What to expect

How therapy works, what it costs, and the words on your insurance card explained.

What to expect from therapy

Feeling nervous before a first appointment is completely normal. Knowing what to expect can take some of the edge off.

How a first session usually goes. You will likely arrive a little early for paperwork. Sessions typically last about 45 to 50 minutes. In the first one, the therapist explains the basics (fees, scheduling, and confidentiality), then asks what brought you in, a bit of your history, and how things are affecting your daily life. This getting-to-know-you phase can take more than one session. Many people leave with a clearer understanding and a little more hope.

Finding the right fit. A trusting relationship with your therapist is one of the biggest factors in whether therapy helps. Look for someone who makes you feel comfortable and respected and who has experience with concerns like yours.

It is okay to switch. Not every therapist is the right match, and that is normal. It is not a failure on your part or theirs. If after a few sessions it does not feel right, it is completely okay to look for someone new.

Individual, group, or telehealth. Individual therapy is just you and the therapist; group therapy brings together a few people working on similar issues, which can ease isolation. Many therapists also offer secure video or phone sessions; telehealth can make care easier to reach. Choose what fits your life.

Questions you might bring to a first session: What is your experience with concerns like mine? What approach do you use? About how long might we work together, and how will we know it is helping? What are your fees, and do you take my insurance or offer a sliding scale? What is your cancellation and confidentiality policy? It can help to bring your insurance card, ID, and a list of any medications.

Paying for it: insurance basics

Insurance language can be confusing. Here are the common terms in plain English. When in doubt, the member-services number on the back of your card can explain your specific plan.

Premium

What you pay for coverage, usually monthly, whether or not you use any services.

Deductible

What you pay out of pocket each year before your plan starts paying its share.

Copay

A fixed amount per covered visit, for example $30 per therapy session.

Coinsurance

Your share as a percentage instead of a flat fee. For example, you pay 20%, the plan pays 80%.

Out-of-pocket maximum

The most you will pay for covered services in a year. After that, the plan pays 100% of covered services.

In- vs. out-of-network

In-network providers have a contract with your insurer (you pay less). Out-of-network usually costs more, sometimes the full amount.

Prior authorization

Approval from your insurer before a service, confirming they will help pay. Some services or extra sessions may need it.

EAP

An Employee Assistance Program: a free, confidential benefit some employers offer that can include a few counseling sessions. Ask HR if you have one.

Sliding scale

Some therapists adjust their fee to your income. If cost is a barrier, it is okay to ask whether they offer one.

Superbill

For out-of-network care, you pay up front, then get an itemized receipt (a "superbill") to submit to your insurer for possible partial reimbursement.

A note on "parity." Under a federal law (the Mental Health Parity and Addiction Equity Act), many plans must cover mental-health care no more restrictively than physical health care. The rules do not apply to every plan, so ask your insurer how your coverage works. What to ask: Is outpatient therapy (and teletherapy) covered? Do I have a deductible left? What is my copay per session? Do I have out-of-network benefits? Do I need a referral or prior authorization, or is there a session limit? Can you confirm a specific provider is in-network?

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