What to Expect from Therapy: 5 Things I Wish Every New Client Knew
By Dr. Laura Greve, Founder and Licensed Psychologist, Health Psychology Associates
Making that first therapy appointment takes courage. You've acknowledged that something needs to change, you've researched therapists, and you're ready to invest time and money into your mental health. That's huge.
But here's what most people don't realize: therapy rarely works the way you think it will.
After years of walking alongside clients through their therapeutic journeys, I've noticed the same surprises come up again and again. Let's talk honestly about what therapy actually looks like, not the sanitized version you see on TV, but the real, messy, and worthwhile process of change.
1. The First Few Sessions May Feel Ineffective (They're Not)
What clients often think: "Why am I paying to recap my entire life story? I came here to fix my anxiety, not discuss my childhood."
What's actually happening: We're building the foundation.
Think of therapy like diagnosing why your check engine light is on. I can't just tell you to "think more positively" without understanding the entire system. That childhood story about your parents' divorce? It might be directly connected to why you sabotage relationships at the three-month mark. The way your family handled conflict? That's probably showing up in how you communicate with your partner today.
The timeline: Most clients start connecting the dots around week 6-8. That's when I hear, "Wait... is THAT why I do this?" Yes. That's exactly why.
What helps: Come prepared to your first session with a brief timeline of significant life events: moves, losses, major transitions, and relationship patterns. This helps us map your history more efficiently.
2. Insight Comes Before Change (And That Gap Is Frustrating)
This is the part nobody warns you about: understanding your patterns doesn't immediately stop them.
You'll have moments of clarity that feel revolutionary. "I people-please because I learned my needs didn't matter!" Amazing insight. And then the next day, you'll still say yes to something you want to say no to.
This is completely normal. You're not failing.
Here's why: Your brain has been running these patterns for years, maybe decades. Neural pathways are like hiking trails: the more you've walked them, the more automatic they become. Awareness is essential, but rewiring takes repetition.
The actual process looks like this:
Months 1-3: Understanding why you do what you do
Months 4-9: Catching yourself mid-pattern, then reflecting afterward
Months 10+: Starting to pause and choose differently in real-time
Change isn't linear. Some weeks you'll backslide. That's part of the process, not evidence that therapy isn't working.
3. I Won't Give You a Roadmap (And Here's Why)
Client: "Just tell me what to do."
Me: "What do you think might help?"
Client: "If I knew, I wouldn't be here."
I get it. This feels maddening. But here's the truth: my job isn't to hand you solutions. It's to help you discover what works for you.
If I tell you to leave your job, set a boundary, or end a relationship, two things happen:
You might take advice that doesn't fit your unique situation
You don't build the skill of trusting your own judgment
I'm not withholding. I'm teaching you to access your own wisdom because I won't be there at 2am when you're making real-life decisions. But your ability to pause, reflect, and choose? That stays with you forever.
What I do provide: Tools, frameworks, observations, and questions that help you clarify what YOU actually want underneath the anxiety, guilt, and other people's expectations.
4. Talk Therapy Is Powerful, But It's Not the Only Tool
For years, the therapy model was straightforward: sit on a couch, discuss your problems, gain insight, and feel better.
We now know it's more complex than that. Some experiences get stored in your body, not just your thoughts. Trauma, chronic stress, and early attachment wounds can live in your nervous system, which is why you might logically know you're safe but still feel anxious.
This is why I often incorporate:
Cognitive-behavioral approaches for thought patterns and behaviors
EMDR or trauma-focused work for processing difficult memories
Somatic techniques for regulation and body awareness
Parts work (IFS) for internal conflicts
You don't need to understand these modalities before we start. I'll explain what might help and why, and we'll adjust based on what resonates with you.
Bottom line: If traditional talk therapy isn't landing, it doesn't mean therapy doesn't work for you. It means we need a different approach.
5. Healing Doesn't Equal Happiness. It Equals Truth
Let me be clear: therapy will probably make your life harder before it makes it easier.
Not because the process is damaging, but because growth requires honesty. And honesty sometimes means:
Setting boundaries that disappoint people
Leaving relationships that aren't healthy
Facing truths you've avoided for years
Sitting with uncomfortable emotions instead of numbing them
I've watched clients make brave, difficult choices in therapy: ending engagements, confronting family members, walking away from careers that looked perfect on paper. These decisions hurt. They're also often necessary.
What therapy actually offers: Not a pain-free life, but an authentic one. Not perfection, but self-awareness. Not constant happiness, but the ability to move through difficult emotions without being destroyed by them.
You'll still make mistakes. You'll still struggle. But you'll do it with more clarity, more choice, and more compassion for yourself.
The Reality: Therapy Is a Long-Term Investment
I wish I could promise you that eight sessions will solve everything. Some issues do respond quickly: specific phobias, recent situational stress, and learning concrete skills.
But profound change, the kind that shifts how you relate to yourself and others, takes time. Months, often years. Not because we're dragging it out, but because you're literally rewiring your brain.
Good signs therapy is working:
You're noticing patterns you couldn't see before
You're pausing before reacting in old ways (even if you still react sometimes)
Your relationships are shifting as you change
You're more honest with yourself, even when it's uncomfortable
Bad days are still bad, but they don't derail you like they used to
Is Therapy Right For You?
Therapy works best when you're:
Ready to be uncomfortable
Willing to look at your own role in patterns (not just blame others)
Committed to showing up, even on weeks when you "don't have anything to talk about"
Open to trying new approaches if the first one doesn't click
Therapy might not be the right fit right now if:
You want someone to fix you without your active participation
You're only coming because someone else thinks you should
You're looking for someone to validate that everyone else is the problem
Making That First Appointment
If you've read this far and remain interested, you're likely ready.
Yes, it's awkward to bare your soul to a stranger. Yes, it's an investment of time and money. Yes, it's going to be harder than you expect.
However, here's what's also true: therapy can fundamentally change how you experience your life, not by making problems disappear, but by equipping you with the tools to navigate them differently.
That email or text to start therapy feels enormous. Send it anyway.
Ready to start therapy?
Complete our new client intake form or text our Boston office at (617) 882-2363. We typically respond within a few hours to help you get started quickly. We offer both in-person sessions in Boston and telehealth appointments throughout Massachusetts.
We'll talk about what brings you in, answer your questions, and help match you with the right therapist on our team.
Not sure if therapy is right for you? Fill out our form anyway. We'll help you figure it out together.
About the Author
Dr. Laura Greve is a licensed psychologist and the founder of Health Psychology Associates in Boston, Massachusetts. With expertise in stress, anxiety, and burnout, the intersection of technology and human connection, and supporting high-achieving professionals, Dr. Greve is committed to providing evidence-based, compassionate care that meets clients where they are.
Dr. Greve has been featured in Business Insider discussing the mental health implications of AI in the workplace and the importance of maintaining authentic human connections in an increasingly digital world. She specializes in helping clients navigate career stress, relationship challenges, anxiety, depression, and life transitions.
At Health Psychology Associates, Dr. Greve leads a team of skilled clinicians offering a range of therapeutic approaches, including EMDR, somatic therapy, cognitive-behavioral therapy, ACT, and menopause-informed care through the EMBERS framework.
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