- How to Prepare for Your First Therapy Session
- Ask for a Phone Consultation First
- Make a List of Topics to Cover Right Away
- Practical Questions You Might Ask at Your First Session
- Manage Your Expectations
- Why the First Therapy Session Can Sometimes Be Frustrating
- Know That It’s Okay to Switch Therapists
- 8 Tips for Anyone Starting Therapy for the First Time
- 4. Expect to feel uncomfortable at times
- 5. Don’t worry about bringing some big thing to discuss into each session
- 6. Speak up if you don’t agree with your therapist
- 7. If things aren’t working out, don’t ghost your therapist
- 8. Remember: Therapy should be bettering your life—even if it’s work
- What to Expect In Your First Therapy Session
- Dispelling Common Myths About Therapy
- You probably won’t be lying on a couch
- Therapy is helpful for many
- All therapies are not the same
- Your first visit
- What you might be asked
- Taking an active role
- Be open
- Ask questions
- Identify your goals
- Ending your first session
- What to Expect From Your First Therapy Appointment
- You might feel uncertain about going to therapy
- Doing some homework can pay off in your session
- You’ll have to wade through some paperwork
- Then, it’s time to start talking
- What you say is confidential
- You might run through a wide range of feelings, including sadness and comfort
- You’ll leave with an idea of what comes next
- And, an idea of whether you want to go back
How to Prepare for Your First Therapy Session
It’s natural for your thoughts and emotions to be jumbled before you begin therapy.
After all, one of the reasons for working with a therapist is to identify and clarify problematic internal experiences that are interfering in your life.
While you don’t have to articulate a detailed list of your concerns and goals, knowing the general reason you are seeking therapy will help you feel ready for your first conversation with your therapist.
A common question mental health professionals ask when they meet a client is what brought them to therapy, because the client’s purpose helps the therapist create a helpful plan.2 Make a list of your symptoms, including bothersome thoughts, emotions, behaviors, past experiences, and current situations and stressors.3
To determine and express your “why,” your reason for seeking therapy and what you want it, actively engage in reflection rather than just letting vague ideas roll around in your mind.
Your process might look this:
- Set aside some time, perhaps 10 or 15 minutes, to ponder your purpose for therapy.
- Choose a quiet, comfortable spot where you won’t be interrupted.
- Create a notebook dedicated exclusively to therapy.1 Select one that appeals to you and even choose a special pen. Use them now to record what you want therapy.
- Make the process positive and reduce stress by sipping a cup of tea or other favorite, healthy beverage. Play music or write in silence, whichever helps you think.
- Focus first on your end goal: How do you want to feel, think, and act after your work with a therapist? You might try brainstorming by free writing anything that comes to mind and later organizing your ideas.
- Then, write down a few notes about what is preventing you from feeling this way now.
Taking time to decide what is important to you will give both you and your therapist a solid starting point for you to get the most your therapy sessions. From there, you’ll build on your ideas as you work together to achieve your goals.
Ask for a Phone Consultation First
If you hate the phone and the thought of talking to a therapist you’ve never met in person causes anxiety, just jump ahead to the next section. Having a phone consultation before you begin therapy is an option, not a requirement. If it’s helpful to you, you have the right to do so. If it isn’t, you can confidently forgo this option and wait until your first session to ask questions.
It is acceptable to request a phone consultation with your therapist before officially beginning sessions.
In fact, therapists expect (but don’t require) it because they understand that choosing a therapist is a big decision and that anticipating your first session can be nerve-racking.
You might have many questions that your therapist can answer to alleviate anxiety before you begin in earnest.
Here are some helpful questions to ask during a phone consultation with a potential new therapist:4,5,3
- How do you approach helping people?
- Do you have experience working with people who have concerns mine?
- Do you make treatment plans? If you do, will I be involved in mine?
- What can I expect during our sessions?
- What will you expect of me? Will I have homework?
Your initial phone consultation may help you prepare for your first in-person session by removing some of the mystery from the vague and often-intimidating idea of therapy. There are other things you can do to prepare for your appointment to further put yourself at ease.
Make a List of Topics to Cover Right Away
The first visit with any therapist can feel a bit awkward. After all, you are meeting with a stranger to discuss things you might be uncomfortable talking about. Where do you even begin? Rest assured, a therapist is an educated and skilled helper who will gently put you at ease and guide the first session. Still, arriving prepared can reduce anxiety.
Writing a list ahead of time of what you want to discuss during the first session (and bringing it with you) can help.6 In the dedicated mental health notebook discussed above, create a list of topics you might want to discuss at your first session. Having it with you when you meet with your therapist can help keep you centered and focused.
Consider including topics such as:
- Challenges you are currently facing that you’d to explore in later sessions (mentioning topics upfront will help the therapist guide future sessions)
- Recent changes in yourself or life circumstances that prompted you to seek therapy
- Things you have already tried in order to feel better
- Observations from family or friends (have they expressed concern about certain behaviors or moods, for example?)3
- Information about your personal background (your family situation, significant events, etc.)7
- How long you’ve been experiencing your current difficulties (if you’re bothered by social anxiety, for instance, has this plagued you for years or is it new?)
It might feel intimidating at first to talk about some of these topics. As you prepare your list, consider what you want to say and jot down some notes to guide you during the session.
Keep in mind that honesty is paramount to successful therapy. In order for your therapist to help, they need to know what you’re experiencing. Therapists aren’t there to judge you. They chose their profession so they can help people improve mental health and wellbeing—not to make things worse.
Your therapist will ly emphasize confidentiality. All therapists are ethically bound to safeguard the information you share with them.
Other than a few rare circumstances, such as if they believe you may harm yourself or others, they can’t talk about you to anyone else without your permission.
During your very first meeting, your therapist will clearly explain confidentiality and its limits. If they don’t mention it, you can ask them about it.
Practical Questions You Might Ask at Your First Session
In some cases, you might have talked with your therapist or their office staff ahead of time to learn about the logistics of therapy. If you didn’t receive basic information about their policies, the first session is the time to ask questions.
Some logistical things you need to know:
- Billing information such as the cost of therapy, if they accept mental health insurance, and whether they offer a sliding scale or payment plans
- How many sessions you can expect to have
- How frequently you’ll meet with this therapist
- The length of each session
Understanding your therapist’s procedures will allow you to plan accordingly and integrate therapy into your life.
Whether it’s your first appointment or any other session, blocking out extra time before and after your session can relieve unnecessary stress and allow time for you to process the work you and your therapist accomplished during the session. You might want to ask your boss for a mental health day off to have an appropriate amount of time to prepare beforehand and process after your first session.
Often, anticipating a therapy session can cause stress and anxiety, and feeling rushed before a session can cause you to feel frazzled. Arriving early and practicing slow, deep breathing turns off your body’s stress response, decreasing the stress hormones cortisol and adrenaline and easing physical symptoms such as muscle tension, dizziness, or digestive discomfort.2
It can also give you time to review homework you might have been asked to complete between sessions, look back through your notebook to see if you have new questions, or simply enjoy a bit of relaxed downtime.
Adding some extra time to your schedule after the therapy session can allow you to reflect on what you and your therapist discussed. Devoting part of your notebook to post-session journaling can lead to deeper insights or new goals.
However you decide to use your time before and after each session, giving yourself even 10 extra minutes on both sides of the appointment might give your sense of wellbeing an extra boost.
Manage Your Expectations
Your first appointment will probably be a bit different from subsequent sessions.
The first meeting may involve housekeeping tasks such as:
- Taking care of insurance and billing information
- Completing initial paperwork (your address, contact information, emergency contacts, authorizations to obtain information from or provide information to others, if applicable)
- Explaining the process of therapy
- Discussing confidentiality
Each meeting will build on previous ones, but this first one is a blank slate. You may feel nervous and unsure of what to say (which is why having a prepared list of topics and knowing your reason for seeking therapy can be extremely helpful).
Your therapist doesn’t know much, if anything, about you yet; therefore, they will ly ask you many questions as they start to understand you and what you’re experiencing.
Depending on the therapist and their approach to therapy, you might be asked questions about your childhood, education, job, relationships, thoughts, feelings, or actions.
Your responses help your therapist understand you and know how best to help you.
An initial session is often more helpful to the therapist than the client. For this and other reasons, the session can be disappointing or frustrating if you don’t know what to expect.
Why the First Therapy Session Can Sometimes Be Frustrating
You’ve decided to seek therapy, selected the professional you want to work with, and you’re ready to dive in. In addition to feeling a bit anxious, you might also feel excited.
After all, you’re eager to feel better and improve your wellbeing.
This is a great attitude that will keep you motivated even when therapy might be difficult; however, it can also set you up for disappointment in your first session.
It’s important to have realistic expectations for the therapeutic process in general and the first session specifically. Therapy isn’t a quick-fix. Quite ly, you won’t discover solutions at your first session because mental health is complex. Just as it takes time for problems to develop and begin interfering in your life, it takes time to work through and unravel those challenges.
Perhaps the most important and most helpful aspects of therapy is the relationship between you and your therapist.8 This relationship, though, takes some time to develop. The two of you might begin to develop a strong rapport from the very first handshake, but the deep connection and trust won’t develop instantly.
Further, while you’ll begin to express yourself during the session, it won’t be until later sessions that the therapist knows you well enough to know what to ask and how to interpret your words and nonverbal communication, and you feel comfortable enough to go deeper in what you express.
Therefore, it will be unly that you emerge from session one feeling transformed. It is, however, realistic to expect that after your first meeting you will feel a sense of hope that, in time and with work, therapy will help your mental health and quality of life.
Know That It’s Okay to Switch Therapists
Because it does take time to develop a relationship with your therapist and begin to feel positive movement toward your goals, it’s advisable to be patient and try a few sessions with a therapist before deciding whether to continue working with them. According to the APA, “By the end of the first few sessions, you should have a new understanding of your problem, a game plan and a new sense of hope.”1
If you feel frustrated after three or four sessions, it’s okay to find a new therapist to work with.
Signs that this therapist isn’t for you include:
- You feel disconnected from the therapist
- You don’t notice any progress toward change
- Each session has ended with you feeling confused or discouraged
Mental health therapy is a gradual but steady process of developing insights, overcoming obstacles, setting and achieving goals, and enhancing wellbeing and the quality of your life.
The first session is just the beginning of what can be a rewarding journey.
With preparation and realistic expectations, you and your therapist can start to develop rapport, trust, and an important sense of hope for healing.
8 Tips for Anyone Starting Therapy for the First Time
“Sometimes people get frustrated because they’re starting at zero and want to be at 10, and that’s going to be a very long road,” clinical psychologist Merav Gur, Ph.D., tells SELF. These check-ins can help you stay motivated and develop short-term goals to work towards.
4. Expect to feel uncomfortable at times
Just as with your workouts, sometimes you’ll be really excited going to therapy and sometimes you’ll loathe it, Dr. Smith says. This can be particularly true if you’re trying to navigate virtual therapy at the moment.
“Change is hard. It will be uncomfortable at times, but it’s part of the process to get you to where you want to be,” Dr.
Smith says, adding that a skilled psychologist will monitor the intensity of the sessions so it’s not minute-after-minute or session-after-session of deep, hard work. Dr.
Gur specializes in treating anxiety and depression, and she says that at first clients may feel their symptoms are exacerbated as they work through the uncomfortable issues. But doing so ultimately helps them work toward where they want to be.
Of course, the work you do in therapy—just your workouts—should never be unbearable or debilitating, so if things are getting to be too much, speak up.
5. Don’t worry about bringing some big thing to discuss into each session
Sometimes the sessions when you think you have nothing to talk about lead to the biggest breakthroughs, says Dr. Smith. “It’s part of my job to make sure each session is productive and stays on track, so I always have things to ask a client,” she says. “That’s when we can talk about the really good stuff—the meat of the issue.”
This is especially true because we tend to avoid things that are hard to deal with and may not even consider bringing them up in therapy.
But with an open agenda, you and your therapist will have the opportunity to talk about a variety of things going on in your life, where you may discover that there’s something you really did want to talk about, after all.
(Here’s more advice for what to do when you have seemingly nothing to say in therapy.)
6. Speak up if you don’t agree with your therapist
Therapy should feel a safe, comfortable space where you can say anything.
And that includes if you don’t understand something, if your therapist pisses you off, if you disagree with something they said, or if you’re fearful of what they will say. “I appreciate it when patients bring these issues up,” Dr. Gur says.
“It’s important for me to understand their experiences so I can help them better.” Giving your therapist feedback is actually a really powerful part of therapy.
Not only does this help you practice if you struggle with conflict avoidance or asserting yourself, but it also allows your therapist to tailor treatment to what will work best for you.
For example, if you hate journaling and know you won’t do it, let them know that before you miss a homework assignment. “Putting all your cards on the table is the only way you’ll get real help,” Dr. Howes says.
“I had a client once say, ‘I’m angry at you for being late’—and then we both celebrated it because he was able to assert himself.”
7. If things aren’t working out, don’t ghost your therapist
Especially if you have been working together for some time, it’s worth talking about ending your relationship if you feel your therapist is no longer serving you. “It’s important to explore things rather than just leave treatment.
There can be a lot of good stuff, and if you don’t address that, you may find the same thing in the next therapist,” Dr. Smith explains.
Here’s some more advice on how to know when it’s time to break up with your therapist (and exactly how to do it).
8. Remember: Therapy should be bettering your life—even if it’s work
When I decided to try therapy this time, I sought out someone who specializes in treating people with my condition. Luckily I found someone in my price range whose approach I d during an initial phone call.
And even luckier, I’ve d working with her. I don’t just chit-chat when I come in, I’m not afraid to speak up if she says something I disagree with, and I make sure to leave with concrete action items to work on.
So far, I feel I’m getting further than I ever did in the past.
Remember that you are giving your time, money, and emotions to this process and this person. Those aren’t things to waste, so demand that you get what you need, and if you don’t, find someone who will give you that. Being an adult is hard, and therapy can help—don’t give up.
Additional reporting by Casey Gueren.
See more from our Guide to Caring for Your Mental Health here.
What to Expect In Your First Therapy Session
By Charlene Fuentes, PsyD
A client once told me during her first visit, “I’ve been putting off therapy for too long and finally felt the time was right. I knew I couldn’t face my problems alone anymore.” Perhaps you have also faced ambivalence about starting therapy in the past but have finally gathered the courage to seek help.
And so many others, you may also be dealing with new or worsening mental health challenges amid the coronavirus pandemic that are prompting you to try therapy. If questions such as, “What should I expect?” or, “How should I prepare for my first session?” are running through your mind, you’re not alone.
Whatever your reason for getting help, one of the hardest parts is getting started.
According to a national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), 47.
6 million adults in the United States lived with mental illness in 2018, or about one in five adults. However, only 43 percent of these adults received treatment in 2018. Meanwhile, one in six U.S.
children had a mental health disorder in 2016, but only 50.6 percent received treatment.
For the many people who have yet to seek the mental health care they need, lingering questions about what to expect in therapy can create added anxiety. What follows are some general guidelines to help you prepare for your first session with a therapist, and hopefully to ease some of that uncertainty.
Dispelling Common Myths About Therapy
There are many persistent myths about therapy that can influence a person’s decision to avoid it. Knowing how to separate fact from fiction when it comes to therapy can help you make those first crucial steps toward getting care.
You probably won’t be lying on a couch
The idea of being expected to lie on a couch and open up about your childhood is one I often hear from new clients.
Therapy is intended to be a supportive environment that may involve learning a specific set of skills to tackle life’s challenges in healthy ways.
Pre-pandemic, most therapy sessions were conducted face-to-face, but video therapy has quickly taken its place as people across the U.S. stay at home in accordance with shelter-in-place orders.
Teletherapy makes it easier and more convenient for people to access help from home. (You can learn more about the benefits of video therapy here.
) Make sure you have a private space in your home and are able to set aside an hour of time weekly or bi-weekly to connect with your therapist via video. If you share your home with others, ask them to wear headphones, move to another room, or take a walk during your session.
Set up a cushion or chair in a closet or bathroom if you must–but don’t let quarantine stop you from seeking needed care during this time.
Therapy is helpful for many
There’s a common misperception that therapy is for “crazy people,” or the severely mentally ill. Rest assured that this is far from the truth. In fact, putting off therapy can cause smaller, more manageable issues to fester and worsen over time. The longer you wait, the harder it may be to tackle your issues.
All therapies are not the same
Another widespread myth is that all therapies are the same. In reality, there are a variety of evidence-based therapies (EBTs), or those that have been tested by researchers and proven effective in reducing symptoms of stress, anxiety or depression.
These therapies are typically short-term and goal-directed, and emphasize specific practices or skills to work on between sessions. As I often tell my clients, “The real work towards change happens outside of our sessions.
” In other words, your commitment to practicing these skills in your daily life is essential.
Your first visit
So you’ve made it to your first appointment and you’re sitting patiently in the virtual waiting room to meet your therapist for the first time. Maybe you’re trying your best to quell your anxiety but find yourself overcome with discomfort as your appointment time nears. To ease your mind, here’s an overview of what you can expect.
What you might be asked
This process, also known as the initial assessment, involves asking questions about how you’ve been feeling lately, when you think any problems may have started, and what, if any, steps you’ve taken in order to feel better. There may be some additional forms to complete, too. Your first session may look different from subsequent visits that will ly focus more on learning new coping strategies and skills. Your therapist may ask questions such as:
- What brings you to therapy?
- How long have you experienced these problems?
- Have you been in therapy before?
- What are ways that you cope with distress?
- Who is part of your support network?
- Were you prompted to seek care mostly in response to COVID-19 concerns?
You may experience a range of emotions
Sharing private details with someone you are meeting for the first time is difficult for most people. You may be asked to share unpleasant aspects of your life, perhaps for the first time.
Keep in mind that you never have to share more than you’re comfortable sharing, though being open and honest with your therapist is key to feeling better. Sharing difficult thoughts, feelings or experiences from your past may lead to you to experience a range of emotions, from sadness and anger to excitement and hope.
While sharing can be tough, many first-time clients express relief in having a safe and supportive environment to talk openly about their problems.
Taking an active role
Organize your thoughts in advance and consider how you want to describe what brought you to therapy. You might find it helpful to dedicate a few minutes each day to reflect and document important points to highlight. You can also maximize your appointment time by completing initial paperwork beforehand, such as forms or questionnaires that were sent to you before your appointment.
Therapists aren’t mind readers, so it’s important to be open about your problems and share what you’re feeling in session. Your therapist can be more effective at helping when you’re forthcoming with answers to their questions.
At the same time, it’s important to know your limits. As mentioned, you don’t have to discuss anything you don’t feel comfortable sharing during your first visit.
It’s normal to build a sense of trust before disclosing more sensitive topics or issues.
There are no right or wrong questions for your therapist. Remember, getting to know each other is a mutual experience. You might ask about their training, what type of therapy will be used and how it works, or how long therapy is expected to last. Or maybe you’ve researched your therapist prior to your first appointment.
Don’t be afraid to ask clarifying questions or for information you didn’t quite understand. Not every therapist is a good fit, and the more you know about your therapist and their style, the more comfortable you’ll feel about therapy overall. Gather information to determine if this working relationship feels a good match for you.
Some questions you might ask include:
- How long have you been practicing?
- What therapy approach(es) do you use? Can you describe them to me?
- How much experience do you have working with people who have similar issues?
- How long does treatment typically last?
- Is the teletherapy platform that you use safe and secure?
- How should I prepare for my video session and what should I do if I have trouble connecting to the meeting?
- Is video therapy as effective as in-person therapy?
Identify your goals
It’s helpful to establish goals for therapy in order for your therapist to create an effective treatment plan. You can collaborate with your therapist to identify attainable goals to work toward together.
These might include learning healthy skills to cope with parenting stress, managing symptoms of bipolar illness, improving your sleep quality, or overcoming your fear of public speaking. Whatever your aims, it’s best to come to your first session with realistic expectations.
Your therapist will also help you set expectations and develop a plan toward achieving your goals.
Ending your first session
You’re nearing the end of your first session. What happens next?
If continuing to work together makes sense, your therapist might summarize your first meeting and suggest some possible goals for therapy. You may also learn more about what to expect in follow-up sessions.
In some cases, your therapist will teach you a skill or give you an assignment to complete before your next appointment, such as increasing healthy habits taking a walk or engaging in a mindfulness exercise.
Before wrapping up, you and your therapist will ly agree on a second appointment time.
If at the end of your first session, you’re left with unanswered questions, or if your experience is not quite what you imagined, be open about how you feel with your therapist and ask questions. This process is about your mental health and personal growth, and you want to walk away feeling that you’re moving in a positive direction.
If you need support with stress, anxiety, depression, or other mental health issues, Lyra can connect you to a behavioral health solution that is right for your needs. You can get started today if Lyra is offered by your employer. Sign up now.
And check in frequently here or follow us on , LinkedIn, and for more insights into optimal well-being.
DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Charlene Fuentes, PsyD is the Associate Director of Clinical Programs at Lyra Clinical Associates. Her clinical specialties include Cognitive-Behavioral Therapy (CBT), Health Psychology, and Behavioral Medicine. She has extensive experience in chronic illness management and has developed inpatient and outpatient psychosocial programs for hospitals in the San Francisco Bay Area.
What to Expect From Your First Therapy Appointment
If you've decided it's time to see a therapist, then you’ve already done the hardest part: recognized you could use support with your mental health or an emotional issue, found an appropriate doctor or counselor, and booked a visit. But what actually goes on once you arrive at the office—and is there anything you can do beforehand to make things go smoothly? This guide will help you understand the process for beginning therapy if you're a first-timer.
You might feel uncertain about going to therapy
For all the progress that’s been made, the stigma against seeking mental health treatment is still real—and that’s despite the fact that about half of us will have to deal with a serious psychological issue at some point, says Marla Deibler, a licensed clinical psychologist and executive director of The Center for Emotional Health of Greater Philadelphia.
“We all have our own coping resources and repertoire and sometimes the stressors in our lives exceed our abilities to cope,” she says. “There’s no judgment in that.” You might still second-guess your choice to go, even as you enter the waiting room, but that’s no reason not to give it a try to see if it benefits you.
Doing some homework can pay off in your session
There’s probably a reason you made the appointment (or that someone else encouraged you to do so).
“ If that’s not clear for you, it's good to sit down, perhaps journal a little bit,” says Adam Gonzalez, a licensed clinical psychologist and founding director of the Stony Brook University Mind-Body Clinical Research Center in New York.
“Ask yourself: What’s going on right now in my life, and what would I my life to look ? What are some goals that I might have?” That can help you narrow down what you hope to get the experience.
Also consider whether or not you’re open to taking medications. If you’re seeing a psychiatrist (an M.D. or D.O. who specializes in mental health) or a nurse practitioner, that’s an option; psychologists, counselors, and social workers can’t prescribe, but may refer you if that’s a recommended part of your treatment.
A little online research into the types of concerns you’re having and what works to address them can also be useful.
Look at the websites of advocacy organizations the Anxiety and Depression Association of America or the International OCD Foundation, taking special notice of the evidence-based treatments, Deibler says. That said, don’t feel stressed out by the need to study up.
The most important thing to arrive with is an open mind and a willingness to discuss your challenges and goals, says Atlanta-area psychiatrist Dion Metzger.
You’ll have to wade through some paperwork
Your therapist or the office staff will ly handle issues the copayment or visit fee up front. If you’re using insurance, you might want to inquire beforehand as to what your benefits cover.
Sometimes, the number of sessions is limited—if you’re worried about this, bring it up with your therapist.
Together, you can often request an exemption or explore other options that supplement therapy, such as group sessions or stress management and relaxation programs, Gonzalez says.
You’ll also have to sign some standard documents saying you’re consenting to treatment and specifying who your records can be shared with, and probably fill out questionnaires about your symptoms and medical history.
If you’re taking medications—even for non-psychiatric reasons—bring them along, or come with details about the drugs and dosages.
This gives your therapist a clear picture of your overall health (after all, some physical conditions or treatments can have psychological side effects).
Then, it’s time to start talking
Once you’re in the office, you may or may not see the stereotypical couch and clipboard—Metzger has both, though she notes you don’t have to recline unless you want to.
Her goal is just to make patients feel at home. (If the clipboard makes them nervous, she’ll try to minimize her use of it.
) Once you’re nice and comfy, your therapist will guide you through a conversation about who you are and why you’re seeking therapy.
“I always start off saying: ‘This is just about me getting to know you. These aren't going be intense, burning questions,’” Metzger says. “People come in a very guarded, nervous about what this is going to be . Once I say that, I can literally see them breathe a sigh of relief. They’re , ‘OK, I can talk; I can have a conversation.’”
She also reassures patients they don’t have to discuss anything they’re uncomfortable sharing. Therapy tends to work best when you’re open and honest.
But even when you’re talking with a mental health professional, it’s normal to want to build up some trust before you spill all. “We want you to be comfortable and it can be a process,” Metzger says.
“I have patients who don't disclose things to me until six months down the line.”
As you talk, you’re getting to know your therapist, too. You can ask questions about their training, experience with the types of issues you’re facing, and typical approaches.
Some focus more on skills—coping strategies you can use to manage emotions—while others are more insight-oriented, helping you search for and understand the root causes of your negative feelings. There’s not necessarily a right or wrong approach, but at this visit, you can start to get a feel for what might resonate with you.
“Not every therapist is a good fit for everyone, so try to get a sense of what it may feel being in the room with that therapist,” Gonzalez says.
What you say is confidential
Anything you do decide to disclose remains strictly between you and your therapist, with a few notable exceptions, Gonzalez says. If your therapist fears you’ll hurt yourself or others, he or she may act to intervene.
They’re legally required to report domestic violence and abuse or neglect that involves children, the elderly, or people with disabilities. And, if they receive a court order to release your files, they’ll have to do so.
You might run through a wide range of feelings, including sadness and comfort
Even if you don’t get too deep, you might find merely opening the box on feelings and topics you haven’t discussed openly before leads to powerful responses.
“Sometimes people are surprised by how emotionally evocative it can be,” Deibler says. Often, when you’re struggling, you spend more effort than you realizing holding things together; it doesn’t take much to pull them loose.
“ I usually tell them, I’m a psychologist. If people don’t cry in my office, I’m not doing a good job.”
Though some of this can be uncomfortable, Metzger's first-time patients primarily report a sense of relief. “They feel they've unloaded it, and really even before we even started working on our therapeutic techniques, there's something very beneficial to just be able to talk about what you've been through,” she says.
You’ll leave with an idea of what comes next
Though you might already feel better, don’t expect a quick fix to all your problems: “There aren’t many one-session cures,” Gonzalez says. Nor does therapy work an antibiotic, where you swallow a pill and see results. Your therapist will provide observations and guidance, but you’ll have to put in effort to change your thoughts and behavior, Metzger says.
At the end of your first visit, your therapist will ly review what you covered, offer some thoughts, and propose a plan for how you’ll work together.
This might or might not involve a diagnosis—sometimes that takes a few visits—but you should at least have an idea of what your therapist suggests you work on and some of the logistics of how you’ll do it.
That usually includes what techniques you’ll try, how many sessions you might need, and what you’ll need to do on your own between them.
And, an idea of whether you want to go back
Some therapists just aren’t that great, and even good ones aren’t right for every patient. Sometimes, you can tell right off the bat the two of you don’t click. If you seem to be labeled with a diagnosis too quickly—within just a few minutes—or if you feel judged, that’s a red flag things probably won’t work out, Metzger says.
Otherwise, it’s a good idea to give the relationship at least a two- or three-visit trial. If you’re unsure, you can actually bring up your discomfort with the way things are going to your therapist.
“Tell me what doesn't feel comfortable to you and maybe we can figure out why that is—that might be actually something to work on,” Deibler says. “You know, maybe you have difficulty sharing private stuff because it feels really shameful.
It's not necessarily reflective of that therapist, but of some of the things that are hard for you.”
After a while, if things really aren’t progressing, you might get more changing therapists or treatment approaches. Good therapists will understand this if you tell them or just don’t schedule another appointment, Deibler says.
If your first attempt doesn’t pan out but you still think you could use help, don’t give up. “A bad experience, unfortunately, can really sour somebody's complete vision of what therapy is,” Metzger says. Her advice? Do some research on therapists, armed with your newfound knowledge about what doesn’t work for you, and try again. “Therapy has the potential to be life-changing.”
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