Many people who have never participated in a therapy session wonder what it will be like. Will the therapist ask you a lot of questions about your feelings? Will he or she ask you to discuss your fears? Will you have to talk about your childhood? The truth is that different therapists handle their first therapy sessions differently. They may even encourage you to ask them questions about their lives, training, or experiences in the first session. Here, several therapists explain what goes on in their first sessions with people new to their practices:
Damon Constantinides, PhD, LCSW: I think of the first three times that I meet with someone as a trial run. I encourage people that come to me to pay attention to how they feel both while we’re meeting and afterwards. My style is not going to work for everyone, and what’s most important to me is that you find someone who feels like a good fit.
therapy style. It’s also a time for me to learn a little bit about you generally and to begin to get an idea of your expectations of therapy. What do I need to know about you to understand where you’re coming from? How you had any experience with therapy before? If so, what was good about it? What wasn’t so good? These questions help me to understand what you’re looking for and if I think we’ll be able to work well together. With some people, this takes our entire first session. For others, they want to get started with the problem they’re coming to therapy to solve.
It’s important to me that therapy feels useful to you. For people who are ready to get started right away, we begin with what’s been going on recently and what’s on their mind in that moment. At the end of the first session I check in with people to see how it felt during the session and if they have any other questions about me or my work. For therapy to be useful, we need to build trust together. This trust building happens over several sessions. Our first session is an introduction, which is the beginning of forming a trusting relationship together.
Marla B. Cohen, PsyD: In your first session, your therapist will spend some time getting to know you and the issues that brought you into treatment. He or she may use a formal, structured interview, or it may just feel like a more free-flowing conversation. The therapist will ask questions about your presenting concerns, as well as your history and background. Most likely, you’ll find yourself talking about your current symptoms or struggles, as well saying a bit about your relationships, your interests, your strengths, and your goals.
Most importantly, in that first session, you will begin making a connection with your therapist. You should feel safe, accepted, respected, and relatively comfortable. Not all therapists are right for every person, so use your first session to assess whether or not the therapist you chose feels like a good match for your personality.
Lynn Somerstein, PhD, E-RYT: Usually, in your first session you will be invited to be seated comfortably. The therapist will usually begin with some initial small talk to help you feel at ease. I usually make reference to the scariness of starting therapy, since I like to honor the feelings that are present. That’s a feature of therapy: find out where the person is and start there.
Sometimes people have lots to say and start talking right away, pouring out their thoughts and feelings, and sometimes their fears and tears, too.
Other people find it very hard to speak, so I’ll ask questions about how they decided to come to therapy, why therapy with me and not somebody else, whether they have been in treatment before, and whether there is something in particular troubling them. Each statement the person in therapy makes leads to many other questions.
I say what my expectations are: that people come on time, that they pay on time, that they say what is on their minds—even if it sounds silly to them. In fact, especially if it sounds silly; those silly ideas are frequently the best things to talk about because they often lead to issues that need to be explored.
Toward the end of the first session I also always thank the person for coming, say that I’ve asked a lot of questions (if indeed I have) and invite the person in therapy to ask me questions. Sometimes people feel it’s not polite, and they are afraid. So, then I say not to worry about courtesy, that I’ll probably feel comfortable answering, but that if for some reason I don’t want to answer something I’ll say so and we’ll move on.
Then we discuss whether we’d like to meet again and, if so, when. I’ll say how often I think we should meet, and we’ll talk about that too.
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