Beginning therapy can be a daunting experience. Whether you’re starting therapy for the first time or you’re returning to therapy after a long break, there can be a lot of questions or concerns that you have about the first steps of the process.
To help answer some of these questions, I reached out to four clinicians at Telebehavioral Health.US (TBH): Jade, Beth, Maggie, and Jessica. I asked them a series of questions about how they approach the first session with a client, and everyone brought a different perspective to the table. Let’s take a look at what TBH therapists had to say:
Question 1: What are your expectations for a first session?
Jade: “My hope and goal in first sessions is to relieve some of the anxiety of uncertainty about what to expect and what it’s gonna be like. I do my best to get a sense of what someone’s expectations or previous experiences have been like in therapy to help inform what I want to review or what expectations I want to establish. If someone says ‘I’ve never been to therapy before; I don't really want to but I don’t know what else to do; No one in my family talks about [therapy], I would be ostracized if I told them’ I would know we’re starting from a place of ‘this is really scary [and] uncomfortable; I don’t like this but I don’t know what else to do’...The conversation will start from a different place [such as], why people go to therapy, why therapy can be helpful...”
“[During] a first appointment, just like the first time you go to a primary care doctor, there's some forms and some information we go over together. We want to make sure that you understand confidentiality and your rights as a client or patient that your information will be kept private. There’s some logistics about going over payment, scheduling, that kind of stuff, and I also like to share a little bit about myself and help people know what my... approach to the therapeutic process is.”
Beth: “Our first session together is pretty action-packed. When I meet with a client for the first time I ensure all of their intake paperwork has been completed and discuss confidentiality. I go over their intake document and ask more questions to get to know them, their history, and about their past. We discuss potential diagnosis and what goals they would like to accomplish in our future sessions.”
Jessica: “I try to keep things pretty grounded, pretty low-key, try to make [the client] feel comfortable, and let them know it’s a safe environment that they’re able to express themselves in. I feel like a lot of people I’ve encountered have been bracing for me to be like ‘the couch therapist’ with a notepad, and my initial session tries to teach them that I’m a person too and I’ll share about myself, whatever they’re interested in. Basically, [I’m] orienting them to treatment...and building rapport with the client.”
Question 2: What would you, as a therapist, expect from new clients during the first session?
Beth: “I expect a client to feel a little nervous coming into the session but hope that by the end of the session I am able to answer any questions that would help them to feel comfortable and hopeful for their journey. They should expect me to ask them a lot of questions so that I can get to know them and I would welcome any questions they have for me.”
Maggie: “We go over the intake forms, as far as getting some history on [the client], some background... What they’re expecting to get out of therapy, why they wanted to come to therapy, and just building that rapport and that relationship and trust [with the client]... You make it more like a conversation, you don’t want to come across too harsh or interrogative....”
Jessica: “I would love [the client] to expect something good and something helpful.... What they might expect could be anything, of course. A lot of them have been in treatment before, and it feels like a lot of checked boxes, which has kind of turned them off from following through on mental healthcare. What I want them to walk away with is a general understanding of what they want to work on in therapy and what that might look like moving forward. Say, their main thing is to reduce symptoms of anxiety, then what would that look like? We’d break it down really generally and then we can formulate a treatment plan, which is something that I guess is not super common in private practice work. I’ve had clients say ‘nope, I’ve never gone over my treatment plan with my therapist’ so that’s an important part.”
Question 3: What questions would you want your clients to ask you in a first session?
Jade: “A good question for someone new to therapy to ask could be: ‘At what point am I going to feel better?’ or ‘How long does it take to feel comfortable talking?’ or ‘How long do you typically work with clients?’ I’m used to preemptively explaining this, that similar to physical therapy, at first it might feel more pain and more uncomfortable before it feels relieving and better.... you might feel more uncomfortable and more distress at the beginning because you’re talking about... addressing and ...thinking about things that are difficult to talk about.”
Maggie: “I want them to feel comfortable enough to ask me questions, to build that relationship. They can ask any kind of questions to [get to know] me, my education, how I can help [them].”
Jessica: “Anything they want! I have a cat that will join me for sessions with permission of course. I want them to ask me anything they want to know. I’m a person, I’ve lived a life, I have my own personal life. I’ve had parents who have questioned my ability to work with their children because I don’t have kids of my own... What my favorite color is, if I like animals, if I have trouble with anything with my mental health. I’ve had quite the range of questions, but as far as what they can ask, it’s an open invite. I do give a little blurb about myself to kind of help them to get to know me. I’ll talk about my animals because most people really like those guys, and also my hobbies, that I love to cook and bake... I like to do creative things. And [the client] will have their things and they’ll go ‘oh, yeah, me too! I like this or that!’ and it just helps things along.”
Question 4: How does your typical session differ from your first session with a client?
Jade: “A main difference in that first one or two sessions is that it might feel a little more like an interview in the sense that the therapist is trying to gather relevant data. I always explain that there’s no requirement to share anything you’re not comfortable sharing, but if you feel comfortable, I’m asking because I believe that this information will help me understand you better so that I can treat you better. So the first session is kind of a therapist interview, it’s more questions and information gathering. In other sessions there’s a lot less talking on the therapist’s end, more listening and it’s usually more directed by the client and what they want or need to talk about...
Beth: “After our initial session the client and I will continue to have conversations about their difficulties and work toward the goals they have identified. I try to have topics and activities prepared but prefer to address any current concerns and recent happenings. I try to be structured but flexible.”
Maggie: “[After the initial session] there’s not as many forms... I would say that it differs [from the first session] because you’re going over how [the client] is doing since the last session, highs and lows, any changes since we’ve last talked, especially if there’s any other appointments with other specialists.”
Question 5: Is there anything else you would like to mention about first sessions?
Jade: “I really enjoy utilizing the medical model as an analogy to help relieve some of that stigma of what it means to engage in talk therapy... Let’s say you're a runner and you've been running a long time but recently your knee started hurting. You’ve tried stretching, you got the new shoes, you read the runner’s magazine, but it’s not working. You [might] go to a physical therapist. A physical therapist would gather information about how long you’ve been running; when did the pain start; what does the pain feel like; or is there any family history of injuries? And then your physical therapist would help you work on a plan of stretching and strengthening to relieve that pain and hopefully help you [become] stronger and healthier. Talk therapy is the exact same thing. We want to know about what your experience has been like and we want to help you relieve the pain or stressors or challenges in your life, and seeking the regular support of a therapist is just as important and effective as if you have a physical injury and you needed to see a physical therapist.”
Beth: “I want to let any potential clients know that they are in control of who they choose to help them through whatever they're going through. They get to make the decisions on what to focus on and will be the ones doing the work to create the changes they are seeking. My clients are powerful and I am hoping to do my best to support and help direct their power!”
Maggie: “I think that making the first step to making an appointment is huge. Setting up the first appointment takes a lot of courage, and going to that appointment is another big step. It may seem scary at first, but I feel like with the right person you can definitely do some good work and get some help. If you have a good relationship and a good rapport there’s some growth that really can be [seen].”
“Knowing that [your therapy sessions] are confidential is huge. I remember my first session, going in and feeling like ‘I’m about to unload all this stuff on this person!’ I feel like [my therapist] explaining the whole confidentiality to me, how it’s just kept between us, really helped me open up more, to know that I was in a safe space. Creating that safe space and building that rapport are always the two best things to come from a first session.”
Jessica: “I think it’s important to have a good fit. If you don't vibe well with your therapist, then you’re not going to do a lot of self work. I think it’s important to be able to say ‘hey, this person might not be the right person for me’ and then that therapist should take the initiative to help them establish with someone who might fit their style better. It’s okay to tell us, we want to help, and it’s not an inconvenience. You’re not a burden; we want to help you because we like to help people.”
If you’d like to work with any of the clinicians mentioned in this article, take a look at their profiles on the Telebehavioral Health.US website!