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Fundamentals of Therapy #3: The First Session

What to expect in the first therapy session.

We've covered who goes to therapy and how to find a therapist — so welcome to your initial appointment. I hope to demystify what can be an anxiety-provoking experience and help get your treatment off to a good start.

I'll assume you've done your research on the types of therapists and therapies available, you've made some initial contact with the therapist to get a feel for his/her style (possibly even "test driving" a few with questions over the phone or in person). You've chosen your top pick and are ready to get started.

This first session is important for setting the tone of your work together — the more involved and collaborative you are, the sooner you'll reap the benefits.

Due to some necessary formalities and introductions, the first session doesn't look like those that follow. Here's what to expect, and how to make the most of the time:

Logistics: If you haven't been there, allow for enough travel time to find parking and locate the office. Therapy offices don't often stand out like Starbucks, they usually have a low profile. The waiting rooms tend to be small and comfortable with a few chairs and magazines. There may be music, a fountain or a white-noise machine to mask voices from the office, protecting the confidentiality of clients inside. Sometimes offices have a receptionist, others might have a "call light" switch — flip this to let the therapist know you're here.

While you wait, want to guess how long your therapist has been in private practice? Take a look around the waiting room — we don't redecorate very often. A Miami Vice theme? Probably a mid-'80s graduate. Wicker? '70s. Pottery Barn could be a recent grad or someone who actually does redecorate.

Forms: You might want to show up 10 minutes early to read through and sign any paperwork. These typically include consent forms, a notice about the confidentiality of treatment, any policies the therapist has about cancellation and billing information. You can request a copy of these forms for your records.

Introduction: You're sitting in the waiting room, your heart is pounding with anxiety and anticipation, and the door creaks open. In comes your therapist, looking vaguely similar to his Find a Therapist photo. A handshake is typically offered, along with the standard, "Did you find the office okay?" We all ask this.

Business: Your therapist may want to go over the consent form with you and discuss payment. This is a good time to set a precedent for future sessions. Pay and take care of other business (session times, cancellations, insurance, etc.) at the beginning of the session. This helps prevent the awkward we-just-had-a-powerful-moment-and-now-I-need-to-write-a-check-while-crying scenario in the final minute of the session.

Your Story: With business aside, the therapist will ask something like: "So, what brings you today?" Here's where you give a thumbnail sketch of your story. Don't plan to give a full autobiography, just a rough draft. You'll have plenty of time to fill in the gaps. You can go about this however you'd like: starting with where you were born and moving forward, or starting with your current issue and moving back.

Either way, your therapist will help by asking questions that help her understand who you are and what problems you're facing. Here's where you'll really get a feel for therapy — how it feels to talk about yourself, how well she pays attention and how comfortable the conversation feels.

Feedback: In the last few minutes of the session, the therapist may want to summarize what you discussed and give some feedback. According to his experience and therapeutic orientation, he may want to let you know how he conceptualizes your story and how the two of you might go about addressing the issues. He might ask if you have any particular goals you'd like to achieve through therapy. This is your time to begin collaborating on a plan.

Time's Up: You don't need to watch the clock, your therapist will let you know when the session is over. Hopefully, by this point you've worked through any first-session anxiety, you've got an idea of how the process works, you've been able to tell some of your story and you're beginning to formulate a plan of action with your therapist. You can cover a lot of ground in 50 minutes.

Reflect: I suggest you take some time after the session to think about what was said and how you felt. Were there any red flags? Did you feel comfortable being open and honest? Were there questions you forgot to ask, or info you weren't able to share? What do you want to talk about next time?

If your first session went well, great. If not, you can either choose another therapist or discuss your concerns with your current one. You're not stuck in this therapy, not now, not ever. If you decide therapy isn't right for you at this time, or if you get a bad feeling about this therapy, you can always call and cancel further sessions. Hopefully, there's a good match from the beginning, and you're quickly getting the help you need.

Check Psychology Today’s directory of therapists for a professional near you.

More from Ryan Howes PhD, ABPP
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