The Five Stages of Psychotherapy


Many people who are considering starting psychotherapy wonder what actually happens during therapy. How does it all play out over time? How long will it take? It is completely understandable to feel nervous at first and to have many questions.

There are five stages that the therapist and client will journey through from the intake appointment to the last appointment. This article will describe what to expect from each stage, so that you have a clear understanding of how the process works.


Engagement: Getting to Know Each Other, and Where Are You Now?

During the first stage, you and your therapist will get to know each other and start to build a working relationship.

The first session, the intake session, is very important. It is not like any other session because your therapist will gather a lot of information at once. It is normal to feel shy or nervous at first, but as you go along, your therapist will help you feel more comfortable. Feel free to ask any questions as you talk with your therapist.

First, the therapist will tell you a little about how the practice works and will explain details about confidentiality and about how to cancel or change appointments. After that, there will be a great deal of focus on what has been happening for you and what brings you into therapy now. Your therapist will ask questions about what you have been doing to try to cope, what’s working, and what’s not. There will be some questions about your history, your family history, and other medical conditions you might be dealing with. All of these questions help your therapist learn about you and will help them determine how they can best be helpful to you. If you use insurance to pay for sessions, the therapist will need to assign you a diagnosis in order to submit bills to the insurance company. So, some of the questions will help them decide which diagnosis makes the most sense.

After the first session, the next three to four sessions will be focused mainly on getting to know each other, feeling comfortable working together, learning more about what you have been experiencing and feeling, and starting to think about what you want to get out of therapy.


Goal Setting: Where Do You Want to Go?

Once you and your therapist both have a clear understanding of what difficulties and challenges you have been experiencing, you will work together to set one to three goals that you would like to work on in therapy. This usually takes one or two sessions. Some common goals are:

  • Improve symptoms of anxiety or depression
  • Improve your communication in a particular relationship
  • Feel more motivated on daily tasks
  • Understand and accept an aspect of your identity
  • Improve problems with sleep
  • Improve problems with eating
  • Reduce (and eventually eliminate) behaviors that are causing you distress
  • Overcome fears about certain people or situations that are holding you back

There are many types of goals that clients might set. Your therapist will carefully listen to what you want to work on and what you want to do. You are always in the driver’s seat!

Sometimes clients have many goals that they want to work on. It can be overwhelming to work on too much at once, so your therapist will help you prioritize your goals. It’s best to work on only one to three goals at the same time. You can always add more later as you see improvements in your initial problems.



Planning: How Will You Get There?

Once you are satisfied with your goals, you and your therapist will discuss what the plan will be for you to achieve them. This usually takes one or two sessions. Your therapist will suggest different options, and together you can both decide what makes sense for you.


Implementation: Working Together on Your Goals

This stage is the “meat” of therapy. When you come in for each session, you can share what’s been going well, and what has not been going well for you. You can discuss anything that you’d like to with your therapist. Over time, you and your therapist will work together on learning new coping skills, communication skills, and ways to manage painful emotions and experiences. You will explore your thoughts and feelings and how they may be impacting your work, school, relationships, and social life. You might explore your sense of self, your acceptance of yourself, or your identity. Whatever your goals and plan are, you and your therapist will be working on them together.

Periodically during this stage, your therapist will check in with you to see if the current plan is working for you. If it isn’t, your therapist can suggest ways to change things up. You might adjust a goal, or you might decide to try a different approach for working on an existing goal. If something is not working for you, it is always okay to say so. At every stage, you are in the driver’s seat!


Wrapping Up: Celebrating Your Accomplishments

Therapy can last as long as you need it to. Sometimes, clients achieve their first goals and then decide there are other goals to work on. The process returns to setting goals, making a plan, and getting to work. Other times, clients are happy with the progress that has been made. Then it is time to wrap up.During the wrap-up stage, you and your therapist will spend two to six sessions (or however long you’d like) reviewing all the hard work you have done and the skills, insights, and new ways of being that you have mastered. You will review all your sources of support and how to access them if things get difficult. Together, you will both celebrate your success and accomplishments!

If, after some time has passed, you decide you would like to return to therapy for a “brush up” or to work on new goals, that is always an option.


The therapists at the Rollins Counseling Center would be honored to get to know you and to journey with you as you define your goals and make the positive changes you want to transform your life. Please feel free to reach out today!