Starting therapy as a new patient can be an anxious experience. People often have a lot of worries. They wonder what their therapist is like and if the therapist will judge them. They worry about what therapy is like and what is expected of therapy. And they may worry about what they need to do to prepare for treatment (if anything).
All of these concerns can make going to that first therapy appointment a lot more nerve-wracking. In some cases, it may even deter some people from going to therapy and getting the help that they need.
To reduce stress and uncertainty, I developed this post to shed some light into the first therapy session and to expect before, during, and after a session. Although the information provided is likely generalizable to many types of therapies, I have tailored the information specific to cognitive behavioural therapy since this is my area of expertise in terms of my own clinical training.
What to expect before the session
First and foremost, don’t stress about preparation in terms of knowing about CBT or how the process will go! All you have to do is dress comfortably and get to the clinic (if it’s in person) at the pre-determined time. Perhaps sometimse a little earlier if the clinic asks you to complete a couple forms beforehand.
At the clinic, you’ll check-in at the reception and likely complete a few forms to get some patient information. You may also complete a couple questionnaires about your health and wellbeing to establish a baseline and to get a sense of your progress throughout treatment.
Oftentimes, waiting in clinics can be a stressful experience because we’ve associated this process with medical procedures like waiting for your medical doctor or going in for a teeth cleaning at the dentist. It makes sense that we would be a little bit nervous to go into an office to be prodded by a cold stethoscope or a pointy needle!
When it comes to therapy appointments, this fear is less substantiated. After completing the forms, the therapist will welcome you into a room with a comfortable and supportive atmosphere to start the therapy session.
And if you’re still a little afraid, it can be reassuring to know that the therapist is often has a bit of anticipatory anxiety as well to do a good job working with their new patient. You’re both meeting each other for the first time after all!
What to expect during the session
1. Introductions and housekeeping. The first session is very low pressure. The main goal of the first treatment is really just to learn more about each other, start developing a positive working relationship, and understand more about your specific goals for treatment.
The therapist will likely start the session by introducing who they are and their experience, in addition to going over some housekeeping. Housekeeping includes information such as confidentiality (and limits to confidentiality), structure of the treatment, and some therapist/patient responsibilities. The therapist may also provide some information at this time (or a little later on) about CBT and what therapy will look like.
2. Learning more about your presenting problem. After initial introductions and housekeeping, the therapist will ask to learn more about why you came for treatment. This is a period of exploration for both you and the therapist and can be beneficial for both sides. This should not feel like an interrogation; if the therapist is doing their job right, you should feel listened to, validated, and may even gain further insight into your own challenges.
3. Collaborating on therapy goals. After understanding more about the reason why you are coming to therapy and your current specific problems, you and the therapist will then collaborate to develop goals for treatment.
I would like to emphasize the word ‘collaborate’ here because that’s exactly what it is. You should never feel like the therapist is completely directing the treatment or bulldozing your desires in lieu of theirs. What the patient wants out of the treatment is always the most important thing.
The therapist’s role should be to guide the patient to developing goals and help mold these goals into specific and actionable that is consistent with what the therapy can provide (i.e., SMART goals). For example, ‘sleeping better’ is a great goal but may be hard to quantify in therapy. The therapist could help to develop SMART goals based on this initial desire by querying what the patient would like to see change in their sleep based on this goal (e.g., falling asleep quicker, keeping to a regular sleep schedule, etc.).
4. Setting home practice. In a typical 50-minute session (and depending on your comfort levels), setting a goal this week for home practice may not be part of the first session. This is because developing positive rapport, providing psychoeducation about treatment, learning more about your presenting problems, and developing of therapy goals is already quite a packed schedule!
However, it is helpful to know that home practice may be assigned in the future to support you in your goals. As helpful as therapy can be, I am a firm believer that what you get out of therapy is what you put into it. And engaging in consistent home practice developed by you and your therapist can be helpful to move closer to your ultimate goals. It’s also a way to consolidate the skills you learn in therapy to take with you after treatment completion!
What to expect after the session
At the end of treatment, you and your therapist will agree on frequency and timing of future appointments and they will likely ask you to reflect on how treatment was. Here, you can provide open and honest feedback about the session (the therapist will not be offended!).
If the therapist has assigned home practice or readings, then you might practice those new skills. If not, I simply hope you had a positive experience and that you are feeling hopeful for what’s to come in the future!
Additional recommendations when starting therapy
Here’s a few additional recommendations for when you are working with your therapist.
1. Be open and transparent with your therapist. It can be a little nerve-wracking to open up with your therapist about your struggles. And for some, it can be even tougher to provide negative feedback if there was something about treatment that bothered you. However, being honest with your therapist will allow them to better support you in terms of delivering therapy and changing how therapy is being conducted if it’s not working well for you. Moreover, if you find that this specific therapy isn’t working for you, then they will be able to help provide resources to seek different avenues of treatment that is a better fit.
2. Take a curious and non-judgmental approach to therapy. As discussed before, therapy works best when you give it a shot and take a curious, non-judgmental approach to seeing if this treatment works for you. I would encourage you to take an earnest shot with the therapist and the specific treatment recommendations before writing it off. However, it’s okay if the therapy doesn’t work well for you – it may not always be the best fit. Again, you and the therapist can work together to determine other strategies or treatments that might be more helpful.
3. Take ownership of your progress and goals! Although therapists can be wonderful, kind, and intelligent human beings, they are not necessarily miracle workers. The therapists helps to understand your problems, create a safe and supportive space to work on your mental health goals, and provides research supported skills to help you along in your goals.
However, the bulk of the work will remain on you to earnestly learn from therapy and try out the recommendations. It can be a very empowering experience to become your own therapist and recognize that there are things you can do yourself to improve how you think and feel!
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