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So, What's Therapy About Anyways?

In this article Audrina Smith, LMFT demystifies what therapy is about. She goes over what new clients can expect from the whole process, start to finish, from the initial search for a therapist to how to know when it’s time to end therapy.

There is a lot of stigma about accessing mental health services. Recently we've seen a change in the trend any many people are being more public about their struggles and even about going to therapy.

Maybe you've thought about giving therapy a try. Maybe someone (or multiple someones) in your life keep telling you that you “should talk to someone”. Maybe someone you love is in therapy and you're curious to know what it's like for them. Read this article to learn the answers to some common questions about how therapy works.


Hi there, My name is Audrina Smith. I am a licensed marriage family therapist who owns a private practice in Alameda, California. The name of my license implies that I work with couples and families but I actually work with individual children, teens, adults and families. I specialize in working with highly sensitive people and people who struggle with anxiety, relationship concerns, low self-esteem or navigating changes in life.

I’ll admit that I am a little biased when it comes to therapy. I love it and I think everyone should have it. I’ve seen the dramatic, life changing effects of a good therapeutic relationship and witnessed many beautiful transformations and healings in my office. I do know that not everyone shares these positive feelings about therapy; in fact, some people even fear the idea of going to a stranger to talk about all their problems. My goal is to explain the process of therapy from start to finish to take away some of the scary unknowns that may be getting in your way of reaching out for support.

Do I really need therapy?

Where to start: Therapy might be worth considering if any of the following apply to you:

[ ] You are starting to feel that your emotions are taking over your life. You are feeling less and less able to contain emotions like sadness, anger, irritability or anxiety/worry.

[ ] You are going through a change and feel unsure about how you “should” be handling it: a break-up/divorce, a loss, a career change or setback, a move, or anything that feels unknown.

[ ] You have had some painful experiences in your past that are starting to get in the way of the present. Maybe you thought you weren't affected by this thing that happened so long ago but find your mind starting to wander to it more often.

[ ] You can’t do the things you like to do. Maybe you used to like going out, being active, seeing friends, or having a hobby but lately you feel unable to get yourself to do these things. This can be a sign of depression or that something is off.

[ ] You feel like you are exhausting all the other resources in your life; your friends or family seem unwilling or unable to provide the support you need.

[ ] You feel stuck, maybe in a bad relationship, in a bad mood, or you feel unhappy at work,. if things feel like they aren't improving on their own, therapy might be indicated.

[ ] You just want to learn more about yourself. Plenty of people come to therapy not because anything is particularly wrong but because they value self-exploration/understanding. Many people see this is self-care;having a place once a week to check in with themselves and look deeper.

But I’m smart and capable, can’t I fix that on my own?

Sometimes, you can get better on your own, but in most cases you’ll get better results, faster, with a therapist. Therapists are professional trained experts in how humans process thoughts and emotions. They can help you see things in a different way and guide you to make lasting changes.

Talking with a therapist over a friend or family member has its benefits. The therapeutic relationship is unique in that the therapist is an unbiased listener. They don't have personal opinions/feelings about your behaviors and choices. It won't be a two way relationship. You won't have to caretake your therapist or wait your turn to talk about your feelings. You don't have to worry if you are annoying or overwhelming your therapist.

It’s not a matter of intelligence; most therapists have their own therapists.

Okay, maybe I need therapy, but how do I find a therapist? And what is it going to cost?

There are many ways to locate a therapist near you. One of the best ways is through word of mouth. If anyone you know sees/has seen a therapist ask if they would recommend anyone. If you happen to know a therapist personally you can ask them to refer you to another therapist (it is not ethical for therapists to have their own friends or family as clients but we often have a network of many therapists we would love to recommend, even in other cities/states).

If you don't know anyone or are not comfortable asking someone you know you can turn to the internet or look into going through your insurance.

If you have health insurance you can visit your doctor and ask for a recommendation. Some insurance companies cover some or all of the cost of therapy. You can call the number on the back of your insurance card and ask about the process of finding a therapist. Some companies will provide you with a list of therapists in your network.

Some workplaces have an EAP (Employee Assistance Program) program which provides short term solution focused therapy to employees at no cost.

Keep in mind that if you are using your insurance or EAP your services may be limited. You may need to meet symptoms of a qualified diagnosis (which then becomes part of your medical record) and may only be able to have a certain number of sessions. Insurance often does not cover couples or family sessions.

If insurance is not an option or you are not able to find a therapist you like who accepts your plan, you can go the private pay route. This is currently the way I see all of my clients.

You can expect to pay anywhere from $100-200 per session for weekly therapy in the Bay Area. Some therapists provide sliding scale or a few reduced fee spots for clients who are in need. If you find a therapist you like but their fees are outside your budget you may still want to reach out and see if they are able to be flexible. I currently have ¼ of my caseload in reduced fee spots.

You can find a therapist online in many ways - is one of the most trusted resources, you can enter your zip code and any preferences you have in terms of the therapist’s gender, areas of expertise and treatment modalities. You can also try a google search of “therapy for ‘X symptoms’ in my area” or even a yelp search.

For any licensed therapist in California, you can verify their license and disciplinary history at

What happens when I reach out to a therapist?

After you've called or emailed a therapist, expect to hear back within 1-3 business days. I make an effort to respond the same day to new client inquiries if possible because I know once you've taken that step you can feel a little anxious waiting to hear back. I respond and offer a free 15-20 minute consultation call. This is best done over the phone so you and your therapist can get a sense of what it might be like talking and working together. The therapist will let you know their fee and availability. If it's a good fit they will then want to hear about your reasons for seeking therapy. I usually ask people to tell me in 1-3 sentences what brings them to seek therapy at this time. You won't be able to convey everything in this phone call. This isn't therapy, it's just an intake. Saying a few things that you've been struggling will be enough for the therapist to know if they can help. I will sometimes ask follow up questions to determine if I am a good fit. I then tell clients how I imagine being able to support them and answer any questions they have.

If everything goes well we schedule something, ideally within the next week. In some cases I am not the best fit, if the client is struggling with something I do not feel able to or comfortable with treating, I let them know that I am unable to see them but get back to them within the same week with a list of at least two other therapists that would be a better fit.

Questions you might ask: You are allowed to ask questions about the therapists education, training and experience with your concerns. You can ask how they work, what interventions or theories they draw from and how they believe therapy might benefit you.

Feel free to consult with more than one therapist. I encourage clients to talk with an even have sessions with multiple therapists, “therapist shopping”, if you will. One of the most important factors in a positive therapy experience is the relationship you have with your therapist. The connection you share and the way you feel with them in the room is more important than where they went to school or what theories they use. You want to find someone you feel comfortable around, someone you trust and someone who makes you feel understood. Their office feel or feng shui is also important. The location, temperature, coziness and even the way they decorate can have an impact on your mood when you are in that space. Take time to find the right fit for you.

I’ve scheduled an initial session, What will happen? Will I have to lie down on a couch?

Most therapists have a couch, but I don't think any of my clients have actually laid down on mine. This is a stereotype about therapy from the Freudian days, when in truth, your therapist just wants you to be comfortable. I tell my clients to feel free to take off their shoes, pop their feet up, to use the blanket or do whatever they need to feel cozy and comfortable.

Different therapists plan their first sessions differently. Usually there is some conversation about why you are in therapy and usually the therapist will ask some questions. I tell clients that the first 4-6 sessions are a sort of assessment period. That I might be asking more questions in this time to gather information. But I also like to make sure there is time to just connect as humans. I might ask about new client's lives in areas that might not relate to their presenting problem. I ask about their support systems, the things that they are passionate about, the things that are going well in their lives, how they have successfully dealt with hard things in the past, etc. I work to build trust and rapport with clients in these early sessions.

I sometimes take notes in the beginning, writing down small facts like partners/family members names or other small pieces I want to be sure to remember. I promise I am not writing down everything you say or opinions about what you are sharing. It’s just a memory tool for me.

At the end of each session I usually reflect what we have discussed, thank clients for their courage and vulnerability, let them know my impressions about how therapy might benefit them and see if they are interested in scheduling another session. I take some time to talk about the relationship, how was the session, what did they notice about how it felt to talk (or not talk), did they feel heard and understood, do they have any feedback for me? Again, the relationship piece is very important in therapy.

Some therapists are more reserved and reflective, others are most direct or challenging. Some give out homework assignments or suggest books/articles to read, others don’t. None of these are “good” or “bad” but just a matter of personal preference. You can let your therapist know what you prefer and they can work to accommodate your requests.

Some clients schedule a session for the next week, others take some time to think about it. Some don't return for various reasons. All of these are okay. Your therapist won't take it personally, but communicating what you've decided is appreciated.

Once you've found the right therapist, you’re ready to begin. Now the real work starts.

Therapy is not easy. It involves looking at the hard, the sad and the painful parts of your life. It might mean confronting your anxiety, looking at your sadness, or questionings some of your unhealthy behaviors. Therapy will involve taking stock of what you've been doing, identifying what hasn't been working and then learning skills and building tools to manage your thoughts, feelings, and behaviors in a more effective way.You’ll be looking at and changing/challenging your ways of being in the world, learning new, healthier, adaptive ways. It’s not easy, but can be very rewarding.

How long will I have to be in therapy?

Some therapy is brief. Others find that they benefit from long term sessions. There is no magic number. That is up to you and your therapist. It also depends on what you are coming to work on; stress and mild anxiety won't need as many sessions as processing trauma or more severe symptoms. You can end at any time. Your therapist won't be mad at you, but it is usually expected to give at least a couple weeks notice so you and your therapist can process the relationship ending and help you think about next steps.

Your therapeutic experience is tailored to your needs. Many people feel the positive effect of therapy in as little as 6-10 sessions. People usually have a goal or two for their time in therapy and once those goals are achieved it is okay to end. It’s kind of ironic that as a therapist we are actually working to lose our clients. We want you to be self-sufficient and not need us anymore. I see most of my clients on average for approximately 6-8 months.

Starting the process can be intimidating. Sometimes it may take a while to find the right therapist for you. However, most people have positive experiences with therapy and feel glad that they got started.

If you have read all of this and still have questions about the process of therapy, or if you live in the Bay Area and are interested in working with Audrina Smith for your own therapy, please click the "Get in Touch" button at the top right of the home screen at

or email her directly at

Stay tuned for the next blog post about therapy for your teen. This article will be addressed to parents and outlines the process of getting your teen started in therapy.

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