So You're New to Therapy:  What to Expect and What to Say

You’ve made the call and scheduled an appointment.  Now what? 

First appointments with psychotherapists can be anxiety-ridden.  You’ve made a step toward talking with someone—a stranger—about your life and your problems. You're making an investment of time and money in hopes that you will feel better and your life will change.  It’s uncomfortable to go to the therapist’s office and meet your therapist because chances are that you feel very vulnerable talking about yourself.  Many questions naturally arise:  Will I be helped?  Is this therapist competent to help me?  Can I trust the therapist?  Will the therapist judge me?  How much will I have to say?  Will I have to reveal my deepest, darkest secret?  What happens if I can’t think of anything more to say?  What if I don’t feel connected with the therapist?  What if I decide I don’t like the therapist? 

These, and many more, questions are common and are accompanied by anxiety.  The anxiety is usually most acutely felt as you actually enter my office and meet me face to face for the first time.  

Although I will spend time getting a general sense of what brings you to treatment, first sessions are really about beginning to build a safe space and a therapeutic relationship so that deeper work can be done.  Yes, I will ask questions:  some basics about who you are, how you identify the issues bothering you, a brief history of the problem and how you’ve been coping, how the issues are impacting your current life, etc.  And I will also make sure I accurately understand your perspectives and the basic outline of the issues.  It’s highly unlikely that any solutions will be offered during the first session, although I may offer some ideas for directions to explore in later sessions.

In addition to getting to know you, I will also talk about how therapy works and how I typically work with patients.  Some time is also given to administrative details:  fees, policies about cancellations, unscheduled sessions, telephone calls, etc.  But the vast majority of time will be spent listening carefully, attending to you, and trying to understand you, the problem and its contexts.

During the first session, I always leave time for patients to ask questions about therapy, about my approach to treatment.  I strongly encourage patients to share their questions, concerns and any ambivalence about entering treatment.  Significantly, I ask patients to not only share concerns at the first session, but throughout treatment.  Indeed, I'll ask how you feel about the help you're getting:  am I helping you?  Where did I misunderstand something that was said?  Have I said too much or too little during a session?  Feedback is, in my experience, essential to a solid working relationship. 

Sometimes it takes a few sessions to feel safe, understood and connected, and sometimes the connection just isn’t there.  I will encourage you to share your concerns about therapy with the me—even during the first session, if you can.  Indeed, I want to know that something just isn’t sitting well with you.  I'll try to explore this with you in an effort to understand and make adjustments in order to overcome whatever might be blocking the connection.  However, if the connection is not there after a few sessions, it’s important to explore other options.  You may do better with someone else. It's important that you be helped in a way that is most meaningful to you.

So, come to that first session of therapy with your problems, questions, and concerns.  Ask questions.  Come to the session with all your feelings—your fears, your ambivalence.  Be honest with me about how you are feeling.  Say as much can, as much as you safely feel able.  All these thoughts and feelings are the fertile soil out of which new growth will emerge. 

You are beginning a new chapter in your life.