Your First Session

Before the first session, your therapist will likely send you some intake paperwork to fill out. Often this includes a questionnaire about your medical history, prior mental health issues and treatments you've used, your current issues of concern, and what you hope to get out of therapy. Other forms are administrative and mandatory, including a consent form for treatment, payment information, and information about confidentiality. It's generally recommended that you complete this before the first session so that the time can be used efficiently.

There's a few things to keep in mind that can help make your first session a productive one.

1. Ask yourself what you're looking for in the therapist. Clinicians all have different styles and approaches to therapy. Think about what you want from your sessions. Maybe you know you want to come in and have the space for someone to listen to you, or maybe you aren't sure what to talk about and want more guidance during your sessions. Maybe you have some ideas about specific treatment modalities (e.g., CBT, DBT, mindfulness, etc.) that you think would be helpful. Share this with the therapist so they know how to best work with you.

2. Be ready to talk a lot. There's a lot of ground to cover in the first session, so expect to spend most of it talking rather than listening. Speak up if there's something you want your therapist to know. The therapist will tend to ask a lot of open-ended questions in the first few sessions in order to get an idea of what you're comfortable telling them. Unless it's directly related to the your issue of concern, the questions tend not to be very invasive because they want you to feel comfortable. It's okay if you aren't ready to bare your soul right away and need time to establish some trust. Don't hesitate to let the therapist know if you do not feel ready to talk about a certain topic.

3. Know that therapy is a place where you can feel heard and not judged. A therapist should never make you feel judged or criticized for what you're thinking, feeling, or going through. If you do feel this way, bring it to their attention in case it was a misunderstanding. If you continue to feel this way, take it as a red flag. The therapist's presence should put you at ease, not make you want to clam up.

4. Think about how you will fit with the therapist. Though you might reflect on this after the session, it's important for you to think about how you feel about the therapist and whether their style matches your personality. If you two are not a good fit, that's okay. Therapy is like dating. If it isn't a fit, then feel free to keep looking for someone who does. It might take time to find someone who's right for you.

5. Make a list of any questions you have for the therapist. If you want to know more about their approach to treatment, their educational background and credentials, or the length and frequency of sessions, the first appointment is a great time to get that information.

6. Understand that you might feel worse before you feel better. Therapy is not a quick fix - it takes time. Most issues cannot be resolved in a session or two. You should expect to do some work outside of the session to enact the change you want. Additionally, therapy can rip off any "band-aids" you've used to protect yourself, uncovering thoughts and feelings that you had bottled up, and this can cause certain feelings and symptoms to temporarily worsen. Uncovering the pain is necessary though so you can learn effective coping mechanisms in therapy that can help alleviate these symptoms. Above all, be patient and trust the process, and be kind to yourself.

Here are a few questions to consider asking:

• Do you accept my insurance? If not, what arrangements do you have for payment? What is your cost per session?

• What is your cancellation policy?

• Do you think I may need to consider medications? If I need medication, can you prescribe or refer me to someone who does? How long would I need to be on medication, and if so what's the process to come off medications?

• Do you specialize in treating children, adults, or both?

• What experience do you have in treating concerns like mine?

• What licenses and specialty certifications do you have?

• How many years of experience do you have as a therapist?

• What is your treatment approach?

• How do you determine my counseling goals?

• Do you provide telemental health? Is therapy offered in your office or online?

• What should I expect from a typical session?

• How will you help me overcome my problem?

• How long will it take for me to feel better? How long will therapy last?

• What are the indications that therapy is effective?

• What do you do if I do not start feeling better in the typical time frame?

1. What prompted you to seek therapy now? The therapist will want to know what's happening in your life that pushed you to make the appointment. It could be something like a family conflict, loss of job or other big life change, or levels of anxiety that are higher than what they have been. Knowing what event or experience preceded your reaching out in order to help understand the nature of your issue and want you want to work on.

2. How have you been coping with the problem(s)? The therapist will want to understand how you handle stressful situations and difficult emotions. This gives them an idea of your current coping skills and can reveal secondary problems related to poor coping. For instance, has the issue been facing caused you to drink more than usual? Or do you engage in healthy habits like meditation or artistic pursuits? Getting a sense of your current coping skills and social resources provides information on how to utilize and build on them to help with your issues. Conversely, unhealthy coping can exacerbate the problem and negatively impact therapy and will need to be addressed.

3. Have you ever seen a therapist before? If you've been to therapy in the past, it's likely that there were some things you liked and some things you didn't like. Your new therapist can use this information to help you more effectively. Why was your previous experience a positive or negative one? What would you like to do different? This is an opportunity for you to drive the session and tell your therapist about what you need from them. If haven't been to therapy before, then the therapist can spend this time orienting you to the process of therapy and how it works.

4. What was it like growing up in your family? Many of the problems people come to therapy with have roots in childhood. In addition, learning about your childhood and family dynamics can offer insight into who you are today, including the internalized role expectations and ways of relating to others that you've carried into adulthood. Asking about major life experiences is an efficient way to learn about you without examining every detail.

5. Have you ever thought about harming yourself or others? For those who have experienced suicidal thoughts or intentionally hurt themselves, this question can bring up difficult emotions, but it's critical for your therapist to know about it from the onset. Regardless of whether this is the reason you came to therapy, the therapist wants to make sure you are aligned with the appropriate level of care. If you answer yes, you should expect followup questions like whether these thoughts are current or in the past, whether you have a suicide plan, or whether you intend to act on the thoughts. These questions are meant to help the therapist keep you and others safe.

6. Who do you go to for support? The therapist wants to know how connected you are to the people around you and whether you have a support system in place. There is a lot of research about the importance of social support in maintaining psychological well-being. Having a good understanding of your social network will help your therapist know to best utilize it to augment treatment and whether you need help building a social support structure as part of your treatment goals.

7. What do you hope to accomplish in therapy? Though this might seem like an obvious question based on your reason(s) for going to therapy, it can be helpful to explore this more in-depth in order to gain an understanding about your expectations for therapy. In cases where expectations are not realistic (this is not a wave of a magic wand), the therapist can help explain how the process of change works through therapy so that you have a better understanding of what to expect.

When setting therapy goals, you'll want to be as specific as possible about what your life might look like after therapy. How will things improve? For instance, instead of saying you want to be "more self-confident," think about what kinds of outward outcomes you'd like to see. How would you know if the change was taking place? What would be different? By having more observable and measurable goals, you and your therapist can better track your progress and know whether the therapy is effective.