What to Expect in the First Therapy Session

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You made your first appointment for therapy. It’s understandable to feel nervous. Knowing what to expect can help ease some of those worries. Read on to learn more about that first appointment and how you can make the most of it.

Informed consent, confidentiality, process of therapy, etc.

Expect to go over some guidelines and sign forms. Many times the therapist may send them to you ahead of time or have you go on their website to print them. While this may feel tedious, these forms are all really important and many of them are legally required. It is important for you to know your rights, limits of confidentiality, the background of your therapist, how the therapist conducts their practice, etc. If you have any questions on these forms it is important to ask.

Be prepared to talk…a lot

The first session is an opportunity for your therapist to get to know you better. They will likely ask you a lot of questions about you, your family, your romantic relationships, your work, and of course what has brought you to therapy and some possible goals you have for therapy. It can definitely feel a little uneasy at first opening up to a complete stranger. If there is anything that is asked of you and you aren’t comfortable sharing yet, it’s okay to say so. It takes time to build up the trust and confidence to open up. It’s also important to know that the more you share, the better your therapist will be able to understand you and provide support.

You are in charge

When you go to a doctor’s appointment for a particular problem, typically you will explain what is going on, then the doctor will provide you treatment and basically give you instruction on what to do next. Therapy is different than this. Think of your therapist as your collaborative guide. Their role is not to give you advice nor tell you what to do. Therapy is not going to be a magic “fix” to what is going on. Therapy is a process and it will take time.

It is important for you to take an active role in your therapy. What you want to focus on and discuss is up to you. Your therapist may have some ideas for what direction to go, but ultimately, you know yourself and your life. The more open you are with your thoughts and feelings, the more your therapist will be able to understand you and ultimately help you.

Some topics can be hard to talk about and even embarrassing. Just as doctors will explain that they’ve “seen it all,” your therapist has probably heard about many different things and topics that are very sensitive, private, and even embarrassing. That is the nature of therapy- due to confidentiality, therapy is a safe place to share those things that you may not be comfortable talking about with other people that are in your life. It’s okay to even share that it’s hard or embarrassing for you and your therapist should respond by helping you feel supported and comfortable.

Don’t be afraid to give feedback

If your therapist doesn’t seem to understand where you are coming from, they misinterpret you or they say something that you find offensive, it’s okay to give feedback. In order for a therapeutic relationship to work, it’s important to be honest. The therapist should be receptive to your feedback and then respond accordingly. Sometimes, they may not even know that something they said may have bothered you.

It’s also okay to share what you want to get out of therapy and how you want therapy to look. Some therapists will like to give homework, others may want to try exercises (such as deep breathing or visualizations) within the session. If there is something they suggest that you don’t like or maybe there is something you want more of (such as homework), it’s okay to share that.

A typical therapy session is usually 45- 50 minutes, not an hour

Many people think a therapy session is an hour when it’s actually 50 minutes. Those last 10 minutes are utilized for the therapist to write up their progress note for the session and any other required paperwork. It may feel like a long time, but you’ll likely find that the time flies by. You also don’t need to worry about keeping track of the time, as the therapist will do that for you and should give a heads up or do a wrap up summary of the session as the time is nearing to the end.

You may experience a “Vulnerability Hangover”

That first session can take a lot out of you. Making the decision to go to therapy, finding a therapist, then scheduling the appointment and then actually showing up is all a lot. Not to mention opening up and sharing about your struggles. It can be very common to feel exposed and even some regret afterwards on sharing. Brene Brown, a researcher on courage, vulnerability, shame and empathy, likes to call this a “vulnerability hangover.” It’s when we put ourselves out there and really share what we think, feel, want, then afterwards we feel very anxious and vulnerable.

A common response when we feel too “exposed” is to then to pull back. In therapy that may look like not scheduling another appointment or cancelling it when the time comes to have another one. We may make excuses that therapy “didn’t work” or that we didn’t connect with the therapist. Those very well may be true, but it can also be good to give therapy some time to see and to give the therapist some time as well to get to know you. It is important that it feels like a good fit with your therapist and that can be hard to figure out right away.

If you are feeling resistant to continue with therapy after the first session, it can be important to explore that feeling. Is it due to not being a good fit or is it possible that feeling is from being too vulnerable and putting yourself out there? If it’s the latter then I’d encourage you to continue and even share that with the therapist.

You may not feel better right away…and that’s okay

Therapy is not a quick-fix. It takes time to change deep-rooted patterns and automatic ways of behaving and thinking. Many times at the start of therapy we may actually feel worse. While that can be uncomfortable and even distressing, it can also be as sign of progress. By actually discussing and processing our emotional pain, we can then get to a place where we can feel better. Many times in life we try to ignore or avoid what is causing us distress and while this may work for the short-term, it will usually pop up in our lives and cause us continual problems.

If those distressing feelings are really bad and you start to have thoughts of harming yourself or others, it is really important to tell your therapist. They will then assess the situation and help you obtain the support you need to stay safe.

Therapy is an investment into yourself

Therapy is a process and it can take some time to feel better and see positive results. It’s important to remember that therapy is an investment into yourself. You are learning new ways to think, feel and behave so that you can create a better future for yourself (and for future generations). Change does not happen overnight. You are important and you deserve to make that investment into yourself.

If you are interested in scheduling a therapy session with me or would like to have a free consultation, you can contact me here.

Disclaimer: This is in not a replacement for a therapeutic relationship or mental health services. This is for educational purposes only and should be in used only in conjunction in working with a licensed mental health professional. If you are looking for a therapist in California feel free to use the contact me to request an appointment or search Psychology Today for local therapists in your area.