Starting, Ending, and
Changing Services

On this page you will find information to help you prepare for starting therapy, ending therapy or changing therapists.

You can also download each section here:

Starting Therapy

Starting therapy can be a significant step toward better mental health, but it’s normal to feel a bit uncertain or unsure about the process. To help you feel more comfortable and get the most out of your therapy experience, it’s important to prepare yourself emotionally, mentally, and logistically. Here’s a comprehensive guide to help you get ready before you begin therapy, covering topics like expectations, readiness, goal-setting, and finances.

The First Session

Your first session is typically an intake session where the therapist will:

Ask about your history (medical, psychological, social).
Discuss the issues that led you to seek therapy.
Set the tone and explain confidentiality and the therapeutic process.
Discuss logistics such as session length, frequency, and fees.

The first session is often about establishing rapport and gathering background information, so don’t expect immediate resolution of your issues. It’s an important foundational step.

Ongoing Sessions

Therapy is a process, not a quick fix. Most therapies involve a series of sessions, with each one building on the last.
Over time, you’ll be expected to participate actively. This may involve homework, practicing new skills, or reflecting on what’s discussed in between sessions.
Sessions may involve exploring difficult emotions, and you may be asked to confront uncomfortable feelings or thoughts. This is normal and part of the healing process.

Assessing Readiness for Therapy

Before beginning therapy, it’s essential to assess whether you’re ready to engage in the therapeutic process.

Self-Reflection:

Emotional Readiness: Are you open to exploring deep emotions or difficult topics? Therapy often involves confronting painful memories or beliefs, so it's important to ask yourself whether you're prepared to dive into this process.
Willingness to Change: Therapy requires active participation. Are you ready to make changes in your life? This might mean changing behaviours, thought patterns, or perspectives that have been ingrained over time.
Commitment to the Process: Therapy takes time. Are you prepared to stick with it, even when progress feels slow or difficult? Be ready for the ups and downs that are a natural part of personal growth

Assessing Emotional State:

If you’re in the middle of an acute crisis (e.g., experiencing suicidal thoughts, severe depression, or emotional numbness), you might need more immediate intervention, such as crisis therapy or psychiatric support before diving into ongoing therapy.
If you’re unsure about your readiness, it may be helpful to speak to your potential therapist about where you’re at emotionally and how you feel about starting therapy. This can help clarify whether therapy is the right fit at this time.

Setting Goals for Therapy

Having clear, defined goals for therapy will help both you and your therapist stay focused. Therapy is most effective when you have an idea of what you hope to achieve, though this may evolve as you go along.

Identifying Goals:

Before your first session, think about your primary concerns or issues. Some questions to guide you:

Are you seeking therapy for mental health issues (e.g., anxiety, depression, trauma)?
Do you want to improve relationships with others, such as family or partners?
Are you hoping to gain better coping skills for stress or emotional regulation?
Do you need to process past trauma or difficult experiences?

You may want to write down a few key areas you want to address or things you’d like to change. Keep in mind that these goals might evolve as you progress in therapy.

Collaborative Goal-Setting:

During your first few sessions, your therapist will help you refine your goals, making them more specific, measurable, and achievable.
Goals might evolve as therapy progresses. You may start with a broad goal (e.g., “I want to feel less anxious”), and through the process, work toward more specific objectives (e.g., “I want to learn how to manage anxiety during social events”).

Remember: Therapy isn’t just about fixing problems; it’s also about growth, healing, and building resilience.

Financial Considerations and Logistics

Therapy can be an investment, both emotionally and financially. Understanding the financial aspects of therapy before you begin is crucial to avoid surprises later.

Understanding Costs:

Insurance Coverage: Check if your health insurance covers therapy. If it does, find out which therapists are within your network and what your out-of-pocket costs will be (co-pays, deductibles, etc.).
Sliding Scale Fees: Some therapists offer sliding scale fees, meaning they adjust their rates based on your financial situation. If you have financial concerns, it’s worth asking about this option.
Private Pay: If you’re paying out of pocket, session costs can vary. On average, therapy can cost anywhere from $100 to $250 per session, depending on the therapist’s experience and location.
Payment Plans: Some therapists offer payment plans or may accept credit cards, which can make paying for therapy more manageable.

Frequency of Sessions:

Many therapies begin with weekly sessions, but as you make progress, you may transition to bi-weekly or monthly sessions.
The frequency will also depend on your goals and the therapist's recommendation. For example, if you're managing severe symptoms, weekly sessions may be needed. For maintenance or self-exploration, bi-weekly sessions may be enough.

Time Commitment:

Therapy often requires a time commitment. Sessions typically last 50-60 minutes, and you may need to allocate additional time to process your thoughts or complete homework assignments.
Make sure that therapy fits into your schedule and doesn’t add unnecessary stress.

Creating the Right Environment for Therapy

Therapy will be most effective when you feel comfortable and safe. Consider how you can prepare your personal environment to enhance the therapy experience:

Physical Space:

In-Person Therapy: If your therapy will be in person, make sure you can get to the therapist’s office without undue stress. Consider travel time, parking, and any other logistics.
Online Therapy: If you are engaging in teletherapy, ensure you have a private, quiet, and comfortable space for your sessions where you won’t be interrupted.
Confidentiality: Make sure you can talk openly without fear of being overheard, especially for sensitive topics. This is particularly important in family therapy or therapy for children/adolescents.

Emotional Environment:

Open-Mindedness: Come with an open mind, ready to explore new ideas, techniques, and perspectives.
Self-Compassion: Therapy can be emotionally taxing. Be kind to yourself as you go through the process. Remember, growth takes time, and it’s okay to take breaks when needed.

Preparing Emotionally and Mentally

Therapy often involves difficult, sometimes painful work. Here’s how to prepare emotionally:

Recognizing Resistance:

It’s normal to feel nervous or even resistant to therapy at first. Some people feel a sense of discomfort when facing their emotions or talking to a stranger about personal issues. Acknowledge these feelings and remind yourself that therapy is a safe and non-judgmental space.
Feelings of Vulnerability: It’s common to feel vulnerable during therapy. Allow yourself to experience these feelings without judgment—therapy is a place to explore them.

Openness to Feedback:

Therapy involves self-reflection, which can lead to valuable insights. Be open to feedback from your therapist. Remember, their goal is to help you grow, not to criticize you.

Starting therapy can feel like a big step, but the process of preparing yourself can make the experience more productive and rewarding. Take your time to reflect on your goals, get informed about the therapy process, and ensure you are ready both emotionally and logistically.

Therapy is a personal journey toward healing, growth, and understanding. By preparing ahead of time, you can maximize the benefits of the therapy process and feel confident in your path toward better mental health.

The Process of Ending Therapy

Ending therapy can be a natural and rewarding part of the therapeutic journey. It’s a time when you can reflect on your progress, celebrate growth, and prepare to navigate life without the regular support of a therapist. However, how therapy comes to an end can vary depending on your individual needs, goals, and the type of therapy you're engaged in. Therapy usually doesn’t end abruptly. Instead, it often concludes gradually as you and your therapist work together to prepare for closure. This process allows you to:

Reflect on Progress: As you near the end of therapy, you’ll likely take time to discuss the changes and progress you’ve made. Your therapist may help you identify patterns, milestones, and areas where you’ve gained insight or developed new coping skills.
Revisit Goals: Towards the end of therapy, you and your therapist will review the goals that you initially set and assess whether they’ve been achieved or whether new goals need to be added. The therapist may help you evaluate whether you're now in a position to continue independently without ongoing support.
Review Skills and Tools: The therapist will review the coping strategies, techniques, and self-care practices you’ve learned throughout therapy, ensuring that you feel confident using them when challenges arise in the future.

Types of Endings in Therapy

There are a few different scenarios in which therapy might come to an end:

1. Reaching Therapy Goals:

Successful Completion: If you’ve achieved the goals you set at the beginning of therapy (e.g., reducing symptoms of anxiety, improving self-esteem, processing trauma), therapy may naturally conclude. This is often considered a successful ending, where you and your therapist acknowledge the progress you’ve made and discuss the next steps for maintaining your well-being.
Goal Review: In the final sessions, the therapist will often help you reflect on how far you’ve come, celebrate your achievements, and ensure you feel confident managing your mental health on your own. For instance, if your goal was to manage panic attacks, the therapist will review what strategies worked and how to handle any future challenges.

2. Therapist’s Recommendation:

Sometimes, the therapist might feel that you’ve reached a point where ongoing therapy isn’t necessary or would be counterproductive. For example, if you’ve achieved significant progress, they might suggest that you transition to maintenance therapy (less frequent sessions) or even end therapy altogether.
The therapist may also refer you to another professional if you have different or more complex needs (e.g., needing a specialist in trauma or addiction therapy).

3. Client’s Decision:

You may feel ready to end therapy when you’ve noticed improvements in your life or emotional well-being. It’s possible that you’ve made progress on your goals and feel confident in the tools and strategies you’ve developed.
In this case, the decision to end therapy will be mutual after discussing your progress with your therapist. If you’ve achieved what you set out to do, your therapist may help guide you through a positive closure.

4. Temporary Breaks or Transitions:

Maintenance Therapy: Some people enter a phase of maintenance therapy, where sessions become less frequent (e.g., every other week or monthly). This allows you to check in occasionally and discuss new challenges without ongoing weekly sessions.
Referral or Transition: In some cases, therapy may transition to another form of support, such as group therapy, or a different type of therapy. For example, someone who has been working on general anxiety might transition to specialized trauma therapy if new needs arise.

5. Unexpected Endings:

Sometimes therapy may end unexpectedly due to circumstances beyond your control, such as a therapist leaving the practice or moving. If this happens, your therapist should offer resources and referrals to help you continue your care.
If you need to end therapy for personal reasons (e.g., financial constraints, moving to a new location), it’s best to have an open conversation with your therapist to ensure a smooth and healthy transition. They can help provide referrals or guide you on how to manage without therapy if that’s your decision.

Common Feelings at the End of Therapy

Ending therapy can stir up a range of emotions, even when it’s a positive and planned conclusion:

Feelings of Achievement: If you’ve made progress and met your goals, you may feel proud of your hard work and progress. Many clients find closure by recognizing how far they’ve come, which can be incredibly empowering.
Sadness or Loss: Therapy often creates a close, supportive relationship. You may experience feelings of loss, sadness, or even anxiety about being on your own again. This is normal—therapy can feel like a safe space, and it can be difficult to let go of that support.
Nervousness or Fear: Even if you’ve made a lot of progress, it’s natural to feel a bit uncertain about facing the future without regular therapy sessions. You might wonder how you’ll handle challenges without your therapist’s guidance.
Relief or Excitement: If therapy was a challenging or emotional experience, the end might bring relief or a sense of freedom. You may feel excited about moving forward with the skills and tools you’ve gained.

Handling These Emotions:

Discuss these emotions with your therapist in the final sessions. They can help you navigate any concerns or feelings that arise about ending therapy.
If you’re feeling uncertain about handling life without therapy, consider setting up occasional check-ins, creating a long-term self-care plan, or considering other support systems (e.g., support groups, family, or friends).

The Final Session and Closure

The final session is important for providing closure. Here’s what you can expect from the last few sessions:

Reviewing Your Progress: Your therapist will likely review the progress you’ve made, including goals achieved, challenges overcome, and personal growth. This is a moment of reflection and celebration of your hard work.
Discussing Future Steps: Your therapist might talk about how to maintain the progress you’ve made and what steps to take if future issues arise. They might provide strategies for managing stress, maintaining self-care, or accessing additional support if necessary.
Final Check-In: Many therapists will check in with you to make sure you’re feeling confident in your ability to manage your mental health. They might ask, “How do you feel about continuing on your own?” or “Do you feel prepared for the challenges ahead?”
Closing the Relationship: It’s important to acknowledge the therapeutic relationship itself. A therapist may acknowledge the trust you’ve built together and how they’ve seen you grow. This mutual recognition helps give the relationship a sense of completion.

Post-Therapy: Maintaining Your Mental Health

Even after therapy ends, there are several ways to ensure that the work you’ve done continues to benefit you:

Continue Applying What You’ve Learned: Make use of the coping strategies, tools, and techniques your therapist shared with you. Keep using the skills you practiced during therapy to manage stress, negative thoughts, or difficult emotions.
Check-In With Yourself Regularly: After therapy ends, it’s helpful to check in with your emotional health periodically. Journalling, mindfulness, or self-reflection can help you stay on track and catch any issues early before they become overwhelming.
Stay Connected to Support Systems: If you feel that you need support or that therapy might be necessary again in the future, don’t hesitate to reach out to a therapist for periodic check-ins or even full sessions.

Ending therapy is a natural and healthy part of the therapeutic process. While it can bring up a range of emotions, it’s ultimately a time to reflect on your journey, celebrate your progress, and feel empowered to move forward with the tools and knowledge you’ve gained. Whether you choose to end therapy because you’ve met your goals or because your needs have changed, the process of closure will help you continue to grow and thrive.

Changing Therapists

It’s common for therapy to be a deeply personal experience, and not every therapist will be the right match for every person. If you find that you’re not working well with your therapist or you simply don’t feel comfortable, it’s important to address the situation with honesty and respect. A therapeutic relationship should foster trust, safety, and progress, and if that’s not happening, it may be time to make a change.

Here’s a step-by-step guide on how to approach the situation when you’re considering changing therapists:

1. Recognize the Signs That It’s Not Working

Before you take any steps to change therapists, it’s important to reflect on why you feel the therapy isn’t working. Some signs that it may be time to consider a change include:

Lack of Rapport: You don’t feel comfortable opening up, or you don’t trust the therapist.
No Progress: Despite consistent sessions, you’re not seeing any progress or positive changes in your thoughts, emotions, or behaviour.
Unmet Needs: Your therapist’s approach isn’t aligning with your needs. For example, if you need more structure, but they’re too laid-back, or if you need a specific type of therapy that isn’t being offered (e.g., you need trauma-focused therapy but they’re using a different method).
Feeling Judged or Unheard: If you feel your therapist is dismissive of your concerns, doesn’t fully listen to you, or makes you feel uncomfortable in any way.
Therapeutic Style Mismatch: Your therapist’s approach, whether it’s too direct or not direct enough, isn’t resonating with you. For example, if you need more of a structured approach (e.g., CBT) but they are using a more free-form or exploratory style.
Personal Discomfort: You may feel uneasy about their personal behaviours, mannerisms, or professional boundaries.

Recognizing these signs early can help prevent wasted time and emotional energy. Trust your instincts and feelings.

2. Assess Your Feelings Before Making a Change

Changing therapists is a significant decision and might require some reflection. Take some time to consider:

Are your expectations realistic? Sometimes therapy can feel uncomfortable or challenging, especially in the early stages. It’s normal to experience resistance or discomfort while working through difficult emotions. Consider whether the issue is more related to therapy itself (e.g., a therapeutic technique that feels difficult but necessary) or whether it's about the therapist's specific approach or personality.
Is it the therapist, or could it be other factors? It’s important to distinguish between a therapist who isn’t a good fit (e.g. difficulty building rapport, not feeling heard or understood) and environmental factors (e.g. the clinical setting, distance, noise) or issues in your own life or mental health that may be affecting your therapy progress (e.g., resistance to change, willingness to share, readiness to engage). Ask yourself if your expectations are being unmet due to the therapist or if there’s something going on that’s affecting how you engage with therapy

3. Consider Talking to Your Therapist About the Issue

If you feel comfortable, it can be helpful to address your concerns with your therapist directly before deciding to make a change. Most therapists will appreciate the feedback and will be open to adjusting their approach if something isn’t working. Here’s how you can approach this conversation:

Be Honest and Open:

“I’ve been reflecting on our sessions, and I’m finding that I’m not feeling as comfortable as I would like. I think it might be helpful to talk about how we’re approaching things.”
“I’m not sure if I’m getting the kind of support I need right now, and I’d like to discuss whether there might be a better approach for me.”

Frame It as a Personal Need:

“I’m finding it difficult to engage fully in the way things are going. I wonder if we can try a different approach.”
“I feel like I might need more structure/less structure/another type of therapeutic technique to feel more comfortable moving forward.”

Be Clear About Your Needs:

If there’s a specific issue (e.g., needing a more trauma-informed approach or a more directive style), let them know so they can either adjust or refer you to someone who is a better fit.

This conversation could provide valuable insight into whether the relationship can be repaired, or if a change would be better for both of you.

4. Decide Whether to Change Therapists or Continue

Once you’ve expressed your concerns, you’ll have a better sense of whether things can be improved with this therapist or if it’s time to move on. If the therapist is receptive to your feedback and makes adjustments that you feel will work for you, it may be worth staying. On the other hand, if you still feel disconnected or uncomfortable after discussing the issue, it might be best to look for someone else.

5. How to Find a New Therapist

If you decide that a change is necessary, it’s important to be proactive in finding a new therapist that better fits your needs. Here’s how to make the transition as smooth as possible:

Ask for a Referral:

If you’re leaving your current therapist but still want to continue therapy, you can ask them for a referral. Many therapists are happy to provide recommendations, especially if they feel another professional would be a better fit for you.

Do Your Research:

Therapist Directories: Look for therapist directories or your insurance provider’s list to find professionals who specialize in the issues you want to work on (e.g., trauma, anxiety, relationship issues).
Ask About Specializations: If there’s a specific treatment or approach you want (e.g., CBT, EMDR, trauma-focused therapy), search for someone with that expertise.
Consider Logistics: Make sure the new therapist’s location, availability, and fees align with your needs.

Meet with Potential Therapists:

You might want to schedule an initial consultation or brief phone call to ask about their approach to therapy, experience, and to gauge if their style feels more aligned with your needs.
Don’t be afraid to “interview” a therapist to make sure you’re comfortable with them and that their approach aligns with your therapeutic goals.

6. Make the Transition Smoothly

If you decide to change therapists, here are a few tips for making the transition as smooth as possible:

Inform Your Current Therapist:

If you’re ending the relationship with your current therapist, it’s respectful to inform them. A simple, direct message or conversation can help:
- “I’ve decided to try a different approach with a new therapist. Thank you for the work we’ve done together so far.”
- “I’ve thought about my goals and I believe I need to work with a therapist who specializes in X. I’m grateful for your support, and I think I’ll be better served by this change.”

Keep Your Information for Future Reference:

If you’ve done any work in your current therapy (e.g., exercises, worksheets), keep it! You may want to bring this information with you to your new therapist to help them understand your journey so far.

Be Patient with the New Process:

Starting with a new therapist may require time to build rapport and trust again. Be patient and gentle with yourself as you navigate the new relationship and therapeutic process.

7. Don’t Feel Bad About Changing Therapists

It’s important to remember that therapy is about you and your healing. If a therapist isn’t the right fit, it doesn’t mean you’ve failed, and it doesn’t reflect poorly on the therapist either. Everyone has different needs and personalities, and a strong therapeutic relationship is built on trust and comfort. Seeking a better fit is an important part of your mental health journey, and there’s no shame in recognizing that a change is necessary.

Changing therapists can be a difficult decision, but it’s ultimately about finding someone who can help you make progress and support you in your mental health journey. By addressing your feelings openly, considering your needs, and taking the steps to find the right match, you can ensure that you’re receiving the best care possible. And remember, therapy is a process, and sometimes, the right fit is just around the corner.

Starting, Ending, and Changing Services

The Process of Ending Therapy

Starting, Ending, and
Changing Services