Written by: Virginia Kuhn, LPC
When people picture therapy, they may imagine spending an hour talking about what happened that week. Talking things through can be an important part of therapy, but sessions may also include assessment, reflection, goal setting, learning skills, noticing patterns, and practicing new ways of responding.
Therapy isn’t one fixed process. What happens depends on your goals, the concerns you bring in, the approach your therapist uses, and what feels useful to work on that day. Here are some common parts of therapy and what they’re for.
Getting to know you through assessments and history
At the beginning of therapy, your therapist may ask about what brought you in, what you’ve been experiencing, and how it affects your life. They may ask about your personal and family history, relationships, health, strengths, past support, and what you hope might change.
Some therapists also use questionnaires or other assessments. These can help organize information, understand symptoms, or track changes over time. An assessment is one part of getting to know you; it doesn’t define your whole experience.
You can ask why a question or questionnaire is being used, and you can let your therapist know if something feels difficult to discuss. The first sessions are often about building a shared understanding of what’s going on.
Building a therapeutic relationship
Therapy involves more than the topic being discussed. The relationship between you and your therapist—often called the therapeutic alliance—is part of the work. It includes developing trust and agreeing on the goals and tasks you’ll work on together.
A strong working relationship doesn’t mean you have to agree with your therapist about everything or feel comfortable right away. It means there is room to talk about what feels helpful, what doesn’t, and what you need from the process. Your therapist should make space for questions and feedback.
Setting goals together
Goals help give therapy direction. They might focus on understanding a pattern, managing symptoms, navigating a life transition, processing a difficult experience, or improving a relationship.
You don’t need to arrive with your goals perfectly defined. Sometimes the first goal is simply getting clearer about what feels hard and what you’d like to be different. Goals can also change as you learn more about yourself and your needs. In psychotherapy, goals are often developed collaboratively and revisited over time.
Noticing patterns and making connections
A therapist may help you look at connections between situations, thoughts, emotions, body sensations, and actions. You might explore whether a familiar reaction shows up in different relationships, or whether something from your past is affecting how you experience the present.
This isn’t about blaming you or assuming there is one hidden explanation for everything. It’s a way to make sense of your experience and consider what parts of it you want to work on.
Learning and practicing ACT, DBT, and CBT skills
Depending on your goals and treatment approach, sessions may include practical skills. Your therapist might explain a skill, model it, practice it with you, or help you consider how it applies to a situation in your life.
CBT (cognitive behavioral therapy) may help you notice how thoughts, feelings, and behaviors affect one another. Sessions might include examining a thought pattern, considering other ways to interpret a situation, or planning a small behavioral experiment.
ACT (acceptance and commitment therapy) may include noticing thoughts without treating every thought as a fact, clarifying personal values, and identifying actions that fit those values—even when difficult feelings are present.
DBT (dialectical behavior therapy) teaches skills in areas such as mindfulness, managing emotions, tolerating distress, and communicating in relationships. A session might focus on understanding a strong emotional reaction or practicing a more effective way to express a need.
Not every therapist uses all of these approaches, and therapy doesn’t have to feel like a class. Skills are most useful when they connect to the concerns you and your therapist have agreed to work on.
What exposure work can involve in ERP therapy
For OCD, a therapist may use exposure and response prevention (ERP), a form of cognitive behavioral therapy. In ERP, the therapist and client plan exposures to situations, thoughts, or sensations that bring up OCD-related fear or discomfort. The “response prevention” part involves working on not doing the usual compulsion or avoidance response.
ERP is collaborative. The therapist explains the process and works with the client to plan and approach exposures; it isn’t about surprising or forcing someone into a feared situation. What an exposure looks like depends on the person and their treatment plan. ERP is one example of how therapy can include active practice, alongside discussion and reflection.
What EMDR sessions may look like
EMDR (eye movement desensitization and reprocessing) is another structured therapy approach, often used when someone is working with distressing or traumatic memories. It does not mean that every session involves revisiting a difficult memory.
EMDR typically begins with history-taking and treatment planning. The therapist may also spend time on preparation and discuss what to expect before memory processing begins. During a processing session, the client focuses on a selected memory while following alternating eye movements, taps, or sounds guided by the therapist. The therapist checks in and helps the client stay oriented to the session. EMDR includes phases for preparation, processing, closure, and reviewing progress; the pace and plan depend on the individual.
Checking in on progress and staying accountable
Therapy may include reviewing what you’ve been working toward and noticing what has or hasn’t changed. A therapist might ask what felt useful since the last session, what got in the way, or whether your goals still fit.
Accountability in therapy isn’t about being scolded for not making progress or completing a task. It’s a chance to look together at what happened and adjust the plan. If a goal feels unrealistic, unclear, or no longer relevant, that’s useful information for the work.
Making room for what you need that day
Therapy can also be a place where you don’t have to keep everything neatly organized or make your feelings easier for someone else to hear. A therapist can hold space for what you need in the moment—whether that means crying, laughing, sitting quietly, or talking about something that feels complicated or hard to say out loud.
You might need space to talk about mom guilt, feeling overwhelmed, missing parts of your old life, or loving your family while still finding this season difficult. You don’t have to choose between those feelings or arrive with a polished explanation. Sometimes the session follows the plan; sometimes what you need most is room to be where you are.
Therapy isn’t a performance, and you don’t have to arrive with the perfect words or a clear report. A session is a place to work together on what matters to you. If you’re unsure what to expect, you can ask your therapist how they typically structure sessions and how you’ll decide what to focus on.
At Bloom & Breathe Therapy, we know that therapy can include both practical tools and space to feel what you’re feeling. Our therapists offer compassionate, evidence-based support for people navigating OCD, anxiety, trauma, perinatal mental health, and life transitions. Together, we’ll work toward goals that matter to you and find an approach that fits your needs—whether that includes building skills, exploring patterns, or simply having room to talk. When you’re ready, we’re here to help you take the next step.