What happens in your first therapy session?
I’ve noticed lots of first-time therapy clients often have no idea what to expect at their first appointment. Why would they? It’s a pretty nerve-wracking experience to meet with a therapist for the first time, so I thought I’d explain in a few dot points what will usually happen in a first session with a new client - at least, a first session with me!
Make an appointment: Most GP referrals I get are at least a few months old. That’s because it can be really hard getting in the door - procrastination is real, especially with regards to coming to therapy! Once you book in, pat yourself on the back - that’s a good step forward.
Paperwork: As with any health professional there’s a bit of paperwork to fill out. Some of this is getting your contact details, some explains fees and what happens if you cancel an appointment last minute. But most psychologists will also run through the issue of confidentiality with you. Yes, everything you tell us is just between us. However, there are exceptions to this - for example, if someone is at risk of harm, we may need to get some more help! I’ll explain this to you.
Assessment: This is the main bit for any first session. I ask lots of questions. Lots. About the problem that’s brought you in; about how you spend your days; and about where you come from - your childhood, family, relationships, and experiences. There are also some things I have to ask about to make sure that we manage them safely - things like self-harm or substance abuse.
Some people like to bring in a mental list or notes on paper/their phone to make sure they get out what they want to say. That works well, too. But no pressure - I have no problem bringing the questions for you! As long as you come in willing to talk, we’ll get somewhere.
Set goals: I’ll ask if you have a couple of things you most want to change through therapy. No worries if you’re not sure - we can figure them out, and often this will change and shift over time.
Initial formulation: After talking through what’s been going on for you, we’ll try to recap what we think might be key factors contributing to the issue you want help with. When I say “we,” I mean you and I together - you are the expert on you, and I’ve only just met you! But I’ll try to help you make sense of what’s led to this point.
Of course, we won’t get through your whole life story in one appointment. This is just the starting point! But for many people, leaving your first session with a bit more clarity on your own narrative can help you begin to feel a bit more hopeful about things.
Treatment plan: At the end, I’ll usually give an indication of the sorts of the things that I believe will be helpful for you to work on in therapy. This may be strategies or skills to develop, or it may be patterns in your life that we need to unpack a bit further to understand where they came from (before we can start to change them).
For some issues there are quite specific therapies we know to be most effective (evidence-based treatments); this includes approaches for things like eating disorders. I might briefly describe these to you if applicable, but usually we need another session to really have time to explain the why, what, and how of such treatments.
Really important to know here: you don’t have to engage with any therapy if you don’t want to. This could be for any reason, including just not feeling ready right now. If you feel uncertain about anything, ask. Anxiety when talking about therapy and goals is pretty normal - it shows you understand it will be a process that requires vulnerability! But if you hear what will be required and feel like you don’t want to do it, talk to your therapist more.
Go home and look after yourself: Sometimes it feels really good to knock the first session over. Sometimes, it’s draining. Sometimes it’s distressing, as you might be speaking about things you’ve long avoided. However you feel - acknowledge it, and look after yourself by chilling out, going for a walk, chatting with your partner, or being alone. Whatever you need, do it.
Other therapists may be slightly different in their approach, but I think overall, this is probably what it looks like for most. No doubt you’ll still feel a bit nervous heading to your first appointment, but hopefully this helped demystify things a little for you.