What to expect during your first therapy session.

The time was finally right and you had the courage to go through with it. You made an appointment for your very first counseling session. Congratulations! You just took a big step toward taking care of yourself and inviting balance back into your life.

Most likely you are feeling a flood of emotions and sensations. Thoughts and questions are racing through your head. What will it be like? What am I supposed to talk about? What kind of questions will the counselor ask me? Why do I suddenly feel so emotional?

It’s really common to feel flooded by “what if’s” the first time you start counseling. Some people feel relief just knowing they will get the space to vent their feelings; some people get really nervous and scared about telling a stranger all about their deep, dark secrets; and some people feel shame for turning to a professional when things get hard. All of those reactions and feelings are common, normal, and completely valid. There’s a lot of myth and mystery surrounding what happens during a counseling session and no two counselors conduct intakes or sessions in the same way. So what should you be expecting?!

My goal is to give you a little guide on what to expect out of your first counseling appointment and how best to prepare for it. I can’t speak for all counselors in the world so this is based on my experience of being a client and a counselor.

Contrary to popular belief it takes several sessions for therapy to really get going. I have had the experience of hearing clients’ disappointment that we didn’t “really get into the issues” during the intake. It can be frustrating if you have specific expectations for your first session that aren’t met and may leave you feeling less invested in the process. I once had a mentor tell me “Expectations are premeditated resentments.” That phrase has stayed with me for years. And since I believe in setting realistic and appropriate expectations, here’s what you can expect when you start therapy (with me):

The Intake

The first meeting is usually an intake. The intake consists of getting background information about why you are seeking therapy, providing some personal history (yeah I’ll probably ask you some things about your childhood), getting an overview of your medical and health history, relationship history, substance use, employment or school concerns, legal history, and how to respond to and cope with stress. I have all of this included in the intake questionnaire and you can expect me to ask you about some of your answers as we discuss the paperwork.

You never have to answer a question you feel super uncomfortable about. Unless you feel that it is necessary, you don’t have to give a lot of details about anything. Some people are afraid I will ask them to relive all the details of their trauma during the intake. Share what you are comfortable with while giving me an idea of what experiences you have had and approximately when (i.e. I was in an abusive relationship in my early 20’s, I experienced childhood sexual abuse, At 15 I was in a bad car accident, etc).

Also, never sign anything you have concerns or questions about. I can’t actually do anything “therapeutic” with you until you sign a consent form so rest assured you won’t be “therapized” without your knowledge. Please ask for clarification if you are unsure! It is part of the intake to go over all of the paperwork, discuss the policies, talk about payment, and alert you to the limits of confidentiality. You have the right to ask questions about my education, experience, modalities, theoretical orientation, practice policies, emergency procedures, schedule, HIPPA compliance, record requests, communication preferences, and social media policies.

We will discuss payment during the intake. You can self-pay or use your insurance benefits if I am an authorized provider with that company. Bring your insurance card and a photo ID to the intake because I will need copies. And it never hurts for you to have called your insurance company before the intake to get verification on any co-pays, deductible amounts, out-of-pocket amounts, and confirmation you have mental health benefits. I will also call them but this reduces the chance we get surprised if coverage is denied.

So after going over the paperwork, discussing payment, and getting some background, we will also talk about your goals for therapy and what you want to get out of the experience. You don’t have to have all the answers right away. We’ll have a conversation about how you envision your life changing from participating in counseling and where you might see yourself in a year from the intake. I’ll sum up what you have expressed and ask you to continue to think about your goals for the next session.

Then we schedule the next session.

The First Session

The second time you come into my office is often a continuation of the intake. This counts as the first “session” of therapy. In this session we will talk more in depth about your goals and what you want therapy to look like. I generally take a few notes and write a treatment plan after this session because I want to have a better idea of how best to get you to your goals. Generally the second session is where I may ask you for clarification about some of your history or information and begin to form a deeper understanding of your motivation for attending therapy. We may also spend more time talking about your support structures and coping skills. This is to assess what support is available to you between sessions because you don’t always leave therapy feeling sunny and lighter. It is not uncommon for counselors (myself included) to assign “homework” or an activity for you to do at home between session, starting from the intake. This keeps the momentum going and is often designed to help you cope, give you more information about a certain feeling or behavior you are curious about, or to employ a different problem solving strategy you are feeling stuck in.

We will spend time exploring the reasons that brought you to counseling and how you assign meaning to those circumstances. This tends to be more orientated in the present time as I want to really understand you as you are while you are sitting across from me. Think of it as giving me a snapshot of your life from your perspective.

Therapy generally continues like this until we have cause to redirect. That is to say we talk about what’s important to you that day, heading toward our goal with me providing interventions as needed until we reach a goal or become obstructed by a crisis (big and small).

Going Beyond the First Session

The “good stuff” in therapy really begins when we have built up trust and rapport. This can be either a quick or slow process. The client gets to decide how much to trust and when. As the therapist it is my job to create a safe space in my office for you to begin to trust that I will support you through all the really hard times. As the client, you want to pick a counselor you feel comfortable with and preferably with whom you have some chemistry (not in the romantic way, in the “I feel good about this person” way). Remember this is someone who is dedicated to you and your well-being, even if that sometimes means confronting your coping skills that actually cause you more harm than good. Counselors are nonjudgmental witnesses you invite into your life to help guide you to being the best version of yourself possible (within your specific set of environmental circumstances).

Therapy is not a linear curve, but a sometimes jagged or tangled line that takes you all over until you find yourself in the place you want to be. I often tell my clients during intake that the only expectation I have of them is that they will give me feedback. If I misunderstand something, or suggest homework that will never be completed then I absolutely want to know. Therapy is very much a co-created experience between the therapist and client. I am not the expert of my clients’ lives but the keeper of a very well equipped tool box that I want to share with them.

Starting therapy is exciting, daunting, overwhelming, nerve-wracking, full of possibilities, and something to be celebrated. Timing is everything. If you don’t believe this is the right time for you to seek help then it’s probably not. Therapy can feel really hard sometimes and if you aren’t ready to stick it out through the uncomfortable stuff then wait. There will always be a therapist excited to begin working with you when the time is right. You never have to go it alone.