How Therapy Works: Breaking Down The First Session
Finally, it’s time to talk about your first therapy session! After looking for a therapist, talking to one on the phone, and filling out a bunch of paperwork, it’s the big day, and you’re finally about to start the thing you’re doing it all for. And yet, you’re still not really sure what to expect. How do you go from a short and business-like call and impersonal forms to actually sitting with someone and telling them your greatest fears? Good news: you can take it slow.
Good therapists know that the first session can be nerve-wracking, and part of our job is to help you feel comfortable in the therapy space. Before you can feel safe sharing those deep dark secrets, you need to trust the person you’re telling them to. That trust begins with this session. This article breaks down what to expect from the first session, and the best tips for how to walk in feeling ready for the journey.
I took some time away from this blog in order to focus on a few other things I had cooking. One of those is Chronically Ill Connections, an online therapy group designed for people with chronic illness who need flexibility in their commitments and still want to gather with others who really understand what life with illness can look like. Chronically Ill Connections is an open group, and sign-ups are open and ongoing! To sign up, please click on the name and let me know you’re interested. We’d love to have you!
In future blog posts, I’ll be talking more about how chronic illness shows up in therapy, how trauma therapy looks different from “normal talk therapy,” what makes group therapy so special, and a bunch of other things! Come along for the ride by signing up to get on my email list.
Going over the Paperwork
At the start of the session, your therapist will make sure you know how confidentiality works. Confidentiality essentially means that anything you say in therapy won’t be shared outside of the therapy room. There are a few notable exceptions to this, like if your therapist believes you might hurt yourself or someone else. Before getting too deep into things, your therapist will walk you through confidentiality and whatever their individual practice’s policies are. One to make special note of is how cancellations work, as that might cost you money down the line if you forget.
Beginning to Tell Your Story
Once the final paperwork and logistics have been talked through, it’s finally time for the big moment. Your therapist will ask you some opening questions that gives you space to begin sharing your story, the reason you came here in the first place. The more information they already have about you (this is where filling out that intake paperwork really pays off), the more your therapist will be able to help guide you throughout this process.
Instead of just giving you an impossibly complicated question like, “How was your childhood,” your therapist will likely start by mentioning some detail you mentioned in your intake form and asking you to say more about that. For example, if you noted in your intake form that you hit a really rough patch a year ago but are handling it a bit better now, they may start by asking you more about that rough patch. This way, you have a more specific question to answer, and you’re not thrown into the deep end straight away.
Not all therapists do this, but I like to keep some time available to talk about my new client’s hobbies and favorite things to do, too. The thing that brought you to therapy is probably big and hard to talk about, and in order to support you in processing it, I need to know what brings you joy and gives you momentum. And, like I said above, the first session is all about building trust. Taking a second to connect over something bright in your life helps us build that trust from the start while giving you a moment to breathe during a stressful first hour.
Remember, it’s about trust, and it’s about articulating your strengths and what you love about your life just as much as it’s about the problems you’re facing. There will be many more sessions to continue unpacking the hard stuff. The first session doesn’t have to be a race.
Deciding on a Treatment Plan
The last thing that you and your therapist will talk about during the first session is your treatment plan. This is the document that serves as a guideline for your therapy as you continue with weekly sessions. For example, if you and your therapist agree that you need to work on overcoming anxiety, then your treatment plan might include learning how to take a deep breath and recite a positive self-statement when you’re facing an anxiety-provoking situation. If you’re having trouble with standing up for yourself, your treatment plan might include learning how to say “no” in your relationships.
This is something you and your therapist will talk about together, and then your therapist will use their professional expertise to find the right type of therapy to match your goals. After the treatment plan has been made, therapy truly begins. From here, you may choose to meet weekly with your therapist, or may opt to see them every 2 weeks. Each time you meet, you’ll bring yourself, however you’re feeling and showing up in the moment, and you’ll explore new parts of yourself, and maybe nurture some older parts, too.
Some folks only need a few months of therapy before they feel able to manage on their own again. For others, therapy lasts years, or even a lifetime. No matter your situation, you and your therapist are a team that focuses on bringing out the best in you. That’s how therapy works.
This is the final installment in my blog series, “How Therapy Works,” where I cover some important questions people have about the process of finding a therapist and starting their therapy journey. Before this, we talked about “Picking the Right Therapist,” “The Point of the Consult Call,” and “The TL;DR on Intake Paperwork.” I hope that reading along with these has helped demystify the process of starting therapy and that you feel equipped to find a therapist that works for you.
I specialize in helping folks with C-PTSD navigate chronic illness and identity formation, and I use attachment theory and trauma-informed, person-centered care to do it. I can see anyone in Oregon over telehealth, and I have an in-person office in Newberg for people around Yamhill county on Fridays. Therapy with me involves coping skills to help you stabilize, and deeper work to help you get to the root of things.
A lot of my clients tell me they’ve gotten so good at being who everyone needs that they’re not sure anyone actually knows the real person behind the mask. I help people in those shoes build a life where you get to be fully yourself and still feel deeply connected to the people around you. If that sounds like you, let’s talk and see if we’re a good fit. I can’t wait to meet you!
No AI used ever in the making of this (or any other) post :)