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. 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 usually occur, accompanied by a lot of anxiety. The anxiety is usually most acutely as you actually enter the office and meet your new therapist face to face for the first time. The good news: your therapist is likely aware of questions like these (and may even have similar questions and anxieties about you, the new patient).
Although the therapist will spend time getting a rough sense of what brings you to treatment, first sessions are really about beginning to build a safe space and a therapeutic relationship so that work can be done. Yes, questions will be asked: 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 the therapist (if he is good) will also make sure he accurately understands your perspectives and the basic outline of the issues. It’s highly unlikely that any solutions will be offered during the first session, although the therapist may offer some ideas for directions to explore in later sessions.
In addition to getting to know you, the therapist will also talk about how therapy works and how she typically works with patients. The therapist may talk about how therapy is structured (i.e., agenda setting, use of time, etc.). Some time is given to administrative details: fees, policies about cancellations, unscheduled sessions, telephone calls, etc. But the therapist will spent the vast majority of time listening carefully, attending to you, and trying to understand you, the problem and its contexts.
During the fist session, I always leave time for patients to ask questions about therapy, about my approach to treatment. I strongly encourage patients to share their 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 frequently ask patients how they feel about the help they are getting: am I helping? Where did I misunderstand something that was said? Have I said too much or too little during a session? Feedback to the therapist is, in my experience, essential to a solid working relationship.
You may not feel a good connection with the therapist after the first session. This is common. While sometimes it takes a few sessions to feel understood and connected with the therapist, sometimes that connection just isn’t there. I’d encourage you to share your experience with the therapist—even at the first session, if you can. Indeed, your therapist needs to know that something just isn’t sitting well with you. The therapist may explore this with you in an effort to understand what might be blocking the connection. However, if the connection is not there after a few sessions, it’s important to explore other options. You are not married to your therapist; you may do better with someone else.
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 the therapist 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.