Considering taking the plunge and beginning a course of therapy? It is common to have some questions about what to expect when you have your first appointment. It is an emotional and often difficult decision to finally make the call and set up that appointment. Let's break down five things you can expect.
1. Anticipatory Anxiety: Whether you've been a client several times before, or if this is your very first time meeting with a therapist, it's absolutely normal and expected to be feeling a bit nervous / ambivalent / guarded / avoidant / panicked / excited / freaking-out / oh-my-god-I-want-to-cancel. Therapy is simultaneously steeped in stigma and stereotypes, while also shrouded in mystery and confidentiality, leaving you, a new client, feeling lots of feelings about getting started. I encourage all new clients to ride that wave of anxiety and doubt; don't let it prevent you from seeking the care and support you need, but notice what it IS bringing up for you, as that will be helpful to talk about with your therapist. And believe me, they will be understanding and willing to talk about any concerns or questions you have about the therapy process to help you engage fully in the work.
2. Paperwork: Yup, you'll have to fill out some paperwork. There are certain documents required by law for clients to complete before beginning a course of treatment, including a confidentiality agreement, consent to treatment, and the disclosure of some personal information, including address, phone number, insurance information (if needed), etc. Your therapist may also ask for information about your past mental health, family history, medications, physical health, and any other doctors or providers you wish your therapist to contact (only with written consent). Some therapists also include a questionnaire to assess for depression and/or anxiety to get a baseline score at the start of treatment. It's generally a good rule of thumb to show up for your appointment a bit early to allow time to complete your paperwork.
3. Orientation to Therapy: Before diving into your reasons for coming in, your therapist will often take some time to orient you to the therapeutic process. This "spiel" generally includes a review of confidentiality, which is the core of effective therapy. While there are some variations in limits of confidentiality depending on state, typically, everything you share in session remains between you and your therapist unless your therapist believes you are in imminent danger of suicide or homicide. Your therapist will review these limits with you and answer any questions you may have. The therapist will also likely disclose to you their credentials and background and logistical information about session timing, contact information, fee rates, etc. They may also discuss their approach to therapy, including theories they use (e.g., CBT, psychodynamic, mindfulness) and what to expect during initial and future sessions. This is an excellent time to ask any questions you may have about the process of therapy or your therapist's approach.
4. Information Gathering: Therapists are great contextualizers. While much of the conversation may be focused on sharing your current concerns and stressors, your therapist will want to be able to put those issues in the context of your life as a whole. Take anxiety, for example; though the symptoms may be similar for many people, it has vastly different triggers, sources, and appropriate interventions depending on the bigger context of the client's life. As a result, your therapist may ask about the history of your family and social systems, mental health, substance use, experiences of trauma, hobbies and interests, self-care practices, physical health, self-harm/suicidality, etc. If it becomes overwhelming or too difficult, it is okay to tell your therapist that you need to slow things down. You can also share general things without going into detail, or not share certain things until you feel ready to do so. It is important to remain empowered in what you choose to disclose, especially at the beginning -- which leads us to...
5. Post-Session Emotions: Initial sessions can bring up a lot. Think about it -- you just spilled a whole bunch of very intimate, personal information about yourself! Not to mention, many people don't often share this sort of information with other people in their life, and especially not to strangers. Talking about your struggles with your therapist for the first time can lead to some very positive feelings of relief, connection, and feeling heard and understood. However, it can also lead to some negative feelings of vulnerability, anxiety, or a sense of "unraveling" of things you may not have talked about or even thought about for a long time. You may be revisiting some of your ambivalence about beginning therapy in the first place (see #1) and feeling some hesitance to return for your next appointment. These reactions are expected for the first couple of sessions as you delve into your background and current struggles. As therapy continues, though, you'll notice the negative reactions will lessen as your therapy relationship becomes stronger and more trusting. Plus, you should hopefully feel some relief and improvement in your well-being as you continue in the therapy work.
If you've gotten this far, you should be in pretty good shape for knowing what to expect during your first session. It is a big decision and can elicit some difficult emotions, but the journey of therapy is worth it. Approach it with openness and curiosity, and don't hesitate to ask questions and be empowered!
Dr. Bethany Detwiler is a psychologist practicing in Allentown, PA. She specializes in mood and relationship struggles. She also is an adjunct professor of counseling at Lehigh University.