What to Expect During Your First Therapy Session

You Have the Right to Ask Questions, Too

Woman speaks with female therapist
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You have an appointment with a counselor for your first therapy session and you don't know what to expect. This is the kind of thing you would normally ask your friends and family about, but you've decided not to tell them, yet, about your decision to see a counselor.

How to Choose a Therapist

No two therapists are the same. Asking the right questions will help you choose the best therapist for you. The Ontario Association of Consultants, Counsellors, Psychometrists, and Psychotherapists, recommend asking the following 10 questions.

Questions to ask before you make an appointment:

  • What is your academic background and what has your training been to prepare you to practice as a therapist?
  • What specialized training and/or experience have you had in working with the issue I am dealing with?
  • What professional associations do you belong to?
  • What are your fees? How will my insurance claim be handled?
  • What type of therapy do you do? (Does the therapist to mostly talk therapy or include opportunities for role-playing, visualizing, hypnosis, artwork, "bodywork")
  • What are your office protocols? (booking appointments, payment for missed appointments, emergencies, building access after hours, etc.)

First Things, First

When you get to the therapist's office, expect your initial experience to be similar to a doctor's appointment. You will sign in when you get there, sit in the waiting room, and wait for someone to call your name. If your therapist has a home practice, the scene might be a bit more casual.

While waiting, you will likely fill out some paperwork, including:

  • Insurance information
  • HIPPA forms
  • Therapist-patient services agreement
  • Record release form
  • Your medical history, including current medications
  • A questionnaire about your symptoms

If you feel uncomfortable answering any of the questions on paper, you can wait until you are with the therapist and answer the questions orally. You might also have the option to complete this paperwork at home prior to your first visit.

Your First Meeting

Your first session with the therapist will be different from future visits. The initial visit is a period for you and your therapist to get to know each other and get an idea of how to proceed. Future visits will be more therapeutic in nature. For example, in your second session, you may explore a specific symptom, problem, or past trauma you mentioned in the first session.

Keep in mind that psychotherapy usually requires multiple visits, so don't expect any instant solutions to your problems the first day. Therapy is about equipping you with life-long solutions and not a quick fix.

During the first session, she will ask you:

  • What brought you to therapy?
  • What do you feel is wrong in your life?
  • What are your symptoms?
  • Some questions about your history, including your childhood, education, relationships (family, romantic, friends), your current living situation, and your career.

You and your therapist should also come to an agreement about the length of your treatment, methods to be employed, and ins and outs of patient confidentiality.

Length of Treatment

Depending on your issue and therapy goals, therapy can last a few sessions or several weeks or years. While you likely want to know how long it's going to take to "feel better," there's no simple answer. It's very individualized. In addition, some insurance plans only cover a set number of sessions in a given year, so you may need to factor those limitations and/or work with your therapist to come up with a payment plan.

Therapy Methods

Therapists have training in a variety of techniques that can help you better cope with mental illness, resolve personal issues, and create personal changes in your life. Finding out what technique or combination of techniques your therapist will use can give you a better idea of what will happen during your sessions.

  • Client-centered therapy (person-centered therapy): a non-directive form of talk therapy that emphasizes positive unconditional regard
  • Psychoanalytic or psychodyamic therapy: focuses on getting in touch with and working through painful feelings in the unconscious mind
  • Cognitive or cognitive-behavioral therapy: focuses on making connections between thoughts, behavior, and feelings
  • Existential therapy: focuses on you (free will, self-determination) rather than the symptom
  • Gestalt therapy: focuses on the "here and now" experience of the client

Patient Confidentiality

In most cases, a therapist is required to keep information discussed during therapy private. However, according to the American Psychological Association's "Ethical Principles of Psychologists and Code of Conduct" confidential information can be disclosed with the permission of the individual or as permitted by the law. While the specifics of a legal duty to warn vary by state, in most cases a therapist is required to breach confidentiality if a client poses an imminent threat (to themselves, the therapist, or a third party). The information must be divulged to a person capable of taking action to reduce the threat, for example, a police officer.

What You Should Ask

When the therapist finishes, she should ask you if have any questions. You can use this opportunity to get to know your therapist a little better by asking more about their training, experience, approaches, and goals for therapy.

Questions to Ask During Your First Session

  • Will you briefly explain what I can expect to happen in my sessions?
  • How long will each session last?
  • How many sessions will it take to resolve my issue?
  • How can you assure my confidentiality?

Is The Therapist Right for You?

A big part of successful therapy is feeling comfortable with your therapist, which may come over time. However, if after a few meetings, you’re just not clicking, you do have the choice to seek out another therapist.

To determine if you're receiving the best care from your therapist, the National Alliance on Mental Illnesses recommends asking yourself the following questions:

  • Do they guide you to your goals?
  • Do they show acceptance and compassion?
  • Do they challenge you?
  • Do they check-in with you?
  • Do they help you learn?
  • Do they treat you as an equal?

If your answer to any of these questions is "No," then it's likely time to consider changing therapists. At the end of your session, just tell your therapist that you will not be returning. Don't be surprised if your therapist asks why. You can answer honestly (you just feel like you're not clicking) or just say that you prefer not to say. In most cases, your therapist will be professional and can recommend another therapist who will be a better fit. 

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