What to expect first day of therapy

You’ve contacted a therapist and your first appointment is on the calendar. You’ve already pressed through the knot in your stomach by finally making that call after days, weeks- or maybe months - wondering if a professional might be able to help you make more progress than you’ve been able to make on your own. But now the date is approaching and you are wondering how it will be when you actually sit down with this professional to begin tackling your issues.

Over the years, I’ve learned that helping clients understand what is going to happen during their first appointment (often called the “intake session”) can be greatly helpful in putting them at ease and starting our relationship off on a warm and welcoming note. Similar to anticipating a medical procedure, just getting a mental picture of what’s to come can really increase confidence and bring the anxiety monster down to size. Think about it- if you were undergoing a blood draw for the first time and you had no idea what was going to happen, how nervous would you be? Your mind would make up all kinds of stories about what was coming to fill in the blanks. Although therapy is different from having a medical procedure done (in lots of important ways), there is no reason for the first session to be so mysterious. It is anxiety provoking enough to think about facing your struggles and starting to openly talk about them with another human being. So let’s identify some common elements of a first counseling session, talk about ways of engaging most effectively at your first therapy session and identify a few ways to calm yourself so that your session can be as open, clear and enjoyable (yes, therapy can be enjoyable!) as possible.

What happens at a first counseling appointment

Obviously I can’t speak for every therapist in the world, but I know lots of them and there are some common elements to first therapy sessions. I will tell you what happens in my office when someone first comes in.

• I usually start an initial session off by greeting a new client, asking about their day, just general nice person small talk. Because it’s important to feel like you’re easing your way in to a conversation with a stranger about your “big things”. So I will make sure a new client has a comfortable seat, has found my office without too much stress, has a place to put their things and is able to settle in.

• We will start from what I already know. My intake paperwork covers the major basic questions (demographics, history and what’s bringing you in, generally speaking). The reason for that is that I’d rather use the time we have to fill in details rather than to share basics. I will have looked at this information by the time you come in and will be able to ask more details about the things you have written there. I will also ask you to elaborate on topics we discussed during our phone consultation (I always talk to potential clients by phone before scheduling a first appointment to make sure we might be a good fit). Some therapists have you fill paperwork out at your first session, but I prefer to have this all finished up front so we can delve into the important task of building our relationship.

• I will ask about additional things that may or may not pertain to you. The reason for this is that I consider our first session an “evaluation”, meaning we get a 360 degree view of your life and your goals. If you haven’t already mentioned issues like physical health, substance use, work history/satisfaction with work or significant relationships in your life, I will want to know a little bit about those areas. Sometimes folks come in for therapy thinking that a certain area of their lives is “irrelevant” to the problem at hand and we discover after some ongoing conversation that that area really is connected with their struggles.

• We will talk about a plan moving forward. This discussion usually involves setting a few general goals for our work together and talking about how frequently we will meet.

• I will ask you if you have any questions for me. Sometimes clients ask me “how do you propose that we approach this problem?”, or “how long do you think I will have to come see you?”. I welcome any questions that are on your mind and we will discuss them.

• We will discuss our next appointment time and you’ll be on your way.

Tips for getting the most out of a first therapy session

• It is so important that you find the right fit in a therapist, and one size does not fit all. You should feel a warmth, a welcoming attitude and an earnest desire to see things from your perspective and help you acheive your goals. This is really a sense of “vibe” rather than anything that might be easy to identify. However, I have found that the best way for clients to go about assessing this with a therapist is to actually try to forget about this question during the bulk of the session. Just focus on being yourself and saying what you need to say. It might take three sessions for you to decide whether you feel comfortable, or it might take one. As things are wrapping up at the end of your session, the therapist might ask you how you feel about working together (as I always do). Even if they don’t, this is a good time to discuss your feelings about the potential relationship. If you aren’t sure about your comfort level yet, this is also ok to express! Personally, I always appreciate hearing about how clients are feeling in session since feelings are the reason we are here in the first place. If your answer is “I’m not sure how I feel about working with you. I could see it going well but I need some more time to figure it out”, that’s a valid answer too.

• At the same time, recognize that you WILL feel uncomfortable. People enter therapy because there is a problem. Usually facing problems isn’t what we choose to do with our leisure time and there is a reason for that- avoidance is easier. You have sought out counseling because you are ready to stop avoiding your problems, at least to some degree, but you might feel anxiety, guilt, sadness, embarrassment, etc creeping in when you actually start to do this. Do not be alarmed by this experience, and again- talk about it! I love it when clients share with me, “This is hard to talk about. I’m not sure I want to talk about this”, and we can process that feeling too.

• If there is anything you do not want to discuss up front, it is always within your power to say so, or to indicate that the topic is an area of concern but that you would like to provide more details later. I believe it is an important self-care strategy for each of us to keep information to ourselves until someone has earned the right to know about it, and it’s ok if you think I need to earn that right for a few meetings before you share. But if you are wondering if something needs to be out in the open in order for me to help you, I encourage you to lean into that feeling and take a risk in sharing. Often, clients have held something back for several sessions (sometimes even months!), will finally share that “deep dark secret” and then tell me that they feel SO much better having it out in the open. Our work together often takes a powerful and effective turn after such a disclosure. Keep in mind that confidentiality is a foundational feature of therapy. It is quite challenging for me to really get inside your experience without all the information. So if you feel like being brave, go ahead and share what you want me to know on day one.

• Do some self-reflection in advance. There are no “right” or “wrong” answers in therapy. It is about you, your perspective, your challenges, your values and your goals. Here are a few questions to think over as you prepare to enter counseling:

  • What are your biggest, boldest hopes and dreams? What is getting in your way?

  • Has anything changed in the past several months in your life that has made your problem worse or brought it to your attention more than in the past?

  • What has changed in your behavior/thoughts/feelings that makes you know this problem exists?

  • Why now? If your problem has been in existence for a while, what was it that motivated you to seek help at this moment in your life?

  • If you were to fast forward to 6-12 months from now and in that future you could say, “Therapy is really helping me and I’m glad I’ve been going”, what would look different in your life? How would you know I had been helpful to you?

Ways to calm your anxiety about a first therapy session

• Remember that therapy is 100% confidential. This means that nothing you share would ever be shared with another individual unless you were to talk about harm to yourself, harm to others or any kid of child or elder abuse. Even if you talked about those things we would have a conversation- if at all possible- before discussing next steps before I disclosed that information. Even if you live in a small town and you see your boss or your next door neighbor in the waiting room on your way out (thus discovering that they are also seeing your therapist), you can rest assured that the law as well as our code of ethics has you covered. Unless I have your express written permission for specific information to be shared with a specific person, nothing you say is getting beyond our conversation- ever.

• Remember that your therapist is human. Therapists have a lot of professional training and some helpful techniques and theory, but the most important “tool” that we have is that we are also human beings. We have lived through our own demons, our own losses and challenges and our own share of difficult relationships. While our personal experiences are not the focus of your therapy time, you should know that we are working hard to understand where you are coming from and to empathize with you. When I meet with a client, I am drawing on a deep well of common human struggle to support and understand their perspective.

• Remember that therapy is a process that will unfold over time. Probably not much will change after your first session. You are going to walk out having started getting your therapist up to speed on the complex issues you are facing, but it will be something that you continue to revisit and unpack at each session. If you can have patience with the process, and with yourself in the growth, you will see results; but they will happen more like seeds growing in a garden than like a home improvement project that is finished in one Saturday afternoon. If you forget to talk about something, there will be another session. This works both ways- sometimes I have a thought about a client during the week and I am reassured to remember that I can bring it up again the next time I see them. Please do not feel pressured by anything about your first session.

I hope you walk away from reading this post with a sense of hopefulness about your first therapy session. That you are empowered by knowing what to expect and how you can prepare and that you are put at ease by having some tips for getting ready to meet with your new therapist. So many clients have told me that after their first session, they feel like a weight has been lifted. Just knowing that they are finally on a path of having professional support makes them feel a little bit better right away. I hope you find the right therapist for you and that you feel this way, too.

For more informative posts about the counseling process, check out my other posts "What is Therapy and How Can It Help Me?"- Part One and Part Two.