Everything You Ever Wanted to Know About Starting Therapy in College

Hi. I’m a college student. And I’m in therapy. 

If you’re reading this post, you might be considering starting therapy yourself.

Whether you’re just feeling sort of ‘blah’ or you have a diagnosed mental health condition, ALL college students can benefit from therapy.

You might have a lot of feelings about therapy. You might be: 

• Not sure whether or not you need therapy
• Worried that you won’t like your therapist
• Nervous about how much it will cost
• Concerned you might be crazy for needing therapy
• Scared your family or friends might judge you

From one college student to another, I want you to know that you are not alone.

I was worried about all of these things at one point or another. So many students have these worries.

This blog post is exactly what I needed when I was a college sophomore, sobbing in my dorm room, finally ready to admit that I needed help, but had no idea where to start. 

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In this blog post, I’m going to discuss:

1. Different types of therapists and counselors
2. On-campus versus off-campus therapy
3. Your first appointment: what to expect

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I am speaking on this topic from my own perspective, which includes my mental health diagnoses: anxiety, depression, and ADHD, the privilege I hold as a well-educated, able-bodied, white woman, and from my past and current positive experiences with therapy.

All thoughts and opinions are my own.

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Different Types of Therapists and Counselors

What’s the Difference?

To start, a lot of people (myself included!) use ‘therapist’ and ‘counselor’ interchangeably.

In a lot of ways, they are. Both therapists and counselors provide a variety of mental health services to patients and clients.

The real difference between a therapist and a counselor is: 

Counselors generally work with people who have acute (short term, sudden) issues, over a shorter period of time.

Therapists generally work with people who may have chronic (long term) issues over a longer period of time. 

There is a LOT of overlap in the types of issues that a therapist and a counselor might help people with, and many therapists and counselors see a wide variety of clients. 

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You might see a therapist or a counselor who has letters behind their name like: 

• LCSW: Licensed Clinical Social Worker
• LMHC: Licensed Mental Health Counselor
• Psy.D or Ph.D: Someone who holds a doctoral degree in psychology, also known as a psychologist (not to be confused with a psychiatrist)
• LMFT: Licensed Marriage and Family Therapist
• LPC: Licensed Professional Counselor

There are also psychiatrists: medical doctors who specialize in medication therapy and management for people with psychological problems. 

Generally, the role of a psychiatrist is primarily to prescribe and manage medications, and they do not generally provide therapy, but there are a few psychiatrists who have the training to do both. 

Between all of these different types of certifications, one is not any ‘better’ than another, it just refers to the type of training that a therapist or counselor (also known as a ‘provider’) has received.

Every provider can choose to specialize in the types of issues or conditions they work with, the demographic they prefer to work with, and the types of therapy they may provide. 

It can be helpful to read a little bit about your provider, their training, and their specialties to find out if they might be a good fit for you. 

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On-Campus versus Off-Campus Mental Health Providers

Many college campuses offer on-campus counseling services for free, or at a reduced cost to students. This is how I got my start with therapy, and it is an incredible tool for students to access. 

Nowadays, I see an ‘off-campus’ provider, meaning that my therapist is not affiliated with my university. She has her own private practice and takes both insurance and private-pay clients (more on that later). 

There are plenty of pros and cons to seeing an on-campus versus an off-campus provider, and I wanted to lay them out for you! 

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Pros to On-campus Mental Health Providers:

• On-campus counseling centers nearly always provide free or low-cost services to students
• These services are conveniently located (literally, on your campus!)
• On-campus providers frequently work with students and are experts in the issues that students face
• On-campus providers can refer students as needed to other on-campus resources, like residence life or the student health center
• On-campus providers can refer students as needed to off-campus resources for specific needs; this might include substance abuse resources or eating disorder treatment programs.

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Cons to On-Campus Mental Health Providers

• A limited number of providers and operating hours means sometimes it can take a few weeks to get an appointment
• Not all colleges offer long-term 1:1 appointments: some colleges instead utilize a group therapy model or might refer students to off-campus resources after a certain number of sessions
• On-campus providers are there for college students, meaning when you graduate, you may not be able to keep seeing them
• On small campuses, it may not always be easy to go to therapy without anyone knowing; you may see professors or classmates on your walk to the counseling center, for example**

**On campus, People may see you going to the counseling center, but no one will know which provider you see or what you speak about in therapy, unless you decide to tell them yourself. Your private health information is confidential and protected under HIPAA, and your therapist will never share that information with anyone.

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Pros to Off-Campus Mental Health Providers

• There are thousands of providers out there, and you can choose the person who will be right for you, or see a few different providers until you find one you click with
• Many providers take insurance, so having insurance means you can receive services for free or at a low-cost
• You can see the same provider through college and after graduation
• Seeing an off-campus provider can provide more anonymity for students who would prefer to keep their therapy private

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Cons to Off-Campus Mental Health Providers

• There is nearly always a cost to seeing an off-campus provider, even with insurance coverage
• Not every provider will take your insurance, which can limit who you may be able to see
• For students without reliable transportation, it may not be practical to travel off-campus to see a provider regularly

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What To Expect At Your First Therapy Appointment

So, you’re almost there! You’ve found a provider, you have an appointment set up…

But what is your first appointment going to be like? 

I’ve seen 4 different providers in my life and have had 4 different first appointment experiences. 

Every provider chooses to do things differently, but I’m going to talk about what you can most likely expect from your first appointment. 

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Before You Arrive

Many providers will have forms or paperwork for their clients to fill out prior to their first appointment. 

Practically speaking, your provider will want to have your name, contact information, insurance information, if relevant, medical information, and an emergency contact number on file, just in case. 

Your provider may also ask you to fill out a questionnaire that asks about your family, your schooling, your relationships, significant life events, and why you have decided to start (or continue) therapy, so they can get to know your situation a bit before meeting you in person. 

Your provider will have you sign a form that states you understand that your medical information will be kept confidential and private, and that you understand what the few exceptions to that confidentiality agreement are.

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That First Appointment

Your first therapy appointment can sometimes feel a bit like a first date or a job interview. 

You’re meeting this new person and they are meeting you for the first time. Your first appointment is a great chance for you to begin to get to know one another. 

Your provider might start by asking you some questions about yourself–who you are, and why you may have chosen to come to therapy. 

They might ask what you feel are your biggest concerns with your mental health or what you think you want to work on. (If you aren’t sure about this yet, that’s okay!)

Your first appointment is also the chance for you to ask questions as well. 

You can ask your provider about the types of clients they see, the types of issues they work with, or the types of therapy they do. 

Sometimes, you may start discussing your concerns to introduce them to your provider, and they might have a few ideas or pieces of advice that can help you right away. (Cool, right?)

In one of my first appointments, my provider gave me a few pieces of guidance about finding balance in my busy schedule, which helped alleviate a lot of the overwhelm and anxiety I was feeling at the time.

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At the End of the Appointment

Towards the end of your first appointment, you and your provider may choose to discuss how often a provider prefers to see their clients and what time might work best for future appointments. 

At this time, you can also ask questions about payment and other technical details.

If you feel comfortable making another appointment, then do it!

If you’re feeling unsure, I’d encourage you to make a second appointment anyway. That way, you can continue to get to know your new provider and they can continue to get to know you.

If you’ve gotten some uncomfortable vibes or if you’re pretty sure that this isn’t a good match, it’s okay to say that you’d like some time to think about it before making another appointment.

This happens more often than you might think, and it’s totally okay. It’s not your fault, and it is not the fault of the provider. Some personalities and styles of therapy just don’t click.

You will find a provider who is right for you, I promise.

Congrats, you’ve survived your first appointment! Let the self-work, begin!