“So, What Brings You In Today?”
If you’ve never had a therapy session before, it’s likely that you have some questions about what to expect, not to mention some possible nerves or excitement. This blog is for you!
Before your first session, you and your therapist may have already met during a consultation in order to get to know each other. This consultation serves as a great way to get a sense of what the therapeutic relationship may be like, as well as answer some basic questions about your connection- Does this person make me feel comfortable? Are they more casual or more formal? Do they have experience helping clients with the things I’m currently going through?
I feel that this first meeting is so important for both the client and the therapist to establish an idea of what working together will be like, before the financial and emotional commitment of having your first official session. This is why I happily offer free 30 minute consultations that take place via video chat!
Once you and your therapist have agreed to begin working together, you are usually sent a virtual invitation to join an online patient portal. Accepting this invitation gives you access to your scheduled appointment times, a messaging system, and any necessary intake paperwork.
Intake paperwork is documentation for new clients to fill out prior to their first therapy session. This paperwork typically includes informed consent forms, practice policies, and some assessments. Informed consent is a term given to mean that you are aware of the services/treatment you are receiving, and you voluntarily consent to them. Practice policies include important information pertaining to your therapist’s no-show/cancellation policy and billing information. I recommend reading these policies before your first session so you aren’t surprised in the future if your therapist references them. If your therapist did not already explain their practice policies in your consultation, it may be beneficial to ask them questions about their cancellation policy, what happens if your virtual session is interrupted, and the fee for service.
Some assessments may also be included in this intake paperwork, which give the therapist more insight into your current state. These assessments may ask questions about feeling depressed or anxious, substance use, or medical history. We can think of these as a self-report measure of progress, and use these intake assessments to compare to future self-assessments to see if your symptoms have improved. If you have a question about any of these assessments, you can always ask your therapist for further explanation. However you answer these assessments is confidential between you and your therapist.
Now it’s time for your first session! Since I offer virtual sessions, I will write this from the perspective of a telehealth meeting. Be sure to locate the link to join the session prior to the starting time to ensure no technology issues. To ensure that I am present for the session and not distracted, I like to spend a couple minutes before the session closing other tabs on my computer, clearing off my desk, closing my eyes, and taking some deep breaths. When you click the link to join the session, you are admitted into a virtual waiting room and from there your therapist can admit you into your private telehealth session.
For your first session, your therapist will likely check in with you about how you are feeling starting your therapy journey. This is a great time to practice checking in with yourself and being honest about whatever thoughts and feelings come up during this time! I promise no therapist is offended or judgmental if a client mentions they are nervous or not looking forward to beginning therapy. We understand that being new to therapy can feel scary, just like feeling new to a lot of things.
In your first session, the therapist will be gathering background information about you and your symptoms. For example, if you said you had trouble sleeping, the therapist might ask you how long that has been the case, or how many hours of sleep you are able to get, or if you have tried anything to help you sleep.
Your therapist might also ask background questions that you may feel don’t exactly relate to how you are feeling now, such as questions about your parents or siblings, your cultural or religious influence, or if you had any developmental delays. These questions aim to get a more well-rounded view of who you are and where you come from, and it is also useful to write notes of important people in your life so when you mention them in the future we know the role they play.
Some clients may enjoy this background information gathering process, as the therapist takes their time to get to know you. In reality, we are always taking the time to get to know you, whether it be your first session or your 50th. Other clients may find the background information to be a distraction from diving into what you want to discuss in therapy, which is also a valid way to feel. However, being too specific in the beginning of treatment can make it difficult for the therapist to get a full view of you, which is why the first few sessions of background information is the time for you to be the painter of your life’s picture.
Your therapist will also inform you of confidentiality in the first session. This is essentially letting you know that what you say in session is private, and does not get shared with others. This agreement of confidentiality is essential to the foundation of trust and vulnerability in the therapy space. Your therapist will also inform you of limits to confidentiality, which are instances where something said in session would need to be shared. These limits are if the therapist was given a court order from a judge that requested information, if any instance of child, dependent adult, or elder abuse was disclosed in session (past or present), or if the client reported a plan or intent to harm themselves or someone else. If the client wishes to have information shared by the therapist to someone else, such as the client’s doctor or previous therapist, the client can sign a release of information to grant the therapist that ability to share. Even then, though, the client will specify what information is okay for the therapist to disclose.
Since I am an associate clinical social worker, I would also specify in session that my title means that I am under the supervision of a fully licensed therapist. This means that information from our sessions might be brought up in supervision in order to get a new perspective or new treatment ideas. I like to think of this as an advantage for clients in the sense that you are getting more than one therapist’s opinion, worldview, and expertise.
Your therapist might also ask you about your goals for therapy. If you haven’t already come into session with goals in mind, that is perfectly okay. Some goals might be specific, such as I want to be able to complete a specific task or attend a specific event which I have previously avoided due to anxiety. Other goals may be a little more broad, such as I want to talk about my relationship with money, or I want to be better at holding boundaries. Goals in therapy also change and evolve, so know that you’re always free to adjust or add goals in later sessions.
If you have any questions about the therapy process not answered in this post or in your first session, feel free to ask your therapist! And if you scheduled your first therapy sessions and read this blog, take a second to recognize the work that you are putting in to better yourself. It’s not always easy, but it is always worth it!