Considering Therapy for the First Time

By Bruce Alan Kehr, M.D.May 25, 2017

Bruce Alan Kehr, M.D. is an author, psychiatrist, and the founder and president of Potomac Psychiatry. He has partnered with TWLOHA for the upcoming release of his book “Becoming Whole: A Healing Companion to Help Untangle Your Heart.” A one dollar donation will be made per every book sold. Below is an excerpt from “Session 2.” You can preorder the book here!

Considering therapy for the first time can be a daunting prospect—filled with emotions ranging from fear and anxiety to anticipation and eagerness. You may wonder to yourself, What will the doctor be like? Will they be kind and understanding or strange and awkward? Will they judge me or think I’m crazy? Will they tell me what to do or help me figure it out for myself? Will I want to run out of that office and never go back? Or will I want to continue, because I feel understood and supported? It is understandable if you are dreading the initial encounter. On the other hand, perhaps you can’t wait to start unburdening yourself and untangling your life. All of these feelings are normal.

The following steps will help you reflect on this matter.

Step 1: Identify what you are feeling and begin to help yourself.

You may feel despair or that something is just not right. Do you feel scared or worried about a recent life event? Are you suffering from depressed feelings that just won’t go away? Do you experience emotional pain that feels like too much to bear? What are the feelings at those times?

Step 2: Begin to identify patterns that sabotage your happiness, and search for some of the root causes in your childhood.

Do you keep repeating self-sabotaging patterns of thinking, feeling, or behaving? Describe them.

Have you spoken with a friend or family member to seek emotional support, and a sounding board to figure out what is going on with you? Did this help? If so, how? Have these talks helped for a while but don’t result in any lasting benefit. What happens? Despite outside support, do you feel increasingly depressed? Describe your mood.

Step 3: Explore entering psychotherapy.

Psychotherapy is devoted to helping you feel better, function more effectively, and examine yourself and your life in a new way that will liberate you from emotional restraints, from the shackles that have held you back for years.

Although you may feel afraid to start therapy, deep inside you is an awareness that you need a new approach to solving your emotional problems. The old ways of managing and coping just aren’t working anymore, and without a new approach you will remain stuck in a very painful emotional state.

Step 4: Are you resistant to entering therapy? Here are some commonly held fears.

Do you feel that once you start talking, you will never want to stop (because what you are wrestling with feels so overwhelming)?

Do you fear there is no hope for you?

Did a friend or family member engage in therapy and have a bad experience or never get better?

Do you have conscious or unconscious fears that the therapist will be judgmental?

Are you concerned that therapy will make you feel worse?

Do you believe that the therapist will not understand, will give you bad advice, or urge you to break off an important relationship?

By writing out these fears and considering each of them, I hope that you will be able to put them to rest. All of these fears are unfounded if you select the right therapist.

Step 5: How to select a good therapist.

Seek out a psychiatrist, therapist, or a leader at your church or temple (if you prefer a faith dimension) with a strong reputation for being caring, effective, and ethical. Ask your doctor or other trusted healthcare professional for a recommendation. If a particular name is mentioned more than once, that’s a good sign. Check online for information regarding their education, background, and what other patients have said about them.

Is it possible to have an introductory phone call? If so, prepare your questions in advance. Ask the following questions:

  • What is your treatment philosophy?
  • What will take place in the first session?
  • If I need medication, is it something that you would prescribe, or will you refer me to someone else? If you refer me, how do you coordinate my care with them?
  • What is your experience in evaluation and treating patients like me?
  • Based on what I have told you so far, is it possible to estimate the length of time that I will need treatment?
  • What are your fees? What is your cancellation policy?

The goal of the introductory phone call is to help you decide whether it makes sense to schedule that first appointment—to make a preliminary determination as to the likelihood of a good fit between you and the psychiatrist or therapist.

Step 6: Have the courage to persist in therapy.

It takes courage to continue in ongoing therapy. Fantasies, memories, feelings, and hidden aspects of oneself begin to surface, which may be frightening or emotionally threatening.

It is important to let your therapist know what you are feeling at these times and that you ask for additional emotional support. The love and support of a friend or family member can prove invaluable after a particularly rough session. The unconditional love and comforting presence of a pet can help you feel more supported. And finally, a caring, empathetic, and nurturing therapeutic relationship can strengthen your resolve. Permission to call your therapist after hours or arranging for an extra session when you feel overwhelmed will also help you stay the course.


Continue in therapy until you have accomplished your goals for treatment, and when you feel ready to end your treatment, discuss your reasons with your therapist. Early withdrawal may be associated with a number of negative outcomes.

It is imperative that you not give up, that you not run away. Ultimately, you will develop a deep sense of pride in facing your problems, as opposed to denying or avoiding them. Your return on this investment will be exponential.

You can learn more about the author here.


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Comments (4)

  1. Hannah

    It’s funny that this comes up just when I am considering going to therapy for the first time.

    Reply  |  
  2. e shopping

    That is a very good tip particularly to those fresh to the blogosphere. Simple but very precise info… Thank you for sharing this one. A must read article!

    Reply  |  
  3. Kayla Engle

    beautifully written from the heart and soul. I love your spirit of caring for others. never shun that away regardless of who says anything about you. what you written for us shows how amazing you care about everyoine in here. from God to me to you love youself my homie

    Reply  |  
  4. Meg

    WORST doctor ever. The guy made me disabled from ripping me off all my meds. I was told to go to detox to get off Klonopin, like I was an addict. I took that medication as prescribed for over a decade! You DO NOT COLD TURKEY a patient off a Benzodiazepine and your “tapers” are TOO fast! 5-10% cuts every 2-4 weeks depending on a persons response and any withdrawal they might have. You just don’t have the time? How can you justify what you did to me? I should have sued as I’ve been disabled for 5 YEARS now with no income and no money to take care of my medical bills. When I came home damaged and unstable, this guy wouldn’t return my frantic phone calls and I was left without care in a crisis. I ended up in the ER several different times due to the Akathisia I got, 5 YEARS ago! No, no one figured it out until 2 yrs after it started. I was pacing, couldn’t sit still, couldn’t stop moving my legs. I was having panic attacks that would last all night. I’d be rocking back and forth, moaning usually. You can’t calm down. It’s hell. You feel on edge 24/7. No it doesn’t stop with coming off a med. I was ripped off Latuda and it still didn’t stop, the “treatments” DO NOT work. I am most likely permanently disabled at this point after coming off one of your favorite drugs to prescribe, Latuda. You did put me on it. Wasn’t psychotic, manic, or hypomanic. Never have been to my knowledge.

    Also want to mention that he thinks DNA testing helps people find “the right med” for them. That’s super dangerous and can get someone seriously hurt! Ahem! You can’t justify ripping me off my meds so you could put me on ANOTHER cocktail with just different meds, but the same categories, including those antipsychotics. Have you never heard of Latuda withdrawal? Yeah, keep up kiddo or retire already! You don’t know anything about Benzos but you call yourself a psychiatrist? You could have googled (which he did FREQUENTLY during our visits) how to get off Benzos, but nope. That would probably take TOO long for you and you obviously didn’t want to be held responsible for damaging someone cause you ghosted me. Yet here I am, disabled from your care. I got a letter from this guy later on after I had called several times saying he no longer wanted to see me and I should see someone else in his practice. Should have started with my current doctor instead of this quack! You really have no idea how much you’ve damaged me. And you probably won’t even change the way you treat patients.

    The amount to see this doctor… outrageous! $500+ for this guy. NOT worth it. You can submit a claim to insurance but we’ve always paid out of pocket with the help of a family member because the guy came so highly recommended by a family friend who said he got her disability. Asked about that as well and it was like he didn’t want to make a decision until he screwed around with all my meds. Over 5 yrs now. I saw the guy in late 2017/early 2018 and by August of that year, I was sent to detox for Klonopin after being ripped off all my meds and put on a new cocktail. Even the ER’s wouldn’t cover a few days until I saw the new doctor and decided when I wanted to TAPER off!

    Reply  |  
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