One of the number one issues that causes people anxiety about therapy is that first session. It’s scary since you don’t know what to expect and you know that you’re going in there to talk about things that are hard to talk about. It’s totally normal and OK to be nervous, but I’m going to try to cover the most common things that are going to happen in a first session.Depending on where you go, you’ll probably start off with some or a lot of papers to sign and/or fill out. This will be confidentiality agreements, releases (to talk to your psychiatrist or PCP, if necessary), and treatment contracts. A treatment contract usually lays out things like the therapist’s cancellation policy and the expectation that you’ll attend sessions. Many places will have you fill out a health history form as well.
The therapist will then ask you why you sought therapy. Usually there was some sort of a Last Straw event that made you decide to go to therapy, tell your therapist about that experience. Then your therapist will ask you about your longer-term symptoms: how long have they been going on, when do you usually experience the problem (i.e. do you have situational anxiety or are you always depressed no matter what, etc.), they may ask what you do or have tried to do to alleviate the problem and how helpful it has been.
Your therapist will probably ask questions about suicide, self-harm, anger management, eating and sleeping, and any hearing voices or seeing things. This helps them take note of any safety concerns and helps them form a diagnosis.
The best thing you can do is be open and honest about everything you have been feeling and experiencing. But don’t feel like you need to spill absolutely everything. In fact, it’s better if you don’t. It’s important to develop a trusting relationship with your therapist, and sometimes if you spill too much too soon it can actually impede building that relationship.
It’s helpful if you think ahead about what you want to tell your therapist and how you’re going to be the most clear about it. Make a list or write little notes if that is helpful to you. Being a little prepared ahead of time will go a long ways towards reducing your anxiety and may make that first session as worthwhile as possible.
In my opinion, you should feel better after an initial therapy session, and I am skeptical of therapists who don’t believe that the first session is meant to put clients at ease. The first session is by no means an immediate cure, but taking steps to improve your mental health should be making you feel like things are less hopeless and should give you a feeling of self-power. You may have other feelings too, but you should feel a little calmer or more hopeful.
Ask as many questions as you want! Feel free to ask them about their education or credentials or training they have had with your particular issue. You can ask how many sessions you should expect to have, although many therapists don’t set a time limit, which is fine too. You may get a diagnosis after the first session, but probably not. Every mental health clinic I’ve ever worked at has given therapists three sessions to come up with a diagnosis.
I can’t emphasize enough that you should not feel obligated to continue seeing a therapist that you don’t feel is a good match for you. However, I encourage people to give it at least two or three sessions to make that decision. Of course, you should be using your feeling about what is right for you. If a therapist makes you at all uncomfortable or is really inattentive or rude, then by all means don’t think you need to keep it up past that initial session. I think of therapy as a team effort, and you have to work together to get the help you need.
That’s it for the first session. Just describe what’s been going on! Easy enough, right? Anything else you want to know about therapy that I haven’t covered. Let me know in the comments or send an e-mail!