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What to Expect from Your First Session with a Therapist

Seeking professional help is a courageous first step. Here’s how to prepare.

For anyone struggling to bring about positive change in their life, it often takes a monumental act of courage to walk into a therapist’s office.

Indeed, engaging in the process of therapy is an act of bravery that is not for faint of heart. Successful therapy demands that you see what you do not want to see within yourself.

“Deciding to begin therapy, to be willing to try to do things differently, requires a great deal of bravery,” says Rebecca Newman, MSW, LCSW, lead social worker at Thomas Jefferson University Hospitals. “Even when things may feel like they aren’t working, they’re typically fairly comfortable and familiar. Change can be disorienting and overwhelming, and knowingly taking on this personal endeavor is one of the most beneficial investments you can make in yourself.”

So, what will that first session with a therapist be like? Well, at first, it probably won’t be unlike a first visit with any other healthcare provider. You might check in with a receptionist, fill out initial paperwork and then wait for your therapist to bring you back for your session.

The first part of any initial therapy session will likely be spent getting to know one another. “Building a relationship is one of the most important aspects of the therapeutic process,” Newman says. “Because there can be so many clerical tasks in the first session, it can be a little more challenging to get a sense of your vibe, and some people don’t vibe right away. That’s OK. Try to give the relationship a little bit of time to blossom before making a decision about whether you want to stay with the provider.”

As a patient, you want to walk out every session feeling better, but the actual goal is to get better at feeling. – Rebecca Newman

Following the first session, it’s important to “check in” with oneself. Take a walk, or take yourself out for a coffee and reflect on how the first session went, and how you would feel about going to another one with this therapist. “Sometimes the process of going back through a lot of experiences, many of which can be painful, kind of creeps up on you,” Newman says. “You can feel a little bit overwhelmed or flooded with emotions. So plan to take some time to decompress.”

Newman believes it should take between three and five sessions to determine if a therapist feels like a good fit.

Today, that determination may have to be made based on remote sessions, as there’s no denying that the COVID-19 pandemic has altered the nature of therapy. Newman continues to use telehealth prominently, and she is hardly alone in switching up her practice during the pandemic. In a survey of 1,141 clinical psychologists released by the American Psychological Association and reported in Scientific American, 96% said they were providing remote or “telehealth” services to patients, and an equal portion judged them to be effective.

“Telehealth did exist before, and I did use it in the before times, but now we have a more universal use of video telehealth, particularly because this medium is treated with parity by insurance companies,” Newman says. In the early days of the pandemic, it was especially effective in maintaining a connection with established patients who were feeling the effects of the extraordinary circumstances of the time. “It does definitely change the dynamic, but my sense was that having the continuity of someone who already knew you and already knows your sensibilities coming into this completely unprecedented time was really helpful.”

Whether it’s done remotely or in person, what you and your therapist are trying to establish early on is known as a therapeutic relationship, or therapeutic alliance. The therapeutic relationship is fundamentally important to the counseling process.  It can enable confidence, reassurance, openness and honesty, paving the way for you to accept yourself for who you are. Forming a solid relationship can empower you to delve deeper into the issues you may be facing and “open up” emotionally to the counselor.

“The thing I like to say about therapy,” Newman says, “is that a lot of people think the goal is to help you feel better, right? As a patient, you want to walk out every session feeling better, but the actual goal is to get better at feeling. So I could conduct a session so you walk out with a smile on your face, but I actually wouldn’t be doing my job very well. I am here to help you through those tough emotions, to hold those tough emotions with you, so we can work through them together. And it’s going to be hard.”

For some, this may be the first time a patient has ever shared their innermost thoughts and experiences with another, outside of their immediate family or friends. “It’s different than any other relationship that you’ll have in your life,” Newman says. “I think a very important distinction to make is, you may feel very friendly with your therapist, but your therapist is not a friend. You may have a good rapport, but the relationship should really be focused on you and your needs.”

To prepare for your first therapy session, Newman suggests thinking about past experiences, or more contemporary ones, that might be relevant. Think about when you first began noticing the symptoms for which you are seeking care. If seeking care for depression, for example, when did it start feeling heavier than simply being in a sad mood? What other things were happening around the same time?

Think about the type of questions a provider may ask you during your first session, such as:

  • Have you attended therapy in the past?
  • What are your symptoms?
  • Who was at home with you when you were growing up?
  • How was school for you as a child, both socially and academically?
  • Do you have any mental health issues in your family history?
  • Do you have a history of suicidal thoughts or hospitalizations?
  • Do you have a history of self-harm?
  • What do you hope to get from therapy?
  • What do you want to accomplish in our sessions?

It can also be helpful to plan on asking questions of your therapist. Before your session, consider thinking over what worries or concerns you may have about treatment and then brainstorm some questions to ask your provider. Your provider should review practice policies and procedures and confidentiality. Then, you may have further questions about confidentiality/emergencies, etc.  For example:

  • Is this confidential?
  • When would you need to break confidentiality?
  • What types of treatments do you use for my specific type of mental health issues?
  • What kind of things should I plan to do between our sessions?
  • How do you prefer communication, if necessary, between sessions?
  • What is the turnaround time for response?

Ideally, over time, the benefits of your care begins to outweigh the stigma that you may have felt when you began therapy. While many believe that being in therapy is more normalized than ever, the biggest reason for people not seeking it is concern over how others will see them. “As a therapist, it’s important to normalize the value of therapy with my patients and liken it to a part of one’s overall maintenance,” Newman says. “We don’t realize that even calling it ‘mental health’ continues to stigmatize it away from our physical health – as if our mental health is not connected to the whole rest of ourselves.”

It may be helpful for your therapist to share – within reason, Newman says – his or her treatment goals with you. This is something that can be a discussion topic during an initial therapy session. Typically, this involves discussing interventions and modalities that the therapist may want to explore and why they may be helpful.

During the course of therapy, you should also feel empowered to tell the therapist if they feel progress has slowed. “That may be a good time for a therapist to suggest a brain storming session, to talk about what could be done differently,” Newman says. “It’s always a good idea to check in on what has been accomplished and what still remains to be done.”

It may be a given, but there should be a clear understanding that therapy involves hard work and significant breakthroughs will take time. “There’s going to be a need for tough conversations,” Newman says. “You get out of it what you put into it.”

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[Main photo credit: Productions]

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From the Experts, Healthy You