The first session of therapy can feel like a first date. You've been given a brief description of your therapist, perhaps seen a picture or two, but it's hard to know if you'll be a good fit until you've met in person. Whether you are new to therapy or a seasoned pro, knowing what to expect can alleviate the first session jitters. Here are some of the things likely to occur:
You'll be given some information about the therapeutic process and what therapy may look like with your particular therapist.
You may be asked to fill out some forms, including a consent form. Your therapist should discuss consent and confidentiality with you. What is shared in therapy is kept private and confidential, however, there are certain conditions where confidentiality may be breached to protect your safety or the safety of others.
You'll be invited to discuss what brought you to therapy and a brief history of the issues you've been struggling with. Your therapist may also ask about any previous mental health treatments you may have had.
You'll likely discuss what you hope to get out of therapy. You may not have any specific goals other than to feel better and that's OK. New goals may also emerge and evolve throughout the course of therapy. Your therapist is there to meet you wherever you are at and guide you every step of the way.
Your therapist will gather some background information that could be relevant to the work you'll be doing together, such as your family history, school and work experiences and current life circumstances.
Your therapist will talk to you about session costs and methods of payment. You may have insurance that will fully or partially cover the cost of treatment. It is a good idea to look into your insurance coverage before showing up to your session.
At the end of the first session, your therapist will likely share their initial understanding of the issues you've been struggling with and some ideas of how they can help you move forward. You may also discuss treatment plans such as what you can do in between sessions and frequency of sessions that works for you.
The first session of therapy tends to look quite different than the ones that follow. There are administrative and housekeeping items to get out of the way, a lot more Q&A, and it can feel much more structured than a typical therapy session. Nevertheless, you should still feel like there is space for you to be heard. You may feel pressured to cover everything that seems relevant or be unsure of where to start. Your therapist will listen for what sounds important and ask questions to understand who you are and the difficulties you are facing. Alternatively, you may not be comfortable diving into the details just yet or feel ambivalent about being in therapy. Openness and authenticity are important in therapy, however you are never required to disclose anything you are not ready to share.
After you've attended your first session, or maybe a couple, you'll get a sense of whether you want to continue. Not every therapist is the right fit for every client. Research shows that the relationship between you and your therapist, called the working alliance, is more predictive of treatment outcomes than the kind of therapeutic modality (more on that in future posts) or the specific techniques that were used (Ardito, R. B., & Rabellino, D. (2011). Here are some questions to help you decide if your therapist is right for you:
Do you feel comfortable opening up and discussing sensitive topics with your therapist? If you feel judged or consistently misunderstood, especially after a few sessions, perhaps your therapist is not the right match for you.
Does the therapy feel collaborative? Therapy works best when you are actively involved in the process -- from setting the goals to the tasks required to achieve them. It's important that your therapist is open to your feedback and able to modify things to work for you.
Does your therapist have the right training and expertise for what you want to work on? Most therapists are equipped to treat depression and anxiety, but they may not be experienced with more complex or specialized issues, such as trauma, eating disorders and psychosis.
Does their availability work with your schedule? Therapy is not a quick fix solution and length of treatment varies with what you hope to accomplish. Make sure that your therapist is able to see you on a regular basis to make therapy an easier commitment.
If something doesn't feel right, don't be afraid to let your therapist know. It's worthwhile to have a discussion of what isn't working for you, even if you've already decided to move on, so that you can better identify what you need. Your therapist may also be able to provide appropriate referrals or point you in the right direction.