Psychotherapy 101: Starting for the First Time

Starting individual therapy (or any therapeutic treatment) can be an odd thing for some people, and it can result in us feeling anxious and uncomfortable going into the first session.  People often wonder what you’re supposed to say during the first session and whether or not you should completely open up.  Some people worry that they may not like or trust the therapist, and so the first meeting can be quite difficult and awkward.  If you’re new to therapy or treatment, these concerns are natural, along with anything else that’s come up for you.  Having been in the client’s chair and now sitting in the psychotherapist’s chair, I’d like to offer you some basic things to consider as you go into your first session.  This way, you can relax into the experience and allow it to happen naturally.  As always, these are just my suggestions and ultimately, you need to do what you feel is in your best interest.  And keep in mind that these suggestions are general and meant for those entering into individual sessions.  While but I will touch upon some suggestions that are specific to other types of treatment (such as family therapy, couples therapy, and more intense treatment programs), your situation and difficulties may involve others issues that I haven’t addressed (e.g., psychosis, delusions, hallucinations, etc.).

Prepare…Just a Little

I never did this but if you’re concerned about the first session and not sure you want to divulge everything, sit down and do a little journaling.  And if you haven’t journaled before, this is the perfect time to start the practice.  Journaling can serve as a wonderful supplement to your therapy sessions and it’s great for maintaining any improvements you’ve made.  It’s also helpful in gaining additional insight into your difficulties and learning how to be your own therapist.  It might surprise you but becoming your own therapist is an indirect goal of therapy and this happens naturally as you enhance your self-awareness, objectivity, and increase your mental and emotional flexibility.  As you sit down with your journal to consider your first session, freely write about what is really bothering you at the moment.  Ask yourself, what is the biggest problem that you have that you feel comfortable talking about.  Whatever the answer is, is okay.  If there are things that you don’t want to share, make a note of those.  Now, you might end up talking about them if you feel a strong connection with your new therapist but it can be good to know what you feel safe sharing.  Ultimately, there’s no right or wrong answer here, especially when you’re getting used to someone new.  And lastly, write down any questions you want to ask.  This is your therapy and if you want to know certain things, then bring those to the session.  By asking any questions, whether it’s about the therapist or the process of therapy, YOU can bring about a higher level of comfort for yourself.  And keep in mind that therapists know that the first few sessions are all about forming what us therapists call, “the therapeutic relationship.”  This is just a fancy way of saying, “we need to get to know one another and develop some trust.”

Waiting for the First Session

Therapist’s offices and their entrances and lobbies are all different.  Your therapist may be a part of a group or they might have their own private practice.  Regardless, you might see another client while you’re waiting and this is pretty common.  In the old days, therapists used to always have two doors in their offices.  One where clients entered and another where they exited the session.  However, this has changed over the years and there’s often just a single waiting area where people come and go.  This means that even if you’re alone while you’re waiting, you might see another person on their way out.  If you do see them exit, this can be a challenging moment because our social conventions say that we should put on a smile and say hello.  We might even want to offer the automatic phrase, “hi, how are you?”  Well, this common social nicety isn’t all that helpful in a therapist’s office because people are often having a hard time.  Some people might come out of the session crying and tearful, while others might have just had a session where they were fighting with their partner.  You just don’t know how they will come out.  But also, how are you doing?  If you’re starting therapy for the first time, you have your own stuff going on as you’re sitting there…waiting.  In this way, social conventions are pretty much useless and tossed out the window because they don’t fit with the situation.  It’s about as fitting to go up to someone who’s at a funeral where they lost someone and say, “hey, how’s it going?”  Obviously, we’ll want to change it up but how do we know what’s acceptable?

You can start by think about what you would want if you came out of the office upset (if your answer is to be comforted by a stranger…well, I don’t suggest that!).  As you think about this, you may want to consider a couple of basic responses, but keep in mind that not everyone will agree with what I have to say.  As always, be sure to decide for yourself.

Option 1 – Brief eye contact and a light smile, if you’re up for it.  If find this to be workable if I’m pulled to acknowledge someone in a way that’s similar to how we regularly do so.  I suggest not saying anything because you have no idea what is going on for them and by leaving it open, you give them the space to experience whatever it is that’s going on for them.  Greeting someone is typically a demonstration of kindness and safety and if this is what you want to communicate to them, a smile with brief eye contact, if they even make it, is a workable middle ground.

Option 2 – Do your own thing.  Sometimes WE are not in the space to interact with others and this is okay.  You’re just about to start a session and there’s no problem or shame in staying in your own space.  Keeping busy with a magazine, journaling or glued to your phone communicates that you’re in your own space and makes their exit and your entrance easy.

Regardless of the option you choose, you can feel confident that’s it’s okay to be authentic and in your own space.  I’m assuming that you know that I would not suggest going off on them for some reason…so I’ll leave it at that.

The First Session Begins

Ah, the anxiety of this new and odd thing called therapy is starting.  The therapist has come out, you might feel completely awkward and weird, and you both enter the office together for the first time.  My hope is that your therapist provides you with a brief introduction to therapy so that you have some idea of what to expect from your sessions.  Every therapist has a different approach and hopefully they’ll inform you a little about this…but sometimes they don’t and you’ll have to face the discomfort of figuring it out. Just know that there is a huge variety of how therapists interact with clients.

For example, therapists may be: talkative, quiet, interpret what you’re communicating, only reflect what you’re communicating, give you weekly homework, never give you homework, will tell you what you need to do, will collaborate with you in order to identify what to do, will never offer suggestions or their thoughts, will meditate with you, will answer your questions, will answer only some your questions, will turn your questions back onto you, and so on.  These differences should, ideally, be informed by their theory of therapy and this means that there are reasons for how they are.  However, their approach may or may not fit for you, but try to work with it for a few sessions.  You know, the good old college try…whatever that means.

Talking With Your Therapist

The more willing you are to talk, the better.  Why?  Talking makes it possible for your therapist to understand your thoughts, feelings, beliefs, views, history, experiences, etc..  All of this allows your therapist to understand your inner workings and the more you share, the more they can figure out how to best support you.  In the beginning, it can take time to share things because you may not trust them (or the notion of therapy).  If talking is something that you don’t do a lot of, especially when it’s about what’s going on within you, it may be difficult to find the words.  You don’t have to be perfect at describing what therapists call your “internal experience,” but do your best.  If it comes out wrong, say it again.  You may even want to share with your therapist that you’re not used to talking in this way.  Sometimes putting stuff out in the open can help you move forward and when your therapist knows that you’re feeling stuck, they might be able to help you out.

The First Few Sessions – It’s All About the Relationship

Therapists are trained to focus on building a good relationship at the beginning of therapy.  They do this in order to build trust and safety.  This way you can relax, be yourself, and feel understood.  This is often done by asking about your background and discussing what brought you into therapy.  Feel free to disclose whatever you’re comfortable with and in the level of detail that is comfortable.  Hopefully your goal is to share everything with your new therapist, but it’s okay if this takes time.  The reason that it’s perfectly fine to limit what you talk about (if you feel the need to) is because experienced therapists understand that secrets, insecurities, and painful thoughts and memories are hard to admit to ourselves, let alone other people.  If you know that there are things that you want to and need to share with your new therapist but aren’t ready, feel free to let them know about this.  This can help them understand where you’re at.

 

Being Open to Your New Experience

Sometimes we enter into therapy and have an idea of how we want the person to be.  We may even have a very specific and strict idea of how they should be.  While it’s good to know what works for you, it’s also good to be open to an experience that may not line up with this.  Meaning, if your therapist’s style strikes you in a funky way that leaves you thinking, “oh, I don’t know about this,” try to examine what’s going on for you and see how the next session goes.  This may sound counter-intuitive but sometimes when a therapist’s style bugs us, it can actually be the kind that we need.  Of course, you need to ultimately decide this for yourself.

For example, if a therapist practices strictly from a Psychoanalytic approach and I were to go see them, I can’t say that would be comfortable working with them in the beginning.  This kind of therapist does not answer questions about themselves and turns any personal questions back onto me.  Not knowing the person across from me, beyond that of simple observations, is anxiety provoking and feels unnatural.  However, their reason for working this way is to keep the focus on me and whatever my mind projects out into the world.  Despite the discomfort of this kind of interaction, it would be great for me because it can promote an increased awareness of how my mind attempts to make meaning of the people and situations around me.  Also, it forces me to reflect more upon how I am, which is a very important trait to develop.

Again, be open to your experience and attempt, if you can, to see how the interaction could benefit you even though it might not feel the greatest at the start.  If we cater to our emotional reactions only and demand to feel great and amazing in therapy all of the time, we probably won’t make much progress.

Putting It All Together

As you embark on your first therapeutic journey and prepare for your first session, take some time on your own to think about what you want to talk about, what you’re willing to share, and how you might briefly interact with other clients that you see.  As best as you can, remain open to experiencing your therapist’s style and don’t hesitate to ask any questions at any time.  Sure, they hold a degree and are trained at understanding your inner-workings, but they’re just as human as you.  You always have power in the relationships and the ability to choose what you believe is ultimately best for you.  And remember, the start of therapy is about forming a good relationship because it’s the foundation for all of your future sessions.  Lastly, good luck!  Therapy can be an amazing resource if you have a sincere desire to learn how to use it and are willing to change for the sake of your life and future.