Author: Kjersten Hillers, LMHCA
What to Expect From the First Session
Keep in mind that your first session with the therapist will be different from future visits. The
initial visit is a space for you and your therapist to get familiar with each other, to inform
decisions on how to proceed. The first session will most likely include paperwork and
background and demographic questions. Future visits will be more therapeutic in nature,
focusing less on administrative tasks (i.e. insurance, etc). For example, in your second session, you may explore a specific symptom, challenge, or past experience you mentioned in the first session.
During the first session, your therapist may ask you:
- What symptoms are you currently experiencing?
- What brings you into therapy?
- What would you like to change about your life?
- 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, schedule the next session, methods of communication, and information regarding patient confidentiality.
Patient Confidentiality
Therapists are required to keep information discussed during therapy strictly private, between clinician and patient. The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct explains the few instances where a therapist can breach client confidentiality, but only 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.
How to Prepare for Your First Therapy Session
Many feelings may arise as you approach your first therapy session. As the appointment
approaches, taking steps to prepare for your first therapy appointment is a great way to manage those feelings and be sure that you will make the most of your time with a clinician.
Complete Paperwork
The quicker you fill out documents such as HIPAA forms, insurance information, symptom
questionnaire, and therapist-patient services agreement, the more time allotted for the therapist to digest your paperwork and contact you to book an appointment. In order for the practice to assign you a clinician or schedule your first session, paperwork must be completed. If you feel uncomfortable answering any of the questions on paper, you can wait to tell the therapist directly.
Goal Setting
Before your first session, build in some alone time into your schedule to ask yourself what you want to accomplish in therapy, and even jot down some basic goal. It's okay if these goals aren't perfectly clear to thought out but coming in with at least an idea of what you want to work on will help you to be sure therapy is directed at your most relevant goals. For some people it’s to “feel better” or “learn how to cope with ___”. If you can, make time to prepare for each of your following sessions by reflecting on your week and thinking about what you most want to discuss in that appointment.
Open Mind
Go into your first sessions with an open mind. Be honest with your therapist about your thoughts and feelings, including past experiences in therapy. On the other hand, it also takes several sessions to establish a comfortable rapport. Thus, it's important to try to assess if any initial discomfort you might feel is due to a true lack of fit or if is simply due to the "getting to know you" process. Trust your gut if it really doesn't feel right—but don't be afraid to push yourself to sit with some discomfort, especially initially.
What to Say
Don't worry about knowing what to say during your first session. It is the job of the therapist to lead the conversation and to ask the right questions. You can help the process by having done some personal reflection. You and your therapist will collaborate in facilitating the creation of your treatment plan. You will be asked to share the goals you have for yourself and ways to implement this change.
Post-Session Self-Care
Be sure to schedule time for yourself after your sessions. If you can, take time after your
appointment and go for a walk outside, sit and reflect, journal about thoughts, concerns or
questions, or do an activity that is fulfilling to you. Therapy can be emotionally draining, and it's important to give yourself time to process. It is not dissimilar to getting a deep tissue muscle massage—you might feel sore the rest of the day, but over the next week, you'll feel better and better. Be gentle with yourself, allow emotions to surface, and resist judging yourself, regardless of how you need to process.
Final Thoughts
The first steps on the healing journey can be a scary and intimidating process, but as with most things, the magic happens outside of our comfort zone. Remember, we're here to help, so please reach out for guidance and support in taking those first steps.
"The wound is where the light enters you." - Rumi
Kjersten Hillers, LMHCA, is a psychotherapist at Invited Psychotherapy and Coaching, a private practice outside of Chicago, specializing in helping high performers embody their highest potential.
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