What To Expect In Your First Therapy Session
If you’re new to therapy, you might be uncertain about what will happen in the first session. For some people this causes apprehension that can be a barrier to initiating therapy. For others, it can lead to confusion about what can be accomplished in the first meeting. Here is some clarification about how the first session with your new therapist is likely to go.
Prior to Your First Session
You might know some things about your provider and their general policies before the first session. You probably read the provider’s profile which often gives information about the types of issues they treat as well as modalities through which they provide that treatment. For example, the provider’s profile might say that they provide CBT which stands for cognitive-behavioral therapy. One way to be more informed about modalities is to research them online. However, be aware that what your provider does in practice may not be exactly what you discover when you look up the modality online. Such research can give you ideas about what to expect and could help you ask informed questions when you meet with the provider.
Sometimes, providers will offer an initial, brief phone consultation which is an opportunity for you to ask questions and to decide if you are a good fit. If this is available from your prospective provider, I encourage you to have a short call. In that call, you can also clarify issues such as payment and office policies.
Once you schedule your initial session, your provider might deliver intake paperwork via email or an online portal. This saves time in your initial session and will give you more information about practice policies such as payment methods, insurance billing, and late-cancel or no-show fees.
The Main Goals of The First Session
Clarify policies, scheduling process, scope of care, and confidentiality.
Gather history and evaluate your general state of functioning.
Begin the process of clarifying therapeutic goals.
The main goals of the initial session differ from the overall goals of the therapy process. That is, typically clients have complex histories and therapeutic goals which will need to be addressed through multiple sessions. It is rare for a client to arrive with a focused goal which can be accomplished in one session. This means you might have some dissatisfaction after the first session if you have a strong sense of urgency to get to your goals. This is normal. The good news is that with appropriate and competent therapy, you are more likely to achieve your goals than without the therapeutic support. Initiating therapy can help you start to make positive change while also gaining insight and perspective about the path to where you want to be.
In the initial session, your provider will want to accomplish a few things. Office policies including payment, billing, and scheduling and cancelation of appointments will be clarified. The policy of confidentiality of sessions will be explained. Timing of sessions will be explained. Most initial sessions are approximately fifty minutes long with follow-up appointments being around forty-five minutes long. However, some therapists schedule sessions of different lengths.
Your new provider will explain who they are and their credentials and ask you a variety of questions in order to understand what brings you to the process as well as things related to your basic functioning. For example, they will likely as questions about your sleep, alcohol intake, medications, anxiety level and symptoms, your mood, your living situation, your social connections, and your lifestyle.
Some questions might seem a little strange and not very related to what you want to get from the process. Just know that these questions help the new provider be assured that they are good for you, that you are getting the appropriate level of care, and provide a basis for what you two will build on as you develop the therapeutic alliance.
In the initial interview session, your provider will likely ask you some questions you might not have been asked before such as whether you cut yourself or are having thoughts of suicide. Your honesty with these questions is important. While it is ultimately up to you what you keep personal and what you choose to disclose, keeping a relevant detail secret could prevent the therapist from making a good decision about the course of treatment. The most common thing we therapists encounter that our clients keep secret or don’t fully disclose is drug or alcohol use. This partly explains why your therapist is likely to check in with you in future sessions with some of the same questions. A therapist needs to evaluate changing behaviors over time, and clients often become increasingly trusting of their therapist and more open about personal information later in the process.
Be aware that gathering information about your history and what brings you to therapy as well as formulating the goals start in the first session. But, these processes extend beyond the first session. The first session is not your last opportunity to share your history. And, goals continue to be clarified and refined as you and your provider get to know each other. Ideally, goals can be clear so that you and the provider know what they are and how you would know that they are achieved.
Goal setting may be straightforward though sometimes takes some work. For example, a client might have the well-defined goal of reducing or stopping daily panic attacks. Alternately, a client might have a vague goal of “I want to handle my anger better.” With a less clearly defined goal, you and your therapist will work together to clarify what it means in regard to your experience and responses in order for you to gain the ability to know exactly what the positive outcome can look like as well as the steps to get there.
What about Your Emotions?
It is likely that whatever brings you to therapy is heavy with emotions. Your general situation and the history you provide may be emotionally triggering. You want understanding and empathetic support from your therapist. The process of gathering information and addressing the initial process goals may seem interfering with your desire to have the therapist bear witness to and be supportive of your misery. Sometimes, this causes clients to feel a little dissatisfied with the initial session though it can be relieving for many because the process can soften what are often overwhelming feelings. Just know that the provider’s focus on gathering information is not a tactic for diminishing your feelings. Also know that in future sessions, you will continue to have the opportunity to share your experience so that your therapist can be satisfyingly supportive. You probably need and deserve more support than can be provided in the first fifty minutes. Your first session is laying the groundwork for what will come.
Are Initial Sessions Different for Couples Therapy?
All of the issues discussed above apply to couples therapy. However, there are some additional things to think about: fit with the therapist, limited time in the first session, and alliance of each of you with the therapist.
Not all therapists provide couples therapy. Therefore, it’s important to clarify that your prospective provider will see you as a couple. This might be clearly stated in the provider’s profile. If not, you can communicate with the provider to clarify what types of clients they serve.
While many couples go to therapy to improve a relationship that is fundamentally stable, some arrive at what may seem like the last moment to save it. Often a couple has had complex and challenging issues going on for months, or years, before they arrive at their first session. This can result in a strong sense of urgency to quickly address those issues to avoid the end of the relationship. Given the need to address beginning process issues and gather the fundamental assessment information as detailed above, this means that in the first session, there is limited time for each person in the couple to give relevant history and to start the therapy process.
The alliance that develops between a provider and client is supportive of an effective therapy process. Clients want to trust that their therapist is on their side and working toward their goals. The therapeutic alliance is more complicated with couples than in individual therapy because members of a couple may perceive the alliance of the therapist with the other member as a bias against them.
If this emerges as an issue later in therapy, bring it up with the therapist and sort it out. When not addressed, it can derail the therapy process. However, this is a concern starting even with the initial contact with the therapist prior to scheduling the first session. This bias of alliance can be introduced if one member of the couple is much more actively involved in the initial communications with the prospective therapist. It is also a likely issue if the couple decides to use a therapist who has already seen one member of the couple individually for one, or more, sessions. The threat of uneven alliance can be reduced if both members of a couple participate in the initial contact (including the initial, brief phone call when that happens) and avoid doing joint therapy with any provider that either one has already seen individually.
Hopefully the information in this article helps you be less confused about what to expect at the beginning of your therapy process!
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