that specifically offer digital therapy services.
The nice thing about using one of the latter providers is that they can do the work of trying to match you with the right therapist; otherwise, short of a referral, you’re just shooting in the dark.
And if you’re not a fan of video calls, rest assured: They aren’t your only option in the digital therapy space. You can opt in to phone or text-based therapy instead.
If you’d prefer to kick it old-school in a local therapist’s office, licensed therapist Minaa B, LMSW recommends using resources like BetterHelp or Psychology Today to source options in your area. From there, she suggests narrowing down your search results to two or three therapists. Many therapists offer the first session free so that both parties can assess whether it’s a good fit.
If you’re looking for culturally competent care—aka, therapy from someone who understands your experiences with race, gender, sexuality, ethnicity, etc. firsthand—you might want to start with one of the following resources instead: Therapy for Black Girls; Black Female Therapists; Ayana; the National Queer and Trans Therapists of Color Network; the Association of LGBTQ+ Psychiatrists; Inclusive Therapists; and/or Melanin and Mental Health.
3. Understand the different types of therapy
One size does not fit all when it comes to therapy; there are several approaches designed to treat different types of issues. Interpersonal therapy, for example, is designed to treat mental health issues created or fueled by relationships in your life. Cognitive Behavioral Therapy (CBT), meanwhile, is science-backed treatment proven to be effective in treating depression, anxiety, substance abuse, eating disorders, and severe mental illness. Dialectical Behavioral Therapy (DBT) is therapy designed to treat borderline personality disorder, suicidal ideation, and those who otherwise self-harm. Psychodynamic therapy looks to your past to solve present-day problems by digging into their origins, helping you to recognize patterns in your behavior over time, and more. Humanistic therapy takes a positive approach to personal growth by focusing on an individual’s good traits and behaviors and using those to create beneficial change in their life. Eye Movement Desensitization and Reprocessing (EMDR) is used to treat post-traumatic stress disorder. And then there are non-solo therapeutic opportunities such as couples counseling and group therapy, too.
4. Get creative with funding your therapy
One of the biggest barriers to entry for most folks seeking therapy is the cost. Many mental health providers don’t accept insurance these days, and even when they do, it can be difficult to get weekly sessions adequately covered.
What you might not know, however, is that thanks to the Affordable Care Act, your employer is actually required to cover mental health services. So as long as you’re not self-employed, you should expect your company to pay on your behalf (as long as your provider is in-network). But with many providers opting out of insurance partnerships altogether, this benefit often doesn’t mean much.
Still, you shouldn’t immediately be deterred by the prices listed on a practitioner’s website. Often, providers will offer their services on a sliding scale, which means you can essentially negotiate for a lower price if you can’t afford the full cost.
Digital therapy also tends to be (but isn’t always!) less expensive than its in-person counterpart, so that’s a route you may want to explore if you can’t find in-person sessions that fit your budget.
And to bridge the accessibility gap caused by systemic racism in this country, organizations like Black Girls Breathing and Sad Girls Club offer some affordable and even free therapy opportunities for those in the BIPOC community.
Therapy For Women founder Amanda White, LPC also recommends seeking out a nurse practitioner psychiatrist (PMHNP) for treatment instead of a traditional psychologist or psychiatrist. These nurses have been specifically trained in mental health care, and they can provide therapy and prescribe medication—typically at a lower cost than other therapists.
Many universities and state departments also offer free therapy sessions, according to Black Girls Breathing’s founder Jasmine Marie. Unfortunately, there’s no simple way to source these services—you just have to do some digging online to suss them out.
If you’re nervous about the prospect of baring your soul to a total stranger, take comfort in the fact that your first session with a therapist can go as deep or stay as shallow as you feel comfortable with, says clinical counselor Rachel O’Neill, PhD, who works with online therapy company Talkspace. She recommends letting your therapist know if there’s something that would make you feel more open. (For instance: turning off your video if you’re doing digital therapy, or leaving voice memos instead of texting if you’re doing text therapy.) No matter what your setup, just know that it will likely be at least a little awkward at first—that’s completely normal, and to be expected.
Once you’ve settled into therapy a bit, you may start to experience a “therapy hangover,” wherein you feel worse after each session instead of better. This isn’t, however, license to run for the hills. The reason for not-so-great feelings after a therapy session is that you’re being more vulnerable than you’re likely used to, you’re being challenged to change, and you’re doing the hard work to make that change—all of which is uncomfortable, to say the least.
In fact, therapy hangovers are a good sign, says psychotherapist Jennifer Silvershein, LCSW. “If therapy feels exhausting, it means you’re making authentic change,” she says.
Quitting therapy is super awkward, but Minaa says it’s not your job to worry about your therapist’s feelings. In fact, she explains, professionals are trained to endure discomfort—so they can handle rejection. If you don’t feel as though you’re benefitting from their services, you can and should quit at anytime. (But try not to quit due to #6 above!)
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