The Therapy Journey: What to Expect from Your First Session to Last

Before her first therapy session, Li researched for hours: what to wear, where to sit, what to say, whether she'd be "good at therapy." She arrived fifteen minutes early, palms sweating, rehearsing her opening lines.

Six months later, she walked into our session, flopped onto the sofa, kicked off her shoes, and said: "I had the weirdest dream last night—want to hear it?"

Somewhere between those two moments, she'd stopped performing and started simply being. That's the therapy journey.

Understanding what typically happens in therapy—from nervous first sessions through messy middle stages to bittersweet endings—helps you navigate the process with less anxiety and more trust.

This guide walks through the therapy journey: what each stage typically involves, what's normal, and what to expect as you progress.

Before You Start: The Anticipation Phase

Common Feelings

• Anxiety about first contact
• Hope mixed with skepticism
• Shame about needing help
• Relief at finally taking action
• Worry about being "too much" or "not enough"

What's Actually Happening

You're making one of the most courageous decisions: to ask for support, to be vulnerable, to invest in yourself.

Normal concerns: "What if they judge me?" "What if I can't afford it long-term?" "What if I don't know what to say?" "What if it doesn't help?"

Reality: Therapists expect these worries. They've heard them hundreds of times. You won't shock, bore, or overwhelm them.

Stage 1: Beginning (Sessions 1-4)

The First Session

What happens:

• Initial greetings and settling in
• Housekeeping (confidentiality, cost, practicalities)
• Exploring what brought you to therapy
• Your therapist getting to know you
• Beginning to establish trust

What you might feel:

• Nervous, self-conscious
• Relieved to finally talk
• Exposed or vulnerable
• Uncertain if it's "working"
• Exhausted afterwards (common—emotional work is tiring)

What's normal:

• Crying (or not crying—both fine)
• Not knowing where to start
• Rambling or feeling scattered
• Worrying you're wasting time with "small talk"
• Leaving unsure if this therapist is right

Sessions 2-4: Establishing Foundation

What happens:

• Continuing to share your story
• Therapist learning your patterns, history, context
• Testing the relationship (will they handle what I bring?)
• Beginning to identify themes
• Establishing rhythm and rapport

What you might notice:

• Feeling slightly more comfortable (or not yet—also normal)
• Starting to lower defenses
• Seeing patterns you hadn't noticed
• Wondering if you're "doing it right"

Red flags vs. normal discomfort:

Normal discomfort:

• Feeling exposed
• Uncertain where therapy is going
• Awkward silences
• Not knowing what to talk about

Red flags (consider different therapist):

• Feeling judged or criticized
• Therapist talking excessively about themselves
• Boundary violations
• Consistent feeling of being misunderstood

Decision point: By session 3-4, you should have sense of whether this therapist/approach might work. If not, it's okay to try someone else.

Stage 2: Building (Months 2-6)

What Happens in This Phase

Deeper exploration: Moving beyond surface story to underlying patterns

Increased honesty: Feeling safe enough to share harder material

Resistance emerges: As you approach painful territory, avoidance or pushback is normal

Therapeutic relationship deepens: Trust builds; therapist becomes important figure

Patterns become visible: Seeing how you show up in therapy reflects how you show up in life

Common Experiences

The "honeymoon" ends: Initial relief fades; actual work begins

Questioning if it's working: Progress isn't linear; doubt is normal

Difficult emotions surface: Therapy stirs things up before settling them

Talking between sessions: Thinking about therapy, imagining conversations with therapist

Transference begins: Relating to therapist in ways that mirror other relationships

What Growth Looks Like

You might notice:

• Catching yourself in patterns as they happen
• Responding differently in one area of life
• Feeling emotions more fully
• Setting a boundary successfully
• Having compassionate thought about yourself
• Connecting something from past to present pattern

Important: Growth is subtle and incremental. You likely won't feel dramatically different week to week.

Challenges in This Phase

Impatience: "Why isn't this working faster?"

Solution: Remind yourself significant change takes time. Notice small shifts.

Wanting to quit: "This is too hard; maybe I'm fine as I am."

Solution: Discuss with therapist. Wanting to quit often signals you're approaching something important.

Frustration with therapist: "Why won't they just tell me what to do?"

Solution: The frustration itself is material to explore.

Stage 3: Working Through (Months 6-18+)

What Happens in This Phase

Deepest work: Addressing core wounds, beliefs, patterns

Reworking: Experiencing old dynamics in new ways (often with therapist)

Integration: Connecting insights to changes in life

Experimentation: Trying new ways of being

Grief: Mourning what was lost, what didn't happen, who you might have been

Consolidation: New patterns becoming more natural

Common Experiences

Emotional intensity increases: Sessions may be harder before they're easier

Transference peaks: Strong feelings toward therapist (positive, negative, or both)

Resistance intensifies: As you approach core material, avoidance gets stronger

Breakthroughs happen: Sudden shifts in understanding or being

Life outside therapy changes: Relationships shift, jobs change, choices align with values

What Deepening Looks Like

• Bringing material you've never told anyone
• Feeling anger, grief, or vulnerability fully
• Recognizing therapist genuinely cares
• Challenging therapist's interpretations
• Expressing needs directly
• Tolerating not knowing
• Sitting with difficult feelings without solving

Challenges in This Phase

Dependency concerns: "Am I too reliant on therapy?"

Reality: Healthy dependency supports growth. Concern is whether you're increasingly capable outside therapy.

Stuckness: "We keep talking about the same thing."

Explore: Is this genuine stuckness or necessary revisiting as you peel layers?

Therapist idealization/devaluation: Seeing them as perfect or terrible

What's happening: These extremes often reflect early relationship patterns—valuable material

Stage 4: Integration and Change (Months 12-24+)

What Happens in This Phase

Consolidation: New ways of being feel more natural

Separation: Becoming less dependent on therapist, more trusting of yourself

Ownership: Taking credit for changes you've made

Looking forward: Focus shifts from past patterns to future possibilities

Preparing for ending (even if not immediate): Recognizing therapy won't be forever

Common Experiences

Sessions feel different: Less crisis-driven, more growth-focused

You might forget to go: (Occasionally) Not because you don't value it, but because you're not in constant distress

Gratitude emerges: Appreciation for the work you've both done

Ambivalence about ending: Want to continue AND ready to move on

Testing endings: Missing sessions, arriving late, discussing finishing

What Maturity in Therapy Looks Like

• Bringing material without shame
• Accepting therapist's limitations
• Valuing relationship without idealization
• Disagreeing constructively
• Reflecting on process, not just content
• Recognizing your own growth
• Imagining life without therapy

Preparing for Ending

Even if ending isn't imminent, you'll likely notice:

• Thoughts about finishing arise
• Fear of losing support vs. confidence in yourself
• Wondering "when will I be done?"
• Discussing with therapist what "done" means for you

Stage 5: Ending (Final Weeks/Months)

How Endings Happen

Planned endings (ideal):

• Discussed weeks or months in advance
• Time to process the ending itself
• Review of progress
• Preparation for continuing without therapy

Circumstantial endings:

• Relocation, financial changes, therapist leaving
• Less ideal but still valuable to process

Premature endings:

• Stopping abruptly when therapy feels incomplete
• Often due to discomfort, avoidance, or practical barriers

What the Ending Phase Involves

Review: Looking back at where you started, what's changed

Consolidation: Identifying skills and insights to carry forward

Processing the relationship: Acknowledging what therapist has meant

Grieving: Sadness about losing this unique relationship

Celebrating: Recognizing growth and courage

Future planning: Discussing when to return if needed

Common Feelings About Ending

• Sadness and grief
• Pride and accomplishment
• Anxiety about managing alone
• Relief (sometimes)
• Guilt about leaving
• Gratitude

All are normal and worth exploring

Signs You're Ready to End

• Main issues significantly improved
• Coping skills internalized
• Self-awareness and self-compassion developed
• Relationships healthier
• Life feels manageable
• Sense of completion (not perfection)

Important: You don't need to be "perfect" or problem-free. Therapy isn't about eliminating all difficulties—it's about developing capacity to handle life.

The Last Session

Often includes:

• Reflections on the journey
• Saying goodbye to the relationship
• Discussing "open door" policy (can return if needed)
• Final words of appreciation
• Possibly tears
• Warm, bittersweet closure

After Therapy: Continuing the Journey

What Happens Post-Therapy

Continued growth: Changes keep unfolding even after sessions end

Occasional wobbles: Old patterns resurface under stress (normal)

Integration period: Weeks/months to fully absorb the work

Internal therapist: You hear your therapist's voice, questions, perspectives

Confidence: Trusting you can handle challenges

When to Return to Therapy

Consider returning if:

• Major life transition (job loss, relationship ending, loss, illness)
• Persistent difficulty that self-care doesn't resolve
• Old patterns strongly reasserting
• New issues emerge
• Desire for continued growth

Returning isn't failure: Many people do multiple "rounds" of therapy at different life stages

Non-Linear Journeys: When Therapy Doesn't Follow the Script

Reality Check

Not everyone's journey looks like neat stages:

• Some people plateau for months, then sudden progress
• Others make quick gains, then deeper issues emerge
• Some need breaks and return multiple times
• Occasional people realize this therapist/approach isn't right and switch

All valid journeys

If Progress Feels Stuck

First: Discuss with therapist. Stuckness is often meaningful.

Questions to explore:

• Am I avoiding something?
• Is this approach not suited to me?
• Do I need more time on current work before moving forward?
• Is external life preventing internal change?

If genuinely stuck despite exploration: Consider different therapist or approach

Different Therapy Lengths

Short-Term (8-20 sessions)

Typical for: Specific issues, symptom-focused work, CBT

Journey: Condensed stages; less relationship depth; focused goals

Medium-Term (6-18 months)

Typical for: Relationship patterns, moderate difficulties, life transitions

Journey: Full cycle through all stages

Long-Term (2+ years)

Typical for: Complex trauma, deep-seated patterns, personality work, ongoing growth

Journey: May cycle through stages multiple times at deeper levels

Open-Ended

Typical for: Psychoanalytic, ongoing development, no set endpoint

Journey: Continues as long as mutually beneficial

Tips for Navigating Your Journey

1. Trust the process: Even when you can't see progress

2. Be honest: About everything—feelings towards therapist included

3. Notice resistance: When you want to cancel, go quiet, change subject—explore it

4. Be patient: Significant change takes longer than you'd like

5. Celebrate small wins: Subtle shifts matter

6. Communicate about the relationship: Meta-conversations are valuable

7. Remember it's not linear: Setbacks are part of progress

8. Take breaks if needed: Pausing isn't failing

Final Thoughts

The therapy journey isn't a straight path from broken to fixed. It's more like a spiral: circling back to familiar territory but seeing it differently, understanding more deeply, responding with more choice each time.

You'll have sessions that feel transformative and sessions that feel pointless. Weeks where everything clicks and weeks where nothing makes sense. Moments of profound connection with your therapist and moments of frustration or disconnection.

All of it is the journey.

What makes therapy work isn't the absence of difficulty—it's the willingness to keep showing up, to keep being honest, to keep trusting that even when you can't see progress, something is shifting.

If you're in London and considering beginning your therapy journey, I offer person-centred, Gestalt, and TA-integrated counselling. I provide free 15-minute consultations to discuss what you're looking for and whether working together might support your journey.

Every therapy journey is unique, but none of us walks it entirely alone. That's the gift of the therapeutic relationship—a companion for part of your path, helping you find your way.