THERAPY
LAST UPDATED: APRIL 2026
10 Important Things To Know When Considering Therapy
Often, the thought of trying to find a therapist or gearing up to go to therapy can feel overwhelming. Something you probably don’t need or want to feel when you’re likely already going through a tough time.
Last reviewed: June 2026 by Annie Wright, LMFT
Often, the thought of trying to find a therapist or gearing up to go to therapy can feel overwhelming — something you probably don’t need or want to feel when you’re likely already going through a tough time.
SUMMARY
Considering therapy is a meaningful step. And it’s one that comes with a lot of questions, myths, and fears, especially for driven women who are more comfortable solving things themselves. This post covers the ten most important things to understand before you start, so you can enter the process with realistic expectations and find the right fit without unnecessary discouragement.
Questions like, “How do I choose the right therapist?”, “How can I find someone with openings I can actually attend?”, or “What should I even talk about in a therapy session?”, are probably running through your head.
Look, I get it.
Psychotherapy is a collaborative process between a trained clinician and a client aimed at understanding and transforming the patterns of thought, emotion, and behavior that cause suffering. Effective therapy provides not just insight but a corrective relational experience, a new template for what it feels like to be truly seen, heard, and held.
I remember thinking these thoughts when I went looking for my therapist a long time ago.
And since then, I’ve learned a lot both as a therapy client and also as a therapist about how to search more effectively, how to make it affordable, how to get the most of your therapy sessions, and much more. I’ve rolled my insights into today’s post – the 10 important things to know when considering therapy.
Whether you’re a longtime therapy client already seeing a therapist, whether you’re looking to start up therapy again and especially if you’re thinking about starting therapy for the first time, I hope this list of insights and tips feels helpful for you and encourages you to pursue therapy.
I may be biased, but I honestly think it’s one of the best investments you can make in yourself if you’re looking to see some sustainable, measurable change in your life.
So read on, and please tell me in the comments below about one thing you might add to this list based on your experiences in therapy! I can’t wait to hear from you.
1. The times, they are a changin’…
“The curious paradox is that when I accept myself just as I am, then I can change.”
CARL ROGERS
Once upon a time, going to therapy may have held some stigma (think Betty Draper in Mad Men… ugh.). But today, I’m personally and professionally delighted to be living in a time where, thanks to a multitude of celebs, athletes, royals, Millennial-driven media sources, and regular folks like you and me speaking out loudly and proudly about how important mental health is, going to therapy is becoming increasingly destigmatized and increasingly considered as normative as seeking out professional care for any other aspect of your life. It’s a great time to be considering starting therapy!
Research published by Patrick Corrigan, PsyD, Distinguished Professor at the Illinois Institute of Technology and leading stigma researcher, confirms that public attitudes toward mental health treatment have shifted meaningfully over the past decade. And that this shift directly increases help-seeking. The more normalized the conversation becomes, the more permission people feel to reach out before things reach a crisis point. That’s a win worth naming.
2. Seeking out therapy doesn’t make you “weak.” It makes you smart.
Making the decision to seek out therapy isn’t a sign of weakness; it’s a wise act of self-care to reach out for support from professionals when there’s a challenge you need help with. You’d reach out to a doctor for help setting your broken bone or to a lawyer if you needed help filing divorce paperwork, wouldn’t you? When it comes to your mental and emotional health it’s no different. Reaching out for professional support is an incredible act of self-care to address the challenges you’re facing.
What I see consistently in my work with clients is that the women who are most reluctant to start therapy are often the ones who’ve been doing everything “right”. The career, the relationships, the self-improvement habits. They’ve built capable, driven lives, and asking for help feels like an admission that something is wrong with them. But here’s what’s actually true: going to therapy doesn’t mean you’re broken. It means you’re paying attention. It means you’ve noticed a gap between how your life looks on paper and how it feels inside, and you’re willing to do something real about it. That’s not weakness. That’s precision.
The therapeutic alliance is the collaborative, trust-based relationship between a therapist and client. Decades of psychotherapy research consistently identify it as the single most reliable predictor of therapy outcomes. More predictive than any specific technique or modality. It encompasses agreement on goals, agreement on tasks, and the quality of the relational bond. When the alliance is strong, clients feel safe enough to do the vulnerable, uncomfortable work that actually produces change.
Meera is a 34-year-old product director at a fast-growing tech company. She’s the person her team goes to when things fall apart, the one who stays calm in a crisis, the one who always has a plan. At home, though, she’s exhausted in a way she can’t name. Snapping at her partner over small things, lying awake at 2 a.m. running through imaginary worst-case scenarios. She’s been telling herself she’ll “deal with it later” for eighteen months. When she finally books a therapy consult, her first words to the therapist are, “I’m not sure I even belong here. I’m pretty functional.” She does belong there. The gap between how capable she looks to the world and how stretched thin she feels inside is exactly the territory therapy is designed for.
RESEARCH EVIDENCE
Peer-reviewed findings that inform this clinical framework:
- TF-GSH produced moderate-to-large reduction in PTSD symptoms (g = -0.81, 95% CI -1.24 to -0.39; 17 RCTs) (PMID: 35621368)
- Bibliotherapy reduced depression/anxiety symptoms in youth (SMD = -0.52, 95% CI -0.89 to -0.15; 8 RCTs, N=979) (PMID: 29416337)
- Trauma psychoeducation group showed significant pre-post wellness improvements in all 4 domains (paired t-tests p<0.05; 37/50 pairs r=0.52-0.83; N=54) (PMID: 16549246)
- Brief TI psychoeducation reduced PTSD symptoms vs control (1-week d=0.84, 1-month d=0.74; N=46) (PMID: 37467150)
- Cirrhosis increased mortality odds in trauma patients (OR 4.52, 95% CI 3.13-6.54; meta-analysis) (PMID: 31416991)
4. Searching for a therapist can feel overwhelming, so here are some tips.
Look, I know from personal experience just how challenging it can be to find a therapist. I’ve gone through this myself. Where to start, how to know if you’re choosing the right one, how to get a therapist to actually call you back, how to find a time slot in their practice that you can actually make… it can all feel quite overwhelming and maybe even a little demoralizing which is kind of the last thing you want to feel when you already feel anxious or overwhelmed with what’s going on in your life. So I want to offer up some tips and tricks to make the process easier for you.
Understand the implications of using an in-network therapist versus an out-of-network therapist.
Using your insurance to find and pay for a therapist can be a fine option, but just be clear about the possible risks of doing so and learn about why a lot of people choose to look for an out-of-network therapist instead.
If you decide to go out-of-network, search for nearby therapists through Yelp, GoodTherapy, or Psychology Today.
Or ask for referrals from trusted friends, family, or colleagues. Scan the therapist listings and see who you like, who has offices convenient either to your home or workplace, and who just generally seems kind and warm in their pictures. Start by making a shortlist of 5-7 to call or message.
When you call or message them, ask for an initial consult call.
This is to help you assess if they feel like a good fit for you.
Most therapists will be happy to take the time to speak with you on the phone to help you answer any questions you have. A consult call is a wonderful way for you to connect before you book that first session and really get a sense of the therapist.
When you get them on the phone, definitely ask any questions you have.
“Do you have experience working with XYZ?”, etc. But mostly, pay attention to the feelings you have on the phone with them. I say this all the time but, in most cases, it really doesn’t matter what specialties a therapist has or where they trained, what matters is if you actually feel comfortable with this person. If you feel comfortable with them, if you trust them, if you like them, this will make for good therapy because you’ll likely feel safe enough to open up about vulnerable material. If you don’t feel comfortable with the therapist, it’s not likely going to be good therapy. So trust your gut on this one.
If a therapist only has session slots available that aren’t ideal for you, don’t fret or rule them out yet!
Yes, evening therapy slots are competitive and sometimes hard to book but still, tons of people come to therapy during the day or late afternoon through a variety of means. Some folks go into work an hour earlier or later, or make up the time some other way if their boss/team is okay with that. Or, if your workplace allows you to work from home one day a week, that’s a good day and way to squeeze in a therapy session.
Personally, I’m always happy to give a work excuse to my clients if that would be helpful and I also provide online video and phone sessions for those times when you may not be able to make it into the office in person, but you can close your office door and grab some privacy for a session. So all of this to say, if the therapist you want to see only has daytime slots available, you can still totally make this happen. And finally, I have a waitlist that folks sign up for to be the first to learn about new openings in my practice (including those coveted evening hours that may feel more ideal).
5. There is no right or wrong way to do therapy.
I’m privileged to work with a lot of first-timers to therapy so I get told a lot, “I’m not sure what to talk about today.” or “I’m not sure how to do therapy correctly. Where should I start?” and I’m here to tell you: there is no right or wrong way to do therapy.
I encourage my clients to pay attention to what’s at the forefront of their awareness when they sit down on the couch for the session. Notice any feelings in your body, any thoughts in your mind, if a dream from the night before is still bothering you, if there’s a problem you’re having in our relationship as therapist and client, simply bring up whatever feels most at the forefront of your awareness and we’ll start there. I always trust that if we notice where your energy is and follow that thread, it will lead us to the work that needs to be done on any given day.
Remember: there is no right or wrong way to do therapy and everything and anything is grist for the mill when it comes to therapy.
For driven, ambitious women especially, this can be one of the most disorienting parts of the process. You’re used to being evaluated. You’re used to performing well. The therapy room has no rubric, no deliverable, no right answer. And that formlessness can feel threatening at first. What I tell my clients is this: if you walk in and say “I don’t know where to start,” that is where we start. Your confusion, your discomfort with not knowing, your instinct to prepare a neat agenda. All of that is information. All of it is material. You can’t do this wrong.
6. How therapy actually “works.”
This is a question that, if you asked 100 different therapists, you’d likely get 100 different answers to. So I will say is that, in my opinion, therapy. Also called psychotherapy or counseling. “works” because it gives you a different kind of relational experience than you may have had before in your life.
I truly believe that it is through our early relationships that certain patterns get established and certain wounds created and it is only then through relationship that these patterns and woundings can shift and be healed. When we work together as therapist and client, it’s actually the relationship between us that becomes the therapy in addition to the all of the ways we explore, address and clarify the content you bring into the room.
Therapy “works” because it gives you a different kind of relational experience, a healing kind of relational experience that can actually change the neurons and neural grooves in your brain, leading to long-term change in your life. Therapy also “works” in that it provides you with a space, probably unlike any other in your life, that’s confidential, safe, and secure and allows you to get in touch with vulnerable subjects and have a trained, professional guide to help you better understand these subjects and make changes in your life if you want to.
Allan Schore, PhD, neuroscientist and clinical psychologist at UCLA and author of The Science of the Art of Psychotherapy, has spent decades documenting how early relational experiences shape the architecture of the right brain. The seat of emotional regulation, self-perception, and relational attunement. What his research shows is that the therapeutic relationship doesn’t just offer a context for insight; it offers a context for actual neurobiological change. The right therapist, meeting you with consistency and attunement over time, can literally help rewire how your nervous system responds to closeness, conflict, and uncertainty. That’s not a small thing. (PMID: 11707891)
7. Process hangover is a thing.
Another thing I tell my clients, particularly my first-time clients, is that “process hangover” is a thing that they may experience after a first session together, and possibly after we get in touch with deep, emotional material in any given session.
Process hangover can mean feeling a little disoriented, feeling raw and tender, feeling some shame come up because you’ve exposed parts of yourself that you’ve worked hard to keep tucked away, etc.. In other words, you may feel the emotional impact of opening up in therapy in the days after the therapy session has ended. And that’s okay! That’s totally normal and natural and, actually, it’s a really good thing. It means that what we’re talking about matters.
So just take good care of yourself and be curious about what you need to support yourself if you experience “process hangover” after therapy.
What I’ve noticed with the driven, ambitious women I work with is that process hangover often arrives as a kind of cognitive fog. A difficulty concentrating, a heaviness they can’t quite explain to their colleagues or partners. If you’re someone who relies on your mental sharpness professionally, this can feel alarming. Know that it’s temporary, and that the tenderness you feel afterward is a signal that something real is happening beneath the surface. Build in a buffer after your sessions if you can. Even twenty minutes to walk, sit with tea, or simply not be “on” before re-entering your day.
Tasha is a 38-year-old attorney who scheduled her first therapy appointment between two back-to-back client calls. She returned to her desk forty-five minutes after the session ended, pulled up a brief she was drafting, and found she couldn’t focus. The words blurred. She kept thinking about something her therapist had reflected back. A small observation about how Tasha framed every story about her childhood in terms of what she’d learned from it, never in terms of how it had hurt. She sat with her laptop open for a long time, not writing. She called it a lost afternoon. I’d call it evidence that the work was landing exactly where it needed to.
8. Things may feel worse before they feel better.
I know, I know, this may not be what you want to hear, but it’s important to know: when starting therapy, things may feel worse before they feel better. I often describe beginning the work of therapy (particularly if you’re looking to explore and change some deeply held beliefs, thoughts, and patterns) as what might happen if you decide to tackle a thorough cleanout of an overly crammed closet you haven’t touched in years.
When you begin the process of cleaning out the closet, you have to pull everything out and strew it about you on the floor, it may start to look like a big pile of chaos, and you may feel overwhelmed halfway through the project when you look around and see the mess around you. You may want to quit and you may regret having even started. But to get things really, properly cleaned and organized, you have to keep going.
As you do, you can sort out what goes to the trash, what gets donated, what gets returned to the closet and better organized. In time, you’ll have finished the project but please do know that there may be a point (or many points) when it feels worse before it feels better. The same thing happens with therapy.
The therapeutic term for this is “destabilization before reorganization”. Your existing coping structures get disrupted before new, healthier ones take root. It’s not a sign the therapy isn’t working. In most cases, it’s a sign that it is. If you notice this happening, bring it directly into the room. Tell your therapist. That conversation itself is part of the work.
9. Therapy takes time!
Similar to what I wrote above, it’s important to know that healing takes time depending on the content you’re looking to explore and heal. It’s important to remember that it took you however-many-number-of-years to develop the patterns/habits/ways of being that you have, it will take time to unlearn and then learn and practice something different.
Be patient with yourself with this process. Long-term change doesn’t happen overnight (contrary to what some pop culture coaches and speakers may try to sell you). It’s important to know that building or rebuilding a strong, healthy, integrated psychological foundation may take some time, and that’s okay. I invite you to trust the process.
I want to name something that comes up often with the driven women I work with: the expectation that therapy should produce measurable, linear progress on a reasonable timeline. That if you’re working hard at it. Journaling, showing up, doing your homework. You should be able to track improvement week over week. And yes, you’ll have sessions that feel productive and clear. But healing isn’t a KPI. It doesn’t follow a project roadmap. Some of the most important shifts I’ve watched clients make happened quietly, months after a session they thought was unremarkable. Progress in therapy often reveals itself retroactively. You look back and realize you handled something differently, felt something sooner, needed the reassurance less. That’s the work showing up. Just not on the schedule your ambitious brain expected.
10. How to make the most of your therapy.
Some of the tips I share with my clients to help them make the most out of their therapy with me include:
Get clear about your goals.
In my initial intake forms and in my first session with a new client, I always ask the question, “If I could wave a proverbial magic wand and help you get three things from therapy, what would they be?” Sometimes you may only know one or two goals; sometimes you may have five, at times you may not feel clear at all about your goals for therapy. All of this is fine and, certainly if you don’t know what your goals are; one of your first goals in therapy could be actually getting clearer on your goals! Stay in dialogue with yourself and your therapist about what you would like therapy to support you with in your life. Having clarity about this on an ongoing basis can help make your sessions and therapy work more fruitful.
Journal.
Journaling in between therapy sessions is such a terrific way to deepen your work. Journaling about thoughts and feelings that came up after each session, jotting down notes of things that happened during the week that you want to bring up in your next session with your therapist, all of this is great material for your therapy. I personally use an old-school Moleskine for my journal but you can journal in a note in your smartphone, in a Google doc on your laptop, whatever works for you.
Pay attention to your dreams.
I’m a big believer in the power of dreams to help us better understand what work we may need/want to do in therapy, so I always ask my clients to pay attention to their dreams, particularly after what feels like powerful or deeply emotional sessions to see what comes up for them. For some tips about how to interpret your dreams, with or without the help of a therapist, check out this blog post I wrote.
Therapy Isn’t Either/Or. It’s Both/And
One of the most freeing reframes I offer my clients is this: therapy doesn’t have to be either a crisis intervention or a luxury you don’t quite deserve. It can be both a space for deep healing and a regular practice of self-understanding. It can be both for women who are struggling and for women who look, from the outside, like they have everything together.
The both/and frame matters because so many driven women disqualify themselves from support before they even start. “I’m not bad enough off to need this.” “Other people have real problems.” “I should be able to figure this out on my own.” These thoughts are common. And they keep a lot of capable women stuck. The truth is, therapy is both for people in acute distress and for people who simply want to understand themselves more fully and function from a more solid internal foundation.
You don’t have to be falling apart to deserve support. You can be ambitious, capable, largely functional. And still benefit enormously from a consistent therapeutic relationship. In fact, some of the most profound therapy I’ve witnessed has happened with women who weren’t in crisis at all. They were just willing to stop outsmarting their own inner life long enough to actually listen to it.
If you’re wondering whether therapy is “for you,” consider this: if you have recurring patterns that show up in your relationships, your work, or your relationship with yourself. And those patterns feel bigger than willpower alone. Therapy is for you. Full stop. You don’t have to earn your seat in that room by suffering enough first. You can want more. You can want to understand the machinery underneath your life. That’s more than enough reason to start.
For more on what this kind of deeper relational work actually looks like, you might find this useful: What does it mean to be an ambitious, upwardly mobile woman from a relational trauma background?
The Systemic Lens: Why ‘Just Get Therapy’ Isn’t a Complete Answer
When we tell driven women to “get help” for their trauma, we often fail to acknowledge what getting help actually requires: financial resources for quality therapy, schedule flexibility for consistent appointments, a workplace culture that doesn’t penalize prioritizing mental health, and a social environment where vulnerability is safe. These aren’t universally available. For many women, they aren’t available at all.
Even driven women with financial means face systemic obstacles. The pressure to be constantly productive means therapy often gets scheduled in margins that don’t allow for the emotional processing the work requires. The cultural expectation that women should “handle things” quietly means many driven women hide their therapeutic work from colleagues, friends, even partners. Adding the burden of secrecy to the already demanding work of healing. The medicalization of trauma into neat diagnostic categories often fails to capture the complexity of what relational trauma actually looks like in an accomplished life.
In my work, I try to hold the systemic reality alongside the individual journey. You are doing courageous, difficult work. And the world around you was not built to support that work. Both things matter. Understanding the structural constraints isn’t an excuse to stop. It’s a reason to be more compassionate with yourself about the pace, and more outraged at a system that makes healing harder than it has to be.
A Note on the Systemic Context of Seeking Help
I want to name something that doesn’t get discussed nearly enough when we talk about going to therapy: the decision to seek help doesn’t happen in a vacuum. It happens inside systems. Family systems, cultural systems, professional environments. That have their own stories about what it means to need support.
For women who grew up in families where emotional needs were minimized or pathologized, seeking therapy can carry a quiet internal charge. It can feel like a betrayal of family norms, or like an admission of something shameful. For women of color, the calculus is often more complex: generations of systemic exclusion from mental health care, combined with the very real reality of navigating a therapeutic landscape that’s still overwhelmingly white, mean that finding a culturally attuned therapist isn’t a nice-to-have. It’s essential. The research is clear that therapeutic alliance and perceived cultural competence are directly tied to whether clients stay in treatment and whether they benefit from it.
I also want to name that for some women, the professional context creates its own pressure. If you’re in a field where vulnerability is coded as liability. Law, finance, medicine, tech leadership. The thought of admitting to anyone that you’re in therapy can feel risky. Many of my clients maintain careful privacy around their therapy for exactly this reason, and that’s a completely legitimate choice. The therapy room is confidential. Your healing doesn’t have to be public.
What I want to offer, in naming all of this, isn’t discouragement. It’s acknowledgment. The barriers to entering therapy are real. Financial, cultural, professional, relational. And still, I see women clear those barriers every week and find their way into work that genuinely changes their lives. The systemic obstacles are worth naming precisely so that you can recognize them for what they are: external pressures, not personal failures. If starting therapy has felt complicated for you, it might be because it is complicated. Not because something is wrong with you. For a deeper look at some of these intersecting pressures, Attachment Trauma: How Early Relationships Shape Your Adult Connections is a good starting point.
I truly hope it felt helpful for you to read about these “10 Things to Know When Considering Therapy.” I may be biased, but I honestly think that therapy is one of the best and most important investments you can make in yourself.
Here’s to healing relational trauma and creating thriving lives on solid foundations.
Warmly,
Annie
Frequently Asked Questions
This is part of our comprehensive guide on this topic. For the full picture, read: How Therapy Actually Works: A Complete Guide.
DISCLAIMER: The content of this post is for psychoeducational and informational purposes only and does not constitute therapy, clinical advice, or a therapist-client relationship. For full details, please read our Medical Disclaimer. If you are in crisis, please call or text 988 (Suicide & Crisis Lifeline) or text HOME to 741741 (Crisis Text Line).
You deserve a life that feels as good as it looks. Let’s work on that together.
How Resistance to Therapy Shows Up in Driven Women
The driven women I work with who are considering therapy for the first time rarely present their hesitation as fear. Fear doesn’t fit the self-image, and it’s rarely fully conscious anyway. What I hear instead is a particular kind of pragmatism: “I just want to understand what’s actually going on.” “I’m not sure I have the time right now.” “I’ve been handling this fine on my own.” These are real statements. They’re also, underneath, a way of managing the vulnerability of asking for help without quite admitting that’s what’s happening.
Vera is 44, the COO of a regional healthcare network, and she’s been thinking about therapy for approximately four years. On a Sunday afternoon I’m thinking of, she’s sitting at her dining room table with a browser tab open to a therapist directory, her laptop angled toward her so her husband can’t see the screen. Her coffee is lukewarm. She’s clicked on seven profiles, read them thoroughly, and closed them all. The internal monologue runs something like this: she doesn’t know how to explain what she’d even be coming in for. Nothing catastrophic has happened. She functions. She’s good at her job. What would she even say? She closes the tab. She opens her email. There’s a report she’s been meaning to review. She’ll look at the therapist directory again next Sunday, she tells herself. She’s been telling herself this for four years.
What I see consistently in clients like Vera is that the barrier isn’t really about time or logistics. It’s about the threshold of distress required to justify asking for help. Driven women have often internalized a standard so high that nothing short of acute crisis counts as a legitimate reason. The low-grade chronic stress, the Sunday afternoons that feel wrong in a way she can’t quite articulate, the sense that she’s performing her life rather than living it. These don’t register as sufficient. They register as weakness, or self-indulgence, or simply as the acceptable cost of the life she’s chosen. The story she tells herself is: I should be able to handle this. The story underneath that one is: I’m afraid of what I’ll find if I stop handling it long enough to look.
And here’s the bind: the same discipline and self-sufficiency that made Vera genuinely exceptional at navigating difficult professional terrain has also erected a structural barrier against the kind of support that might change her life. She’s good at solving problems independently. Therapy asks you to do something subtly different: to be witnessed solving a problem rather than to have already solved it by the time anyone finds out it existed. That requires a different muscle. Specifically, the muscle of tolerating imperfection in front of another person. For women who’ve built their identities in part around being the one who doesn’t need anything, that’s not a small ask.
If Vera’s Sunday afternoon resonates, the rest of this piece is for you. We’ll cover what therapy actually involves. The practicalities, the common misconceptions, and what to realistically expect in the early weeks. So that when you open that browser tab again, you have something more concrete to work with than a list of bios. The decision to start doesn’t require certainty. It just requires enough curiosity to make one call.
References
- Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest.
- American Psychological Association (2017). Stress in America: The State of Our Nation. APA.
- Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology.
- Cuijpers, P., Karyotaki, E., Reijnders, M., & Purgato, M. (2020). Meta-analyses and mega-analyses of the effectiveness of cognitive-behavioral therapy for adult depression. World Psychiatry.
- Schore, A. N. (2012). The Science of the Art of Psychotherapy. Norton & Company.
- American Psychological Association (2013). Guidelines for Psychological Practice with Boys and Men. American Psychologist.
- Hill, C. E., & Knox, S. (2009). Processing the therapeutic relationship: A qualitative study of clients’ experiences of process and outcome. Psychotherapy Research.
- Stiles, W. B., Barkham, M., Twigg, E., Mellor-Clark, J., & Cooper, M. (2003). Impact of early sudden gains in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology.
- Beutler, L. E., Harwood, T. M., Alimohamed, S., & Malik, M. (2002). Functional impairment and coping style as predictors of psychotherapy outcome. Journal of Clinical Psychology.
If what you’ve read here resonates, I want you to know that individual therapy and executive coaching are available for driven women ready to do this work. You can also explore my self-paced recovery courses or schedule a complimentary consultation to find the right fit.
ANNIE’S SIGNATURE COURSE
Fixing the Foundations™
The deep work of relational trauma recovery. At your own pace. Annie’s step-by-step course for driven women ready to repair the psychological foundations beneath their impressive lives.
Steps Toward Starting Therapy: What Drives Women Need to Know Before Beginning
In my work with clients, one of the most common things I hear in a first session is: “I should have done this years ago.” And I understand why. By the time most driven women reach out for support, they’ve been managing alone for a long time, often convinced that if they just worked harder at the problem they could solve it themselves. What I want you to know, if you’re considering therapy and haven’t yet taken the step, is that there’s no “right time” that you’ve missed. There’s only now. And what I know about beginning therapy is that the most important thing isn’t being ready. It’s being willing.
Here are several things I want you to understand before you begin, because I think they’ll shape your experience significantly. First: therapy is not a performance. This is perhaps the most important thing for driven women to hear. You don’t need to arrive with your symptoms organized and your insights prepared. You don’t need to be a “good patient.” In fact, some of the most powerful therapeutic work happens in the moments when you’re least articulate. When you can’t quite explain what’s wrong, when the feeling is bigger than the words. Let that be okay. Your therapist is trained to help you find the words, and to sit with you in the place before they exist.
Second: the right therapeutic match matters more than you might think. Research consistently shows that the therapeutic alliance. The quality of the relationship between therapist and client. Is one of the strongest predictors of outcome. If you sit across from a therapist and something feels fundamentally off. Not just uncomfortable, but genuinely misaligned. That feedback is worth taking seriously. You’re allowed to try a different therapist. That’s not failure. That’s discernment. For trauma-informed work in particular, the felt sense of safety with your therapist isn’t incidental. It’s the vehicle.
Third: understand what kind of therapy you’re seeking. There’s a meaningful difference between supportive talk therapy and trauma-focused modalities. If you’re dealing with patterns that have roots in your history. Relational wounds, childhood emotional neglect, attachment injuries. I’d encourage you to look specifically for therapists trained in EMDR (Eye Movement Desensitization and Reprocessing), Internal Family Systems (IFS), Somatic Experiencing, or Brainspotting. These are evidence-based, body-informed approaches that work at a different level than supportive conversation alone. Asking a potential therapist directly about their training is completely appropriate.
Fourth: progress in therapy is rarely linear. There will be weeks where you leave a session feeling clear and lighter, and weeks where you leave feeling stirred up, uncertain, or emotionally raw. Both are part of the process. The stirred-up feeling often indicates that something real is moving. That material that’s been buried is coming to the surface where it can actually be worked with. Measuring your progress by how you feel leaving each individual session is a bit like measuring a hike’s progress by whether any given step is uphill or downhill. The trajectory matters more than any single moment.
Fifth: consider the logistics honestly. For therapy to work, it needs to be sustainable. Which means finding a time, format, and fee structure you can actually maintain. Many therapists offer telehealth, which dramatically increases flexibility for busy schedules. Some work on sliding scales. Some offer intensive formats for clients who want to do more concentrated work. Don’t let logistical friction become the reason you don’t start. Solve the logistical problem separately from the question of whether therapy is worth doing. It is.
If you’re ready to take the first step, I’d invite you to explore therapy with Annie to learn more about how we work and who we work best with. You can also take our free quiz to get clearer on which kind of support is most likely to help you right now. Beginning therapy is one of the most self-respecting things you can do. It’s not a sign that something is wrong with you. It’s a sign that you’ve decided you’re worth attending to. And that’s exactly right.
Anxiety is your nervous system’s threat response, designed to protect you from danger. It feels physical because it involves a cascade of physiological changes, increased heart rate, shallow breathing, muscle tension, that prepare your body to fight or flee. When this system is activated by perceived (rather than actual) threats, you experience these physical sensations without a clear external cause.
Anxiety is often triggered by things that remind your nervous system of past threatening experiences, even if the current situation is objectively safe. Your brain is pattern-matching, and if something resembles a past threat, it activates the alarm system. This is why anxiety can feel irrational; it’s responding to a perceived threat based on past experience, not present reality.
Immediate techniques include deep, slow breathing (which activates the parasympathetic nervous system), grounding exercises (using your senses to connect to the present), progressive muscle relaxation, and cold water on your face or wrists. These techniques work by directly calming the physiological stress response.
Anxiety is often deeply rooted in past experiences, particularly early relational experiences. If your early environment felt unsafe or unpredictable, your nervous system may have learned to be on high alert as a protective measure. Understanding these roots can help you approach your anxiety with more compassion and work toward healing the underlying causes.
Seek professional help if your anxiety is significantly impacting your daily life, relationships, or work; if it’s persistent and doesn’t respond to self-help strategies; or if you’re using unhealthy coping strategies. A mental health professional can provide an accurate assessment and develop a treatment plan tailored to your specific needs.
Further Reading on Relational Trauma
Explore Annie’s clinical writing on relational trauma recovery.
References
Peer-Reviewed Research (Vancouver)
- Schore AN. The Interpersonal Neurobiology of Intersubjectivity. Front Psychol. 2021;12:648616. doi:10.3389/fpsyg.2021.648616. PMID: 33959077.
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Annie Wright, LMFT
LMFT #95719 · Relational Trauma Specialist · W.W. Norton Author
Helping ambitious women finally feel as good as their résumé looks.
As a licensed psychotherapist (LMFT #95719), trauma-informed executive coach, and relational trauma specialist with over 15,000 clinical hours, she guides ambitious women. Including Silicon Valley leaders, physicians, and entrepreneurs. In repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
Licensed Marriage and Family Therapist (LMFT #95719)
15,000+ direct clinical hours
California · Connecticut · Washington DC · Florida · Maine · Maryland · New Hampshire · New Jersey · Texas · Virginia · Washington
Creator of House of Life™ and Fixing the Foundations™
The Everything Years (W.W. Norton)
Founder & former CEO, Evergreen Counseling
Regular contributor to Psychology Today. Expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information.
