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 they 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.
A Timeline of Your First Therapy Session
Waiting: The first moments of your arrival to a therapist’s office may be very similar to waiting for any other kind of health care appointment. You might check in with a receptionist, fill out initial paperwork, and then wait for your therapist to bring you back for your session.
Introductions: You’ll most likely spend the first part of your therapy session getting to know one another. Your relationship with your therapist is just any other—it may work best if you’re able to connect with one another on a personal level initially. You don’t have to leap into your deepest darkest secrets immediately—feel free to talk through your favorite book or the movie you saw last week as a way to get a sense of how the two of you will communicate with one another.
Establishing Needs: Your therapist will need to know why you’re seeking therapy. They may ask what kinds of needs or issues you’d like to address in your treatment together as well as what you’ve done to manage your mental health in the past. They’ll want to talk through what worked and what didn’t to get an understanding of how best to help you.
Asking Questions: As a secondary part of understanding what you need from therapy, your therapist may ask some of the following questions:
- Have you attended therapy in the past?
- What are your symptoms?
- Do you have any mental health issues in your family history?
- How is your home life?
- Do you have a history of suicidal ideation?
- Do you have a history of self-harm?
- What do you hope to get from therapy?
- What do you want to accomplish in sessions?
More Questions: It can also be helpful to plan on asking questions of your therapist. Before your session, consider thinking over what worries or concerns you may have about treatment and then brainstorm some questions to ask your therapist. For example:
- Is this confidential?
- When would you need to break confidentiality?
- How long have you been a therapist?
- Do you have any experience with my specific type of mental health issues?
- Have you ever been to therapy yourself?
- What kind of things should I plan to do between our sessions?
What Should I Do After My First Therapy Session?
The most important thing to do after your first therapy session is check in with yourself. Ask yourself how you felt your first session went, and see how you would feel about going to another one with this therapist. Remember: there’s no such thing as a one-session cure, so you may feel a little better or relieved, but your symptoms won’t immediately disappear.
Consider how you felt about your therapist specifically. Did you feel comfortable talking with them? Did you feel like the two of you could work together over a long-term time frame? If your therapist tries to give you a diagnosis in the first session or makes you feel uncomfortable for any reason, it might be a good idea to find someone else. Therapy is an incredibly individualized process, so not every therapist is going to be the right fit for you. It’s okay to interview a few before you find the right person.
Additionally, you may have some “homework†from your therapist before your next session. This could be anything from journaling throughout the week to doing a little reading that may help provide context for your next session. Remember: whatever work you do between sessions is about making you feel healthier and happier, not about getting a good grade.
What Therapists Have to Say About Attending Your First Therapy Session
Several therapists explain what goes on in their first sessions with people new to their practices:
For some people, psychotropic medication may be a necessary component of their mental health treatment. However, in some cases medication and its side effects can cause serious harm to an individual. To ensure your safety, you should only take prescribed medication under the guidance of a qualified clinician. But what type of clinicians can prescribe medication?
There are many different types of mental health practitioners with varying degrees of academic training and medical responsibilities/privileges. These therapists help make sense of the details and explain which among them are permitted to prescribe psychotropic medication:
Different states have different laws when it comes to seeking therapy as a minor. You may or may not need your parent or guardian’s consent depending on where you live and your state’s legal definition of mature.
In What Cases Will I Need a Parent’s Permission to Go to Therapy?
In many states, if you are under the age of 18, you will need a parent’s permission to attend therapy. This is because in order to give any kind of treatment—medical or psychological—a patient’s consent must first be obtained. If you are under the legal age to give consent as an adult in your state, then you’ll need a parent’s signature.
In some states, it may be required that your parent attend the first therapy session with you. If you decide together that you’ll need to attend regular sessions, the therapist can give your parents a form that allows you to attend on your own. If your parents are divorced, talk with them about what custody requirements must be met when giving consent for your treatment. It is most likely as simple as keeping the other parent informed.
It’s also crucial that your therapist speaks with your parent or guardian before making any changes to your treatment—including the number of sessions per month you attend and any medication you may be trialing. Provided you are in an environment where it’s safe and healthy for you to discuss your mental health needs with your parents, seeking therapy as a minor simply requires open and consistent communication between you, your parents, and the licensed mental health professional.
Are There Any Cases Where I Don’t Need a Parent’s Permission?
As with every rule, there are exceptions to the parental permission requirement. Some states, like California, allow minors to give consent to treatment for things like substance abuse or mental health treatment as young as 12. In many states, however, minors can only give their own consent for therapy in specific situations.
One such example is emancipation, whether court-ordered or situational. In court-ordered emancipation, the minor is deemed an adult and can make all of the decisions in their day-to-day life as one. This includes consenting to treatment. Usually, court-ordered emancipation is achieved by the minor when they appeal for it, after proving to the court they are already providing for themselves and do not rely on parental support. In some states, minors may qualify for situational emancipation, in which their marital status, military service, or parenthood will grant them independence.
In all cases in which emancipation qualifies you to give your own consent for treatment, you will need a copy of the decree. It’s also important to note that most states allow minors to give consent for themselves if they are in a situation in which delaying treatment while waiting for parental consent for therapy would put them in danger, such as if they are threatening suicide or self-harm.
What Should I Do If I Need Therapy but My Parents Won’t Let Me Go?
The good news is even if your parents won’t sign off on therapy sessions, you have a lot of resources available to you. Minors seeking therapy without parental consent should start in their schools. Most schools offer a licensed counselor available throughout the day that students can schedule time with. If you don’t feel comfortable talking directly with the school counselor, they may be able to help you find the best solution for your situation.
Additionally, researching the laws regarding minor consent for health care in your state may open more opportunities. Some states allow minors as young as 12 to seek mental health care for either a limited number of sessions or for specific circumstances that may be endangering them.
If it’s safe to do so, talking openly and honestly with your parents or guardian about why seeking therapy is important to you may help them understand why they should grant permission for you to attend. If it’s not safe for you to talk with your family, it may be the most beneficial to consult another trusted adult such as a mentor, teacher, or school counselor on what steps you should take in your situation.
What Therapists Have to Say
Here, several therapists explain how this works in different states, and offer advice on who you can ask within your state about seeking therapy as a minor:
Many people interested in therapy may be hesitant to share private information or stories about themselves with a stranger. They may fear judgment from the therapist, or worse, that the therapist is going to share their details with others. For therapy to be effective, trust must be built between the individual seeking therapy and the therapist.
Is Therapy Confidential?
In almost every instance, therapy is absolutely confidential. You therapist is required to maintain confidentiality about everything said in sessions between the two of you, just like a doctor is required to keep your records private. While there are laws and regulations in place to protect your privacy, confidentiality is also a key part of psychology’s code of ethics. This means your therapist understands from the very beginning that in order for you to feel comfortable sharing openly with them, you need to know your information is safe.
Remember, you can always talk with your therapist if you have questions about the confidentiality agreement between the two of you during your sessions.
What Are the Limits of Confidentiality in Therapy?
For your own safety, there are some exceptions to the rule when it comes to confidentiality in therapy. Generally, these rules have to do with the well-being of the patient or people in the patient’s life.
For example, therapists are required to report if a patient is a threat to themselves or others. This may mean the patient has threatened suicide, is repeatedly harming themselves, or has threatened to harm another person. In this case, a therapist may recommend hospitalization so the patient can be monitored. Once the patient is deemed stable, the therapist may then work with close friends or family members to develop a support plan for the patient in order to maintain that sense of stability.
Additionally, therapists are also required to report cases of ongoing child abuse or neglect. In these cases, a variety of public servants may be brought into the fold, including law enforcement or child protective services. Again, this is a measure created to ensure the safety of a patient and it should not deter you from being open and honest about your situation with your therapist.
Finally, if a minor is seeking therapy and is engaging in risky behavior, their parents or guardian may be informed. Different states have different laws regarding minors in therapy, so it can be a good idea for the parent, therapist, and patient to sit down in an early session and establish ground rules.
HIPAA and Rules of Confidentiality in Therapy
The group of federal laws and regulations protecting the privacy of your health information is known as the Health Insurance Portability and Accountability Act, or HIPAA. They very clearly and thoroughly define when your therapist is allowed to talk about you or your treatment outside of your sessions. These instances may include but are not limited to:
- When you are talking to your family. HIPAA allows your therapist to talk with your family about your mental health treatment in a variety of ways. If you are present and capable of making decisions and want your family to be involved in your treatment, HIPAA allows your therapist to share your information.
- When you are at a mental health care appointment. If you are seeing a mental health care professional for prescription medication, HIPAA allows for some information to be shared with the family you may have present. For example, if there are warning signs your spouse needs to know in regard to your medication, then the provider is allowed to share that with them.
- When you are incapacitated. If you are unable to make decisions for yourself, either because you are unconscious or deemed not of a sound mind, then your therapist may use their own reasonable judgment to share pertinent information with family or friends involved directly in your care. This usually means immediate family members or partners.
What Therapists Have to Say About Confidentiality
Here, several therapists discuss confidentiality of therapy sessions:
Therapy can be a wonderful tool to help people live happy, fulfilling lives. Therapy addresses a wide range of mental health issues such as depression, anxiety, and grief, but therapy can also be used for purposes other than immediate mental health concerns. For example, if you are struggling with the stress of a new career, a therapist can help you develop strategies for managing the stress to get the most out of your new job. Read the answers below from therapists who explain what therapy can accomplish:
Before a couple chooses to seek relationship help from a therapist, cost will likely be a factor. The charge for couples therapy may be the same as individual therapy, depending on the therapist, or it may be higher because of experience, length of couples therapy sessions, or the going rate for couples therapy in your area. Here, several therapists explain the cost of couples therapy:
You may find yourself in a relationship that needs some outside guidance in order to progress in a healthy way. Couples therapy is designed to help partners overcome many relationship obstacles such as communication issues, infidelity, power struggles, or intimacy problems. These obstacles, however, are not simply limited to married couples. Here, therapists explain how couples therapy is available to any kinds of partners, regardless of whether or not you are married:
[fat_widget_right]Many people who are beginning or seeking couples therapy struggle with getting their partner to attend session. This is common, and it occurs for a number of different reasons. Below, several couples therapists explain some of the reasons significant others may be reluctant to go to therapy, and offer their advice for helping to push them in a direction of positive growth for the relationship:
Trust is essential to establishing a good connection with your therapist. Without trust, your therapy may never be as effective as you hope for. If you meet your therapist and do not click with him or her, you may consider searching for a new therapist after you evaluate the situation. Below, a few therapists recommend what to do if you think you may need to find a different therapist:
[fat_widget_right]Couples therapy can have many different outcomes. The final outcome will depend on various factors, especially the therapeutic process and the goals of the partners in therapy. A couples counselor will help couples face their challenges together, but it is up to the partners to determine if their relationship will continue or end in separation. Below, several therapists explain how couples therapy can help couples make the decision to continue a relationship or call it quits:
Meow! I am a cat therapist. No, I don’t have the fancy degree and years of experience like my human does—but like other pets in animal-assisted therapy settings, I collaborate with my human to help in the therapy process.
So what is it like to work with a therapy cat? First of all, I’ll introduce myself and welcome you in to the office. Therapy cats are here to make you comfortable; we’re pretty laid back and we like to go with the flow. Therapy cats are used to being handled and being around humans big and small, as well as other animals.
Nervous about going to therapy? Studies show the presence of a therapy cat will lower your anxiety as well as your stress level. Go ahead—pet us. We lower your blood pressure and help your brain release feel-good endorphins like oxytocin. This might help you talk more openly with our humans.
Now, have a seat—I’ve already warmed it up for you.
There are many of us—probably in therapy offices all over the world! Consider us a perk of therapy if we happen to be in the room to accompany you in your journey to better mental health.
My human and I know that working through therapy can be hard. Therapy cats see a lot of people who are in pain, but we can help comfort them in hard times. We’re here for you, just like our human is.
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I can help people of all ages learn and grow while working through mental health issues. Humans have proven that cats like me can even help children with learning difficulties. Some kids read to me. I love the stories of faraway places, but the ones about dogs can be a bit ruff!
I can also lend an ear to someone working out language difficulties or someone experiencing problems with social interaction or anxiety. See, in our many lives we develop many talents!
People like visiting my office—excuse me, my human’s office—because both of us can listen to you without judgment. As for the paperwork? We’ll leave that up to the humans.
When you go to your doctor for some problem you are having, there is no question that you want an answer to what it is. Not only does it ease your mind because you have clarity, but it also means that there may be treatment for that problem/disease and you will hopefully get better.
It’s not quite so apparent when it comes to our mental health. You may have heard of the Diagnostic and Statistical Manual (DSM), which is like a bible of diagnoses for mental health. Originally compounded by psychiatrists (MDs), it reflected doctors’ beliefs that mental health issues are like diseases, and can be treated once diagnosed.
The most recent version of the DSM, put out in 2013, has been updated to reflect current research and practices. It is used to label mental health issues so that insurance companies know what and how to bill. But for many practitioners it is also a useful way to define a client’s condition. So, is it helpful or not?
On the plus side, there are times when having a label to your experiences gives you peace, as you have a name for it and don’t feel you are “just crazyâ€. It is also critical in determining medication interventions. If one is diagnosed with attention deficit issues (ADD) or bipolar, for instance, it is likely that the right medication(s) can greatly improve quality of life. Having such a diagnosis—and very clear criteria to make that diagnosis—aids therapists and clients in collaboratively identifying courses of treatment.
[fat_widget_right]Labeling also often helps clients in explaining unexplainable behavior to their significant others. Imagine, for example, that your spouse is constantly late, procrastinates, forgets everything you tell him, and seems to space out a lot. Perhaps you are angry because he doesn’t seem to be trying to improve these problems.
If your partner is diagnosed with ADD, that gives a lens through which you can now understand your husband’s behavior, and it allows you to problem solve together, set realistic expectations for change, and, of course, get appropriate help in the form of therapy and/or medication.
On the down side, labeling can be highly stigmatizing and can even limit treatment options. Certain diagnoses come with all sorts of judgments—even on the part of therapists, who should be aware of these judgments, but aren’t always. Clients can become stuck on their diagnoses, instead of working on the solutions.
Most diagnoses don’t come with a clear and definite treatment, like a medical problem might. For instance, a diagnosis of depression might be treated with medication, cognitive behavioral therapy, hypnosis, mindfulness, or dozens of other options, depending on the client’s needs and the therapist’s skills. So some therapists prefer to look at the constellation of symptoms, and decide how to approach them without needing to put them in a box.
Having a label can be freeing, and can allow you and your therapist to come up with the right plan for you without adhering to strict labels. Another serious concern about labeling is that mistakes are made quite often! It could be the result of an unskilled therapist, or perhaps that clients share only selective information or inadvertently leave things out because they don’t know it’s important to share. Sometimes it takes years to piece together the whole picture and fully understand a person.
Whether you believe in labeling or not, it is always wise to do your own research, get a second opinion, ask lots of questions, and trust your gut!