Understanding the Structure of Psychotherapy: What to Expect as a Client?

At certain stages of life, individuals may face overwhelming stress, events that exceed their coping abilities, or crisis situations. For anyone who has gone through such situations, is unhappy with their behavior or feelings, and wants to change, seeking therapy is an appropriate method. In general terms, psychotherapy can be defined as the support an individual receives from a professional with the aim of bringing about changes in their emotions, thoughts, and attitudes (Wall, 2021). How the psychotherapist provides support to the client varies depending on the therapist’s education and theoretical orientation. This orientation will influence the therapist’s style and focus, as well as the methods and techniques used in psychotherapy. For some clients, starting therapy can be both promising and intimidating at the same time. One of the most effective ways to reduce the anxiety that uncertainty can cause is to understand how psychotherapy is typically structured: when the client learns what will happen in the first session, how a standard session will proceed, how progress will be reviewed, and how the therapy will end, they may feel more comfortable starting therapy (Hill & Knox, 2013). A clear structure in the therapeutic environment helps establish realistic expectations, strengthen the working alliance, and lead to better outcomes and lower dropout rates (Swift & Greenberg, 2012; Wampold & Imel, 2015). A brief overview of the general process of therapy is provided below (THealth, 2025):

First Session: The client can share their concerns, past experiences, and goals with the therapist. This is a session where both parties try to get to know each other and, if necessary, discuss the intake documents.

Regular Sessions: The therapist begins the session by reviewing a report from the previous week (or weeks) to establish control. They then ask the client questions, engage in focused discussions, and have conversations within the context of coping strategies. The session concludes with a summary of progress and a recap of the topics covered during the session.

Therapy Method: Many methods can be mentioned in the context of therapy modalities. However, in general, they are examined under three headings: Cognitive-Behavioral Therapy, Psychoanalytic/Psychodynamic Therapy, and Humanistic Therapy (Wall, 2021). The therapist will utilize the methods and assessments of the modality in which they specialize and will structure the sessions within that context.

The Role of the Therapist: In the therapeutic environment, the therapist’s role is to provide a safe space for the client, approach them with empathy, provide expert guidance, and provide the client with appropriate tools to manage their emotions and difficulties.

Therapy that works best with consistency, honesty, and preparation is seen as a step toward better emotional well-being and a healthier life (THealth, 2025). In this therapy sketch, the development of the therapy process will be examined in detail, the structure of the therapeutic environment will be evaluated, and clients’ expectations of therapy will be discussed. It is believed that this sketch will serve as a valuable resource for clients considering therapy and will contribute to their better understanding of their expectations during the therapy process.

What is ‘’Structure’’ in a Therapy Setting and Why is It Important?

Planning in therapeutic processes is critical in ensuring that the time spent both during and outside of therapy sessions is well utilized and that the client achieves a successful outcome within specific time constraints. In a therapeutic setting, structure refers to the planned, sequential, and collaborative organization of treatment elements and encompasses all stages of the therapy process, including assessment, goal setting, intervention, and termination (Barkham et al., 2006). How a therapy session is structured may vary between therapists and clients. In general, an intake session will look different from a standard session, a discharge session, or a crisis session. Specific treatment protocols, such as EMDR, can also shape the structure of a therapy session in a different dimension. On the other hand, the client’s needs can also influence how a session is structured. However, regardless of theoretical orientation and other factors, most evidence-based treatments share common structural features (APA, 2023). Understanding the general structure of the therapy process and knowing how it works is essential for effective treatment. Below is a detailed discussion of how a therapeutic process is structured (Browne, 2024):

Intake Sessions: The goal of the intake session is to gather information about the client’s history, complaints, and general condition. This first session, which is an introductory session for both the client and the therapist, is ideal for establishing a relationship of trust, setting therapeutic goals, and determining the basic building blocks of the topics to be addressed in the sessions. The stages of a typical intake session include the following:

Introduction and Building Trust: The therapist welcomes the client with a warm and empathetic attitude. The seeds of the therapeutic relationship between the client and therapist are sown during this session.

Information Gathering: The client’s history, family history, current problems, medical history, and any previous treatment experiences are questioned in detail.

Psychometric Assessments: The therapist may use some standard tests to obtain data about the client (e.g., PHQ-9, GAD-7).

Informed Consent: The therapist provides the client with a form containing general information about the therapeutic process, methods to be used, fees, confidentiality rules, boundaries, and cancellation policies. Through the informed consent form, the client acknowledges that they have been informed about the therapy process and freely consents to the process. This form is important from both an ethical and legal standpoint.

Goal Setting: The therapist inquires about the client’s reasons for starting therapy and defines their expectations for change.

Follow-Up Sessions: The following sessions involve therapy work carried out in accordance with the goals set by the client and therapist in collaboration with each other. This includes practices such as developing the client’s insight and awareness, focusing on skill acquisition, providing emotional processing, and supporting the change process. The general procedure for ongoing sessions is as follows:

Regular Sessions: Sessions are typically scheduled once a week, and each session lasts an average of 50 minutes. The frequency of sessions can be adjusted according to the client’s needs.

Session Structure: Sessions are mostly structured under three headings: introduction, working section, and closing. In the introduction section, the client’s current situation and experiences from the previous session to the present are discussed. In the working section, questions appropriate to the client are asked, and the process is advanced using appropriate methods within the framework of goals determined by considering the client’s symptoms and needs. In the closing section, the topics discussed in the session are summarized, homework is assigned to the client when necessary, and a brief assessment is made of the topics to be addressed in the next session.

Intervention Techniques: The intervention techniques and tools used in the therapeutic environment vary depending on the school of thought to which the therapist belongs. The therapist uses specific intervention techniques in sessions to achieve therapeutic goals in accordance with their training and the client’s needs.

Progress Assessment: At regular intervals, the extent to which therapeutic goals have been achieved is reviewed.

Termination Session: The primary goal of termination sessions is to bring the therapeutic process to an end consciously. The therapist and client evaluate the gains made during the therapeutic process and review preparations for future challenges. According to Joyce (2007), a well-structured termination process increases the permanence of post-therapy gains. A typical termination session includes the following stages:

Overview of the Therapeutic Process: The therapist and client review the entire journey they have taken together, identifying both what has changed and what goals have been achieved.

Reinforcing Gains: The therapist evaluates how the skills learned during the therapeutic process can be integrated into daily life and, if necessary, prepares a written plan.

Preventing Relapse: The therapist discusses how the client should act when faced with a challenging situation and draws attention to the warning signs to look out for.

Preparing for Separation: The end of the therapeutic relationship can be emotionally significant for the client. It is appropriate for the therapist to address this process during the termination session.

Although the therapeutic process has a natural progression consisting of specific stages, how this process is structured directly affects many important variables, from the quality of the therapeutic relationship to the results obtained. The fact that sessions progress within a specific structure both makes the client feel safe and allows therapeutic goals to be more clear, measurable, and achievable. Other benefits of structuring the therapeutic process include the following:

A Stronger Therapeutic Alliance: A transparent roadmap increases understanding of the two critical components of establishing a therapeutic alliance (goals and tasks) (Bordin, 1979; Horvath & Symonds, 1991).

Symptom Relief: Well-structured therapeutic protocols provide moderate to large effect sizes in the context of disorders (Cuijpers et al., 2021).

Reduced Early Termination: Clear expectations regarding the therapy process reduce the risk of dropout by half compared to unstructured care (Swift & Greenberg, 2012).

Enhanced Equity and Cultural Safety: Openly discussing roles and boundaries in the therapeutic environment reduces power differentials and benefits clients from marginalized groups.

The structure of the therapeutic process plays a critical role in shaping important elements such as the quality of the therapist-client relationship and the effectiveness of treatment. Another important element in the context of the process is client expectations. The client’s expectations of the therapeutic process directly shape their participation in the process, their commitment to the goals, and the benefits they will derive from the sessions. For this reason, it is critically important for an individual beginning a therapy process to know what to expect and to develop expectations that are both realistic and scientifically grounded. The following section addresses what clients can expect from the therapy process.

What Can Clients Expect from the Therapy Process?

Therapy is generally known as an appropriate setting for self-discovery and emotional healing, but research shows that the benefits and structure of therapy are multi-dimensional. One of the most prominent expectations of clients beginning therapy is to undergo a therapeutic process that is both relational and goal-oriented, guided by evidence-based practices that support psychological well-being (Wampold & Imel, 2015). Although expectations vary depending on the unique needs of clients, their circumstances, and the modalities used, research has revealed what clients can generally expect from the therapy process:

1. Collaborative and Safe Therapeutic Relationship

The therapeutic alliance, which shapes the entire therapy process and is an indispensable dimension of therapy, represents the establishment of a trust-based relationship between the therapist and the client. A strong therapeutic alliance between the client and the therapist is considered one of the most reliable predictors of positive outcomes from therapy (Horvath et al., 2011). This alliance is based on mutual agreement regarding goals, tasks, and the emotional bond between the client and therapist (Bordin, 1979). A strong alliance provides a safe space where clients feel heard, validated, and respected while also serving as a fundamental condition for therapeutic change.

2. Goal-Oriented and Structured Sessions

Clients should be aware that therapy will mostly have a structured rhythm and defined goals. While some modalities, such as psychodynamic or person-centered therapy approaches, begin with open-ended questions and unstructured/semi-structured methods, most therapeutic approaches emphasize collaborative goal setting (Norcross & Wampold, 2018). Clear structure and goal orientation in the therapeutic process are significantly associated with greater client engagement, improved symptom reduction, and reduced dropout rates (Swift & Greenberg, 2012).

3. Evidence-Based Interventions

An ethical therapeutic process involves the use of scientific techniques supported by experimental research. For example, in Cognitive Behavioral Therapy-oriented therapy, whose effectiveness has been proven repeatedly by scientific studies, clients learn to identify maladaptive thought patterns and replace them with functional ones; in Dialectical Behavior Therapy, which includes evidence-based practices, clients learn to regulate their emotions and acquire interpersonal skills (Beck, 2020; Linehan, 2015). These methods are not applied randomly but are adapted to the client’s specific needs and goals, thereby increasing the effectiveness of treatment (Kazdin, 2007).

4. Personal Growth and Insight

Beyond symptom reduction, therapy provides clients with deeper self-awareness and personal growth. Clients report gaining new perspectives on their behaviors, interpersonal relationships, and identities through the therapeutic process (Shedler, 2010). In particular, when it comes to insight-oriented therapy approaches, emotional insight serves as a central mechanism of change that contributes to long-term recovery and resilience. Following a well-structured therapeutic process that progresses within an ethical framework using scientific methods, the client gains a heightened awareness of themselves, others, and the world.

5. Fluctuations in Progress

Clients should be prepared for the non-linear nature of therapeutic change. The idea that they will feel better at the end of each session or experience major changes after each session is unrealistic. Therapy is an ups-and-downs process that takes time. Progress in therapy is sometimes accompanied by periods of emotional distress or temporary setbacks, which are considered both normal and necessary for growth (Castonguay & Hill, 2017). Therapists support clients in managing these fluctuations by normalizing the experience and strengthening coping strategies.

6. Termination and Long-Term Maintenance

Clients can expect therapy to end in a structured and conscious manner. The termination phase involves reviewing progress, reinforcing gains, preparing for future challenges, and discussing follow-up or support sessions if necessary (Joyce et al., 2007). A well-managed termination session supports the long-term maintenance of therapeutic gains and creates a sense of closure, thereby reducing the client’s emotional impact. 

Takeaways:

• The structure of each session, from the initial consultation to the termination phase, includes a comprehensive plan covering the steps of assessment, goal setting, intervention, and reinforcement of gains.
• Conducting therapy within a specific structure reduces the client’s uncertainty about the process, strengthens the therapeutic relationship, and ensures more positive outcomes.
• The methods used by the therapist vary according to their educational background and theoretical orientation, and these variables directly affect the style and focus of the therapy.
• The quality of the therapeutic alliance stands out as one of the most powerful determinants of therapeutic change by making the client feel safe and understood.
• An evidence-based, goal-oriented, and structured therapy process increases client participation and is associated with higher treatment success.
• Although therapeutic progress does not follow a linear course, insight, skill development, and long-term emotional resilience are among the sustainable gains of the therapy process.

References

1. TeleveroHealth. (2025, May 6). What to expect in therapy – Televero Health. Televero Health. https://televerohealth.com/what-to-expect-in-therapy/ 
2. Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta‑analysis. Journal of Consulting and Clinical Psychology, 80, 547‑559.
3. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate (2nd ed.). Routledge. https://psycnet.apa.org/record/2008-07548-000 
4. Hill, C. E., & Knox, S. (2013). Processing the therapeutic relationship. Psychotherapy, 50, 52‑61.
5. Wall, D. (2021, June 19). What to expect from therapy. ABCT – Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/what-to-expect-from-therapy/ 
6. American Psychological Association. (2023). Clinical practice guideline for the treatment of depressive disorders. APA.
7. Barkham, M., et al. (2006). Service quality and clinical outcomes: The interface. Journal of Mental Health, 15(3), 291‑304.
8. Joyce, A. S., Piper, W. E., Ogrodniczuk, J. S., & Klein, R. H. (2007). Termination in psychotherapy: A psychodynamic model of processes and outcomes. American Journal of Psychotherapy, 61(2), 151–168.
9. Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252‑260. https://psycnet.apa.org/record/1980-23666-001 
10. Horvath, A. O., & Symonds, B. D. (1991). Alliance and outcome in psychotherapy: A meta‑analysis. Journal of Counseling Psychology, 38, 139‑149.
11. Cuijpers, P., et al. (2021). The effects of CBT in adult depression: An updated meta‑analysis. World Psychiatry, 20, 115‑136. https://pubmed.ncbi.nlm.nih.gov/23870719/ 
12. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.
13. Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence‑based relationships. Clinical Psychology, 25, 344‑352. https://pubmed.ncbi.nlm.nih.gov/30334258/ 
14. Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press. https://psycnet.apa.org/record/2020-66930-000 
15. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press. https://psycnet.apa.org/record/2015-05780-000
16. Kazdin, A. E. (2007). Mediators and moderators of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1‑27.
17. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98‑109. https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf 
18. Castonguay, L. G., & Hill, C. E. (Eds.). (2017). How and why change happens in psychotherapy. APA. https://www.apa.org/pubs/books/How-and-Why-Are-Some-Therapists-Better-Intro-Sample.pdf 
19. Browne, T. (2024, August 10). What to expect in a therapy (Treatment) session — Dr Tess Browne. Dr Tess Browne. https://drtessbrowne.com/journal/what-to-expect-in-a-therapy-session 

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While our physical offices are located in South Loop and Lakeview neighborhoods in Chicago, Illinois for in-person sessions, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more.  

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance, and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

Whether you’re seeking guidance on a specific issue or need help navigating difficult emotions, we’re ready to assist you every step of the way.

Contact us today to learn more about our services and schedule a session with our mental health professionals to begin your healing journey. To get started with therapy, visit our booking page.

First, decide if you’ll be paying out-of-pocket or using insurance. If you’re a self-pay client, you can book directly through the “Book Now” page or fill out the “Self-Pay/Out-of-network Inquiry Form.” If you’re using insurance, fill out the “Insurance Verification Form” to receive details about your costs and availability. Please let us know your preferred therapist. If your preferred therapist isn’t available, you can join the waitlist by emailing us. Once your appointment is confirmed, you’ll receive intake documents to complete before your first session.

This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.