Tips for Starting Therapy

Stress and anxiety are increasingly common challenges in everyday life. According to the American Psychological Association, 43 percent of adults reported feeling more anxious in 2024 than the previous year. Despite this, only 24 percent of adults sought professional mental health support last year. 

“The majority of people who need mental health care don’t actually end up getting the clinical care they need,” says Adrian Jacques H. Ambrose, MD, MPH, MBA, FAPA, senior medical director at ColumbiaDoctors Psychiatry, who provides therapy and medication treatments for children, adolescents, and adults. 

Dr. Ambrose explains how therapy can help, ways to find the right therapist, and how to approach your first appointment.

Starting therapy can feel like a big step. What is helpful for people to know about their first session?

Starting therapy is a brave and important decision. The first session is all about getting to know each other. I’ll ask basic questions like, “What brings you to therapy?” or “How have you been feeling lately?” This helps me understand the concerns that led someone to seek help. There’s no pressure to have everything figured out—just showing up is a big step.

How can someone prepare for their first session?

Preparation can make a difference. I suggest thinking about why you're seeking therapy—whether it’s stress, anxiety, depression, or something else. Some people find it helpful to write down thoughts or key points beforehand. Also, therapy works best when you're open and honest. It’s okay to feel unsure but try your best to share. And remember, this is a process—we don’t expect everything to be solved in one session.

What happens after the first session?

Typically, we’ll schedule another appointment to continue working through concerns. A good sign that therapy is going well is if you feel heard and understood. Over time, we’ll set goals and develop coping strategies together. Even when discussions are tough, you should leave feeling like you're making meaningful progress.

What’s your advice for someone feeling nervous about opening up in therapy?

It’s completely normal to feel nervous. If you don’t know where to start, let your doctors know—that’s part of our job. We can guide the conversation in a way that feels comfortable for you. Therapy is a judgment-free zone, and over time, it gets easier to open up.

What if someone is worried about discussing painful or traumatic experiences?

That’s a very common concern. I usually try to give patients a heads-up that talking about extremely painful or traumatic experiences can feel like pulling off a bandage—it hurts in the moment. The goal here is to properly heal the underlying wounds. We will help create a safe space and work on coping techniques to support you as you process difficult emotions. Healing takes time, and therapy is meant to be a gradual process.

How can therapy help with day-to-day stress and not just major life crises?

Therapy isn’t just for crises—it’s also a tool for managing everyday stress and improving overall well-being. Whether it’s handling work pressures, improving relationships, or developing better coping skills, therapy can provide strategies that help people navigate daily challenges more effectively.

What if someone doesn’t feel a connection with their therapist? 

That’s really important. Not every therapist is the right fit for everyone, and that’s okay. If you don’t feel a connection after a few sessions, speak up. You can ask for a different approach or even try a new therapist. Finding the right provider for you is key to making therapy effective.

Are there ways to make finding the right therapist easier?

Consider what you need—whether it’s help with anxiety, relationships, or trauma—and find someone with experience in that area. For example, I’m a mood disorder expert. If during our first couple of meetings, it seems your challenges are less focused on mood disorders, I may recommend a colleague who specializes in your particular area. The goal is to match you with the right expert, so you can get the best possible care. If language is a concern, ask about bilingual providers.

What would you say to someone who is unsure if therapy is right for them, or if they need more than just therapy?

If you’re struggling with stress, anxiety, relationship issues, or anything that affects your well-being, therapy is worth considering. It’s a space to grow, heal, and build coping skills. There’s no shame in seeking help, and I’m always telling patients, “I’m so proud of you for taking that first step.” Conversely, some patients worry that if they see a psychiatrist, they’ll have to take medications. That is not the case at all. Therapy and/or medications are just tools, so we can work together to match the right tool for the right clinical circumstance. For some mental health challenges, the treatment evidence is actually best in combined treatments with both medications and psychotherapy.

Any final words for those seeking mental health care?

Just know that you’re not alone. Taking that first step is a huge accomplishment, and it means you’re prioritizing your mental health—which is an integral part of your overall health.

Adrian Jacques H. Ambrose, MD, MPH, MBA, FAPA, is the senior medical director at ColumbiaDoctors Psychiatry and assistant professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons. He is a neuroscientist and subspecialist in interventional psychiatry and neuromodulation for treatment-resistant mood disorders.