What Happens in a First Therapy Session?

People put off starting therapy for a lot of different reasons, even when they know they really need help with something. Over the years I've heard a lot of different whys and wherefores for avoiding therapy and a lot of them boil down to this: "It'll feel weird/bad/scary/sad to say all this out loud because it's super personal/awkward/scary/upsetting/overwhelming. What's the point?" Of course, it feels much better once you're in it. And it feels great when you're done. But what happens between the before and after?

You start.

Starting is hard but nothing happens until you start. And it's easier to start when you know what to expect. I had a client recently tell me how helpful it had been to hear me describe during our consultation what his first session would be like. After that, he knew exactly what to expect. So for anyone else out there who needs to know what happens in a first therapy session, here you go. These are the things you can expect, as well as a few things you should consider, whether you're considering therapy with me or someone else.

First, things first - hopefully-not-awkward introductions, shaking hands, smiling and settling in. (Insider tip: if there's a sofa, that's probably for you and the therapist usually takes the big chair. If you're not sure, look for the clipboard and then take the other seat!) Settle in and take this time to assess a few things. First, do you get a good vibe from this person? How does the fit feel? The very, very first sentence Dr. Romano uttered in my very first therapy class is highly applicable here: "The most important thing to remember as a therapist is this: Just be normal." We all laughed at the time, but it's true, right? Normal is completely underrated. And normal is completely relative to YOU. Does this person feel like a good match to your normal? Is this someone you can talk to? Do you feel comfortable with him or her?

Next, usually comes a little chit chat and then I give people a general outline of what to expect over the next 50 minutes or so. These are the things in that list, though they often vary in order depending on how things go:

• Bureaucratic topic #1: Privacy and Confidentiality. Unlike the rest of the topics, which might be in a different order, this one is always first. I will clarify all the rules about privacy and confidentiality. This is important so that you understand your rights regarding what we talk about in therapy. That doesn't take too long.
• Bureaucratic topic #2: The online consent form. I'll ask you if you've read and signed it because it's pretty important. It outlines all the policies of my practice and what we are each agreeing to. You can read and sign it later if you haven't, but it's nice to get it done.
• Bureaucratic topic #3: Insurance, money, etc. At some point, we'll discuss how to make payments, how you would like receipts, what my cancellation policy is, and all that stuff.
• Bureaucratic topic #4: Scheduling future sessions. I prefer to schedule people out for at least four weeks, whether I'm seeing them every week or every two or three weeks, so that I don't accidentally double book myself. Many therapists do that, and it just makes life easier.

 

• General conversation topic #1: Why you're here. This is when I ask you, "Why are you looking for therapy now?" and you get to tell me what's up. I'm not expecting a perfect answer, just a general gist of what's been going on. I'd also like to understand what you hope to get out of therapy. This is just a starter conversation - I know there's way more to what's going on than you can fit into an introduction, but it's good start. You don't have to know exactly what to say, and you don't have to plan it out. I'll help with questions, too. 
• General conversation topic #2: Daily life. This is where I start asking questions about how all of this is affecting your daily life so I understand the impact your situation is having on you. 
• General conversation topic #3: How therapy could work for you. At this point, I'll let you know how I think our work together might proceed, and I'll ask a lot of questions, like, "Do you like to have homework or things to try? Or do you prefer to just think about things? Do you like to read? What have you tried in the past that's worked?" (I promise not to ask those all at the same time.) There are no right or wrong answers. And if you have questions, ask them! This is a way to get to know you and how your mind works so that we can do some good work together. 
• General conversation topic #4: A brief history of you.  Future sessions will involve a more in depth outline of your past, but for now, if there's time, I'll get the bare essentials down like who and where your family is and anything really important about them.

And that's it! A little chit chat, some questions from me, some questions from you, and you're done with your first session. It's not scary and it can feel really good to get it all out there. And pretty soon you'll be deep into the work, which is when the real fun begins.

But first, you have to start. 

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