Starting therapy takes courage. You’ve made the decision to work on yourself, found a therapist, and scheduled your first appointment. That’s huge. But here’s the thing most people don’t talk about. Getting into therapy is only half the battle. How you show up once you’re there matters just as much.

I’ve seen it happen over and over in my therapy practice in Philadelphia. Someone comes in ready to change, but then falls into patterns that slow everything down. The good news is these patterns are totally fixable once you know what to look for.

This is the biggest one and it makes a lot of sense. You’re sitting across from someone you just met, and they’re asking about the parts of your life you don’t even talk about with your best friend. It feels weird to talk about everything.

But here’s what happens when you hold back. Your therapist is working with incomplete information. Imagine going to a doctor and not telling them about half your symptoms. They might treat you for something you don’t even have.

It’s pretty common for someone to spend the first few sessions talking about work stress before finally admitting they’re actually there because of their marital issues. Those early sessions aren’t wasted exactly, but things move so much faster once the real issue is on the table.

You don’t have to share everything in session one. But if you notice yourself leaving out details, softening stories, or straight up lying about what’s going on, that’s worth paying attention to.

Therapy is not like getting your car fixed. You don’t just drop yourself off, wait a few hours, and pick yourself up fully functional. It doesn’t work that way.

Your therapist is more like a guide. They can show you the path, give you tools, and walk beside you. But you’re the one doing the actual walking.

A lot of people come in expecting their therapist to just tell them what to do. And while sometimes there’s straightforward advice, most of the work happens between sessions. It happens in the moments when you catch yourself falling into old patterns. It happens when you try that breathing exercise at 2 AM when you can’t sleep.

If you’re leaving sessions feeling like nothing is changing, ask yourself how much you’re actually applying what you talk about. That gap between sessions is where the real growth happens.

Speaking of what happens between sessions, there’s usually homework. Not every therapist assigns formal homework, but most will give you something to try or think about before your next appointment.

Maybe it’s journaling. Maybe it’s practicing a specific technique when you feel anxious. Maybe it’s having a conversation you’ve been avoiding.

When you skip this stuff, sessions start to feel like the movie Groundhog Day. You end up going over the same things week after week without moving forward.

I know life gets busy. You have work, kids, a commute from South Philly to Center City that takes forever. But finding even ten minutes to practice what you’re learning makes a real difference.

Therapy builds on itself. Each session connects to the last one. When you miss sessions or cancel last minute, you’re essentially hitting the reset button each time.

It’s common for people to cancel when things are going well or when things get really hard. Both are understandable. When you’re feeling good, therapy can feel less urgent. When you’re struggling, sometimes the last thing you want to do is talk about it.

But those are often the most important sessions. The ones when you’re doing well help you understand what’s working. The tough ones are where breakthroughs happen.

If you’re struggling to make it to appointments, bring that up in session. It might actually be connected to what you’re working on.

Your therapist said something that rubbed you the wrong way. Maybe they made an assumption that wasn’t accurate. Maybe a technique they suggested felt ridiculous.

Most people just let it go. They nod, say sure, and never bring it up again. Then they go home and complain to their partner about how their therapist doesn’t get them.

Here’s the thing. Therapists aren’t mind readers. And the therapy room is actually the perfect place to practice speaking up when something doesn’t feel right. That’s a skill that helps in every relationship.

If a technique doesn’t work for you, say so. If you feel misunderstood, explain why. A good therapist will appreciate the feedback and adjust.

This is common with people around Rittenhouse and the Main Line who are used to efficiency in every area of their lives. They want results and they want them now.

But therapy is playing the long game. That first session? It’s basically an introduction. Your therapist is just getting to know you. You’re figuring out if you even like being in that room with them.

Real change takes time because you’re literally rewiring how you think and respond to things. Your brain has spent years building certain patterns. It’s not going to undo them in an hour.

Give it at least four to six sessions before deciding if it’s working. And even then, the timeline looks different for everyone.

Your friend went to therapy for three months and says she’s a completely different person now. You’ve been going for six months and still feel stuck.

First of all, people exaggerate. Especially on social media. That “healed” version of your friend probably still has plenty to work on.

Second, everyone’s situation is different. Someone working through a recent breakup might see faster progress than someone unpacking childhood trauma. Neither is better or worse. They’re just different.

Focus on your own progress. Are you handling things even slightly better than you were before? Are you catching yourself sooner when you fall into old patterns? That’s growth, even if it doesn’t feel dramatic.

There’s a comfort zone in therapy. It’s where you talk about your annoying coworker or that fight you had with your mom last week. These things matter, but staying at this level forever keeps you from the deeper work.

The hard stuff, the stuff you really don’t want to talk about, is usually where the real healing happens. If you find yourself steering away from certain topics or keeping things light week after week, notice that.

Your therapist will probably gently push you toward these areas. Try to let them.

Therapy should feel collaborative. You should have some say in what you’re working on and how you’re approaching it.

If you’ve been doing talk therapy for months and want to try something more hands on, say that. If your therapist’s approach isn’t clicking, speak up.

Some people think questioning the process means they’re being difficult. But actually, advocating for what you need is healthy. It’s probably even connected to why you’re in therapy in the first place.

Maybe you tried therapy before and it didn’t work. You didn’t like your therapist because they talked too much. You didn’t click. You felt judged.

It makes sense that you’d be guarded going into a new therapeutic relationship. But showing up expecting this therapist to be just like the last one isn’t fair to either of you.

Every therapist is different. Every relationship is different. Try to enter with an open mind, even if you’ve been burned before.

The pattern here is pretty simple. Therapy works best when you show up honestly, consistently, and with a willingness to do the hard things both in and out of sessions.

Talk to your therapist like they’re on your team because they are. Do the work between appointments. Speak up when something isn’t working. And give it time.

If you’re looking for therapy in Philadelphia or Haddonfield, we’d love to help you get started. Our practice works with people across the city, from University City to Old City and everywhere in between. Reach out when you’re ready to take that first step.

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