Sarah Fox, PsyD, is a psychologist at New Directions Mental Health’s Robinson clinic. She provides therapy for adults and older adolescents in person and through telehealth. Sarah works from an integrated interpersonal, psychodynamic, and multicultural lens, and she believes a warm, authentic therapeutic relationship is the foundation for change. In this conversation, she talks about taking the first step into care, what early sessions look like, and how to find a good fit.
Why getting started can feel hard
What are the biggest challenges people face when deciding whether to reach out?
Sarah: There are emotional challenges, stigma, and very practical ones. A big practical barrier is insurance. Many people are not sure how to navigate coverage, and that can feel stressful. It’s also hard to know what to look for in a therapist. Therapy is medical in some ways and not in others. You see your therapist more often than a PCP, and it involves more emotional vulnerability. People also carry ideas about what therapy is supposed to look like. They worry about being judged or not understood.
I hear two feelings that can show up at the same time. One is, “I am not bad enough to need help.” The other is, “I am too far gone for help.” Both can keep someone stuck. On top of that, there are so many options. If you Google therapists, you get pages of results and a lot of acronyms. LCSW, LPC, PsyD, PhD, MD. It is a lot to sort through, and people are left wondering what any of it means.
How do you see stigma show up?
It’s layered. Things are improving, but there is still a cultural message that help is for other people, not me. Many families also carry stigma. Someone may want therapy, and others are not ready for change. That can lead to criticism or fear, like worrying therapy will be about blaming parents. Those messages make it harder to walk through the door.
What the first appointment is like
How do you approach the very first session?
I try to remember that, even though I do intakes often, for the person in front of me this might be their first time. It is vulnerable, and getting through the door is already brave. I name that and respect it.
We cover what to expect. I go over informed consent, the privacy of therapy, and the limits to confidentiality in situations like imminent risk. Paperwork alone is not enough. I want people to understand and to ask questions any time. I let them know I will ask background and biographical questions to get a full picture, but the focus is on why now and what they want from the space. We are getting to know each other and deciding together if I feel like the right fit and if they feel comfortable giving it a try.
I also frame the first meeting as a consultation. If I am not the right person, that’s okay. I can help them get connected to someone else. I want people to leave with a positive enough experience that, even if now is not the time or I am not the fit, they can try again later.
How therapy works when it works well
What helps therapy be effective for a new client?
Therapy is collaborative. I bring expertise in psychological care. The client brings expertise on themselves.
No one knows you better than you. We build the work together.
People often ask what makes a therapist good. It is not the degree level by itself, or years of experience, or a single technique. The research supports the importance of the therapeutic alliance, the connection between therapist and client. Do you feel understood, safe, and on the same page? That connection predicts success more than anything else. Comfort matters.
Questions to ask and how to use therapy
What do you wish people would ask early on?
Ask about my approach and how I engage in therapy. That helps us both check for goodness of fit. Ask anything about consent or privacy, and keep asking. Consent is not a one-time event, it’s ongoing every session. You can say, “I want to talk about something, but I am not sure if it will stay between us.” It is my job to help you understand that.
Ask how you might use therapy. There is no one right way. We can talk about what it could look like for you to get benefit from the time. If you are not sure what your goals are, that’s okay. We can figure them out together. You might also ask, “how will I know if we are a good fit, or what might progress look like for me?” Those are useful conversations to have.
If you feel stuck on the starting line
What would you say to someone who wants to start but is having trouble making the first call?
Ask yourself, “why not now”? We spend a lot of time in limbo, and the limbo can be the most stressful place. Taking a first step can bring relief.
If you try and decide the timing is not right, or the fit is not right, that is one data point. You can pause, try again, or try someone new.
Make it easier on yourself. If calling is overwhelming, begin with an online inquiry form. You will talk to someone eventually, but submitting a form is a real start. Tell a trusted person you plan to reach out, and ask them to check in. If you know people in therapy, ask for recommendations.
It can also help to imagine where you might be in six months, a year, or five years if you start now. The time will pass either way. Planting a seed today can matter later.
What about getting started with care at New Directions?
You submit an inquiry, speak with someone about your needs and scheduling, and get matched. I view the first session as a consultation. If you want to try a different clinician after that, I can help with that. Reading clinician bios can also help you get a feel for someone’s voice before you book.
Ready to start your own therapy journey?
If you’re ready to start your mental health journey, New Directions Mental Health offers compassionate, evidence-based care. For new clients, please click here to submit an inquiry form. For existing clients, please click here and find your office location to contact your office directly.