Therapy, Explained: Understanding The Therapeutic Process

People may attend therapy for a variety of reasons, such as to improve their relationships, address mental health symptoms, promote personal or professional development, or learn tools to more effectively respond to life's challenges. The way the therapeutic process unfolds can look different depending on what you’re seeking help with and other factors. However, a few key stages tend to take place in most situations. Understanding them may help you know what to expect if you decide to seek support from an in-person or online therapist.

What is the therapeutic process?

According to the American Psychological Association, the therapeutic process (or psychotherapeutic process) can be defined as “whatever occurs between and within a client and therapist during the course of psychotherapy.” It notes that “this includes the experiences, attitudes, emotions, and behavior of both client and therapist, as well as the dynamic or interaction between them.” 

In other words, the therapeutic process consists of interactions during therapy. It can take different forms depending on:

• The therapist

• The client

• The therapist-client relationship

• The client’s unique challenges

• The type of talk therapy being used (cognitive behavioral therapy, motivational interviewing, etc.)

Why the therapeutic process is collaborative

Therapy can be thought of as an inherently collaborative process. The therapist will typically have specific training and certifications in one or more therapy modalities, which they can use to help a client work toward their therapeutic goals. For the process to be effective, both parties generally need to cooperate and contribute. If you’re ready to begin a collaborative relationship with a therapist to improve your mental well-being, support is available online.

General stages of the therapeutic process

Because there are different types of therapy used for different situations, the therapeutic process may vary from one client to the next. For example, a course of cognitive behavioral therapy treatment may look different than a course of motivational interviewing. Still, the therapy process can often be broken down into five different stages, as follows.

The first meeting

Whether it’s a consultation or a first session, the initial meeting between therapist and client usually marks the start of the therapeutic process. It’s often an opportunity for both parties to ask questions. 

For example, the client might ask the therapist about their professional experience, personal values, and approach to therapy to help them decide if this provider might be a good fit for their needs. Then, the therapist may ask a few basic questions about the client’s:

• Personal life and habits

• Family history and current relationships

• Specific challenges that have led them to seek therapy

Once they’re informed with this context from the client’s stories, the provider may be able to choose a conceptual framework and evidence-based theoretical orientations that may be most useful when working with this client going forward, setting a direction for their care.

Building the relationship

During the early stages of therapy, the therapist-client relationship is developing. The client may be getting to know their provider, becoming more comfortable speaking to them, and learning their approach to therapy. The client may experience feelings of hesitation, uncertainty, or nervousness at first, which is why initial sessions may involve a more general discussion of their life, past experiences, challenges, and relationships. This approach can help the therapist feel like they have more context and background on the situation while the client becomes more accustomed to the therapist. 

Identifying goals

This phase of therapy may consist of treatment planning therapist determines the optimal course of action to address their client’s concerns and help them reach their treatment goals—whether that’s more effective tools for managing anxiety, improved conflict resolution skills, or higher self-esteem. The client may enter therapy with specific goals already in mind, or they may work with the therapist during this stage to develop objectives that make sense for them.

Taking steps forward

This stage represents the point in the process where  the “work” of therapy begins. The client and therapist typically collaborate to take steps toward creating meaningful change in the client’s life, relationships, thought patterns, habits, and more. This phase may also involve explorations of the client’s emotions and beliefs, along with “homework assignments” designed to help them implement therapeutic strategies outside of regular sessions. This is often the phase in which the client may first start to notice positive changes in their thoughts and behaviors that contribute to their overall well-being.

Maintaining progress

The maintenance stage of therapy may occur when a client is satisfied with the progress they’ve made or the changes they’ve seen over the course of therapy so far. After this point, many clients continue to attend regular counseling sessions to check in with their therapist and continue to get advice. Others may decide that they’ve accomplished their goals and stop attending therapy altogether, or for a period. For some, therapy may be a lifelong journey without a defined endpoint. Because no two individuals are the same, how the maintenance stage looks may vary depending on the client, the therapist, and the circumstances of treatment. 

The potential benefits of engaging in the therapeutic process

Deciding to attend therapy sessions may have many potential benefits. Some of these may include the opportunity to process emotions in a safe, nonjudgmental space, the chance to explore potential solutions to personal and professional challenges, and the opportunity to gain a new perspective on one’s thoughts, behaviors, and habits. According to the American Psychological Association, approximately 75% of people who engage in therapy benefit from it in some way.

Note that some people may move through these stages quickly, while others may be in one stage for months or years. Each individual’s journey is different.

The precontemplative stage

The precontemplative stage is when the client has not yet experienced or denies the severity of negative consequences from their symptoms, such as substance misuse. Therefore, they are not yet considering changing their behaviors.

The contemplative stage

The contemplative stage is when the client begins to buildself-awareness and may start considering making changes, even if the underlying readiness is not yet there to take action. The individual may start thinking about why they want to change or the habits they might consider altering, but they typically won’t act on these thoughts yet.

The preparation stage

Once they’ve reached the preparation stage, a person has made the decision to change in some way. They might start preparing to make this change, which usually involves planning what to do and how to do it. An individual who is experiencing challenges with substance misuse, for instance, might start researching different therapeutic approaches or programs for substance use disorder and browsing potential therapists. 

The action stage

In the action stage, the individual makes their first meaningful steps toward change. Seeking professional help is a common action to take during this phase. For example, the individual might reach out to a care provider, share the challenges they’re experiencing, and then receive a personalized treatment plan. After that, they can begin working toward their therapeutic goals with the therapist. 

This period represents the true working stage, when the change process begins to take shape. It’s typically when the client begins investigating the roots of their challenges, developing coping strategies, and working to meaningfully change behavior and promote positive outcomes. If you feel ready to make a change in your own life, connecting with an online therapist may be a constructive step forward.

The maintenance stage

The maintenance stage builds on the action stage. It may involve the person continuing to work with their therapist, recovering from setbacks, and practicing coping mechanisms outside of sessions in order to sustain their healthy behavioral changes. 

The therapeutic relationship and why it matters

A strong therapeutic relationship, or therapeutic alliance, can be a key factor in supporting positive treatment outcomes. It can be defined as “a cooperative working relationship between client and therapist, considered by many to be an essential aspect of successful therapy.” 

What does a strong therapeutic relationship look like in sessions?

A solid therapeutic relationship usually involves mutual respect and open communication. To help promote these qualities, therapists are often trained to use active listening techniques and to treat their clients with unconditional positive regard. Strategies like these may help a client feel safe, heard, and supported, which may empower them to open up and deeply engage in the work of therapy. If the client and therapist are unable to build an effective therapeutic relationship, the client may need to switch providers for best results.

Measuring your progress during the therapeutic process

Tracking your progress may help you understand how well the therapeutic process is working for you. If you notice no progress due to low treatment effectiveness after some time, it may be worth considering a different therapist or therapy approach. If you do notice progress, reflecting on it may help you build self-esteem and self-efficacy and motivate you to keep working.

Many people assume that symptom relief will be their main measure of progress in therapy. However, reducing symptoms often takes time, and there are also other benefits a person may gain from therapy. Improved emotion regulation, healthier emotional expression, and use of positive coping mechanisms are some examples.

There are a few different ways to track your personal growth throughout the therapeutic process. Keeping a journal about your thoughts, feelings, symptoms, and therapy takeaways that you can look back on is one idea. Another is working with your therapist to complete a symptom assessment tool at the start of your treatment and then periodically over time. You can ask your provider for other ways you may be able to measure your progress. 

Common barriers to a positive therapeutic experience

Certain barriers may make it harder for you to have a positive therapeutic experience, so adjusting the process if they arise may be helpful. For example, if you don’t feel comfortable with or heard by your therapist, they might not be the right match for you. It can be normal to switch therapists a few times before you find the right match. 

Other common barriers can include a long commute to the therapist’s office, discomfort speaking with a therapist face to face, and high session costs. To address barriers like these, you might consider exploring online therapy instead of traditional in-person care.

How BetterHelp supports a positive therapeutic process

BetterHelp is a platform that allows you to get matched and then meet with a licensed therapist online—no commuting required. Online therapy sessions also tend to be more affordable than in-person sessions without insurance. 

BetterHelp can support a positive therapeutic process by offering features such as:

• A network of more than 32,000 licensed therapists from diverse backgrounds

• A robust therapist-client matching service to promote strong therapeutic alliances

• The option to switch therapists for free at any time

• Multiple ways to connect with your therapist (phone, video, live chat)

• Journaling and habit-tracking features to help you monitor your progress

What does the research say about online therapy?

A growing body of research indicates that online therapy may be an effective form of mental health care in many cases. For example, a 2023 study indicates that online therapy may often yield “similar effects" to in-person therapy in the treatment of various psychiatric and somatic disorders.