By Cassie Johnston
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I don’t like surprises. I don’t like situations where I don’t know what to expect. Heck, I don’t even like going to public places where I don’t know where the nearest restroom is! I like to be prepared.
Since I know I’m not alone in this need to be prepared, I thought I’d give a quick overview of what it’s like to sit down for the first time in a therapist’s office. Of course, every therapist and every session will be different, but here are a few general ideas of what you might expect if you’re headed into therapy for the first time.
Like childbirth, therapy is yet another thing TV and movies got wrong. I’d say most people don’t lie down on a couch during therapy! Many therapists don’t even have couches! You can sit, stand, lie down, dance a jig—whatever makes you comfortable and more willing to open up.
Always cold? Bring a sweater. Have a tickle in your throat? Pack some cough drops. The more comfortable you are, the more willing you will be to open up into a candid conversation. I always bring water and cough drops (these are my favorite all natural ones) because my throat gets so tickly when I talk for long periods of time. You probably don’t need to bring tissues—most therapists have those covered.
Some practices will have you fill out your paperwork online ahead of time so your therapist can be familiar with your situation before your appointment. Some will have you fill them out in the session.
HIPAA compliance, payment, scheduling, cancellations, confidentiality—all that good stuff will probably be covered in your first session. Thankfully, you get it all out of the way, and you’ll never need to worry about it again!
Many office buildings aren’t so soundproof, and therapists know this. If your therapy session is in a room close to where other people are (like say, next to a waiting room), don’t be surprised if your therapist has a white noise machine, music, fountain, or other way of drowning out voices. It’s to protect your privacy and make you feel more comfortable. If your therapist doesn’t have white noise going and you feel like it’s easy for your session to be overheard, bring it up to your therapist! You can always download a white noise app for your phone and put it near the door.
This gives the therapist enough time to have a drink of water and gobble a granola bar before they switch gears to another patient in the next hour. Don’t be surprised if your therapist sets a timer or alarm to go off at the end of your session. Some therapists are on tight schedules with very strict time limits, and others might give you a buffer to help wrap up an issue.
Some therapists might jump right in, but for many therapist-patient pairs, the first session is mostly a get-to-know-you session—a first date, if you will. Some just have a free-flowing conversation, and some actually follow an intake form or questionnaire to get started.
You’ll probably do a cursory glance at your issues and why you decided to start counseling, but 50 minutes just isn’t enough time to introduce yourselves and do a deep dive. You’re setting the scene for future sessions.
In later sessions, you’ll probably do a lot of talking, but at the first session, your therapist should be engaged and trying to formulate a therapeutic plan for you—and that means asking a lot of questions. Don’t worry if you don’t know what to talk about, your therapist should help guide the conversation at first.
What seems like an innocuous question when you’re interacting with someone on the street becomes an important jumping off point for your therapeutic relationship. This isn’t polite chit-chat, it’s a real question from your counselor, so don’t be shocked if you get probed to go deeper than “fine” or “okay” or “not great.”
A good therapist will ask you about what goals you have for therapy and why you are there. Together, you might start to set a path to reach those goals (or maybe adjust the goals if they aren’t realistic or worthy).
Some therapists take notes during a session. Some take notes afterward. Some don’t take notes at all (mine doesn’t). If notetaking during your session makes you feel uncomfortable, speak up to your therapist and ask if there is a way to work around it.
There is something really freeing about being in room alone with a complete stranger who is encouraging you to speak your mind with the promise of confidentiality. You might be shocked by how freely words start flowing out of your mouth (or tears out of your eyes). Go with it. Crying is good, it lets the boo-hoos out. I bawled my eyes out during my first therapy appointment.
That’s okay, too. Your therapist’s job is to figure out what key unlocks you. As long as you are showing up and willing to work, you will eventually get to a place where talking about yourself is easier. You just gotta keep trying.
Talk therapy isn’t a quick fix. And like I said, a 50-minute session can only cover so much. Think of each therapy session as a chapter in a book, not a book in a series.
I’ve lost count of how many times we’ve had some sort of major revelation at like the 48-minute mark in a session. At first, this really frustrated me—we just had a breakthrough, I want to keep talking! But now I’ve realized that it’s actually nice to take some time and simmer on the breakthrough instead of diving right into it in a therapy session. Then, I can come back in the next session ready to really dive deeply into it.
Therapy always drains me. Always. Of course, the ones where I cry the whole time are more draining than the others, but talking through major emotional topics for 50 straight minutes is always going to take it out of you. Plan accordingly. I wouldn’t recommend scheduling a big client presentation for right after your therapy session.
Like I said, 50 minutes is a short amount of time to do all the work you might need, so some therapists see the session as “in class” time and also assign some homework. Sometimes this homework can be very academic (“read these two chapters on anxiety management techniques“) and sometimes it can be uncomfortable therapeutic work (“spend 15 minutes a day staring at yourself in a mirror”). Don’t skip this part.
This is maybe the scariest, but most important, thing to know about starting therapy: it might get worse before it gets better. You have to knock a hole in the wall so light can stream in, and those first few sessions of demolition can be rough. It’s just a fact of talk therapy. You are going to build something better than you could have ever dreamed, but before you do that, the dirty work has to happen. As therapy goes on, there will be fewer tears, less questioning, and more confidence, I promise. Just hold on.
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Thank you so much for this. Your post prompted me to finally call someone. A huge step for me! I’ve been thinking about it for a year and a half.
I’m a therapist, and I Love that you are writing about your experiences. Therapy can be so scary but so helpful. Thank you!
I have my first ever therapy appointment on Tuesday and I’m really nervous. Thank you for this.
Thank you Cassie for being so open and honest. I love reading your blogs and I always look forward to reading the next one, but this blog on therapy really struck a cord and it’s exactly what I needed to push myself to start much needed therapy. I have wanted to start for a long time but was always afraid. Your blog is really supporting me on this journey. Your words were truly a nudge and a beacon of light to book that first appointment, so I thank you for your genuine character. Keep on writing and thank you for being you.
Wow–what timing! I’m going to my first appointment Monday, thank you.
Thank you. I finally told my doctor I’m struggling and she has referred me for evaluation. I’m terrified. Thank you for this, it helps.
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