Your First Therapy Session

If you’ve never been in psychotherapy before you may be wondering what your first session with your therapist will be like. New experiences — like your first therapy session — can be both exciting and anxiety-provoking. Knowing what to expect may reduce your anxiety and allow you to pay more attention to your excitement.

All therapists are different, so I can’t pretend to describe what a first session is like with all of them. But I think first sessions with me are representative of what a first therapy session is like with most therapists, so I’m hoping my description will be fairly accurate.

First, you come into the office and have a seat in the waiting area. There may be other clients there too waiting to see their own therapists. You can just sit and relax and read a magazine. At the time scheduled for your appointment, your therapist will come and get you from the waiting room. You then go together to the therapy office.

In the therapy office, there will probably be a comfortable couch or chair for you to sit and another chair for the therapist. There may also be a small table with a clock and a box of tissues.

After you and the therapist sit down, the therapist may say something welcoming to you and let you know what to expect from that first session. For example, I would say something like: “It’s good to meet you in person! What I usually do with clients in a first session is to just take some time for us to get to know each other a bit. You can tell me about what issues you are wanting to work on and I am also happy to answer any questions you might have about therapy with me. My hope is that this meeting will give us a good idea of whether we might work well together. If you decide you would like to continue to meet with me, then at the end of the session we will do some paperwork and schedule another time to meet. Does this sound like a good plan so far?”

If clients feel comfortable at that point, typically they will start talking about the problems they are having and how they hope therapy might be helpful for them. The therapist will listen and say things periodically to make sure the therapist is understanding the client. The therapist may also say things that are supportive and validating of the client’s experience. In a first therapy session with me, you could also expect that I would be identifying your strengths and remarking on things you seem to be doing well.

The client can also ask questions about the therapist’s training and style and experience dealing with particular issues. Don’t hesitate to ask what you want to ask. If the therapist doesn’t feel comfortable answering it is the therapist’s job to tell you that. Remember that you are hiring the therapist to help you and you need to know whether it’s a good idea to hire this therapist.

The main goals of a first therapy session are usually:

  1. To allow the therapist to gather background information about the client and the client’s current concerns.
  2. To begin to build trust and therapeutic rapport.
  3. To allow both the client and the therapist to see whether they are likely to work well together.
  4. To come to agreement on basic issues such as scheduling of sessions, fee payment, cancellation policy, confidentiality and the limits of confidentiality, best ways for therapist and client to contact each other in between sessions when necessary, and how the client can access help in an emergency.

In the event that the client and therapist do not think that they would work well together, the therapist might offer some suggestions for other therapists for the client to try. If the client and the therapist think they would work well together, the client will typically schedule the next appointment at the end of the first therapy session.

At the end of the therapy session, you would pay the therapist for the session (or a co-pay if the session is being covered by insurance).

The entire therapy session will generally last between 45 and 60 minutes, depending on the therapist. Sessions with me typically last for 50 minutes. You will notice that as you are getting towards the end of the session, the therapist will start to summarize what you’ve talked about and try to bring your conversation to a conclusion, leaving enough time for discussion of what happens next and any basic issues that need to be discussed.

At the end of the session, you and the therapist will say goodbye to each other. The therapist will then write a confidential therapy note (to be kept in a secure location) that summarizes what was discussed in your therapy session. You will go on your way and have plenty of time to think about what you discussed until you meet again.

I wish you the best of luck in beginning therapy! It can be a fabulous adventure.

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