Your First Therapy Session, Pt. 1: The Nuts & Bolts

For most people, thinking about going to their first therapy appointment is an intimidating process. Most of their idea of how therapy works has come from movies and TV shows which often exaggerate or make fun of the process. This series of posts will aim to de-mystify the process of therapy and let you know a little bit about what you're walking into. I'll also give some brief tips about how to know if the therapist is the right fit for you and questions you might want to ask during your first session.

So what can I expect during my first session?

With most therapists, your first session will be somewhat similar to and somewhat different from attending a standard appointment with a medical doctor. You'll come to an office, check in, fill out some paperwork, and meet with a healthcare professional. However, because your relationship with your therapist will be more in-depth, more frequent, and occur over a longer time-span, a lot of the emphasis in the first session will be on gathering your personal history and determining how you'd like to move forward in therapy. Think of it as setting your "therapy trajectory."

Usually this is done via what is called a "semi-structured interview" (a.k.a. I have some standard categories to ask about, but it's ok if we deviate to other topics some too.) You can expect your intake session with your therapist to last anywhere from 45 minutes to 1.5 hours, depending on who you work with.

Generally, I focused on the following areas:

• Review of Confidentiality/Chance to Ask Questions

• ​What is confidentiality?

• Under what specific circumstances will I be forced to break confidentiality by law?

• What questions do you (the client) have about any of these issues or areas?

• Main Concerns That Brought You to Therapy

• Why did you make an appointment to see a therapist?

• What are your top priorities for being here?

• How did this problem develop and how is it being maintained?

• Family History

• What were things like in your house growing up?

• Who is part of your family now and how is your relationship with them?

• Social History

• Who are your important friends or support figures?

• What has your romantic history been like?

• Medical/Medication History

• Do you have any important past or current health problems?

• Are you currently on any medications (if so, side effects?)

• Psychological History

• Are you experiencing any current psychological issues (depression, anxiety, stress, etc.)?

• Do you have any family history of mental health concerns?

• Goals for Therapy

• What do you want to get better in your life?

• What have you already tried in an effort to make things better? What has worked/not worked?

• By the end of therapy, how will we know we've been successful?

During all of these questions, I'll usually be taking notes to aid my memory and understanding, will be paraphrasing and reflecting back what I'm hearing you say (to make sure I really "got it"), and will be summarizing my clinical opinion of how it all fits together and seeing how that compares to your thoughts.

The most important part is that, by the time you leave, you should feel like the therapist was attentive and had a decent understanding of why you're coming to see them. You should feel fairly comfortable and have at least some idea of "where we're going from here." If you feel uncomfortable, disrespected, frustrated, or lost, those can be red flags! More on that in the next post.

In Part 2 of this post, I'll discuss how you know you've got a good "fit" with a therapist, possible "red flags," and questions you might want to ask at the end of your intake session. See you next time!

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